Predicting Malignancy in Pediatric Thyroid Nodules: Early Experience With Machine Learning for Clinical Decision Support

Radebe, Lebohang; Kaay, Daniëlle C M van der; Wasserman, Jonathan D.; Goldenberg, Anna

doi:10.1210/clinem/dgab435

Cited by 9 publications

(6 citation statements)

References 22 publications

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“…The pathologists were blinded to the sonographic diagnosis of TNs. The FNAB results were classified into six categories, and Bethesda III to V cytopathology were categorized as indeterminate cytology ( 12 ).…”

Section: Methodsmentioning

confidence: 99%

Risk factors and diagnostic prediction models for papillary thyroid carcinoma

Zhang

Sang

et al. 2022

Front. Endocrinol.

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Thyroid nodules (TNs) represent a common scenario. More accurate pre-operative diagnosis of malignancy has become an overriding concern. This study incorporated demographic, serological, ultrasound, and biopsy data and aimed to compare a new diagnostic prediction model based on Back Propagation Neural Network (BPNN) with multivariate logistic regression model, to guide the decision of surgery. Records of 2,090 patients with TNs who underwent thyroid surgery were retrospectively reviewed. Multivariate logistic regression analysis indicated that Bethesda category (OR=1.90, P<0.001), TIRADS (OR=2.55, P<0.001), age (OR=0.97, P=0.002), nodule size (OR=0.53, P<0.001), and serum levels of Tg (OR=0.994, P=0.004) and HDL-C (OR=0.23, P=0.001) were statistically significant independent differentiators for patients with PTC and benign nodules. Both BPNN and regression models showed good accuracy in differentiating PTC from benign nodules (area under the curve [AUC], 0.948 and 0.924, respectively). Notably, the BPNN model showed a higher specificity (88.3% vs. 73.9%) and negative predictive value (83.7% vs. 45.8%) than the regression model, while the sensitivity (93.1% vs. 93.9%) was similar between two models. Stratified analysis based on Bethesda indeterminate cytology categories showed similar findings. Therefore, BPNN and regression models based on a combination of demographic, serological, ultrasound, and biopsy data, all of which were readily available in routine clinical practice, might help guide the decision of surgery for TNs.

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Section: Methodsmentioning

confidence: 99%

Risk factors and diagnostic prediction models for papillary thyroid carcinoma

Zhang

Sang

et al. 2022

Front. Endocrinol.

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“…According to a recent meta-analysis, computer-assisted diagnosis has proven to have reliable diagnostic performance, comparable to that of radiologists [ 53 ]. A machine learning approach to identify pediatric thyroid nodules requiring surgical intervention demonstrated good performance, but additional data on larger cohorts are needed before their application in clinical practice [ 54 ]. These tools can also be trained to autonomously identify and classify cells based on their morphological features and so to detect cancer cells.…”

Section: Discussionmentioning

confidence: 99%

The Complex Cyto-Molecular Landscape of Thyroid Nodules in Pediatrics

Seminati

Ceola

Pincelli

et al. 2023

Cancers

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Thyroid fine-needle aspiration (FNA) is a commonly used diagnostic cytological procedure in pediatric patients for the evaluation of thyroid nodules, triaging them for the detection of thyroid cancer. In recent years, greater attention has been paid to thyroid FNA in this setting, including the use of updated ultrasound score algorithms to improve accuracy and yield, especially considering the theoretically higher risk of malignancy of these lesions compared with the adult population, as well as to minimize patient discomfort. Moreover, molecular genetic testing for thyroid disease is an expanding field of research that could aid in distinguishing benign from cancerous nodules and assist in determining their clinical management. Finally, artificial intelligence tools can help in this task by performing a comprehensive analysis of all the obtained data. These advancements have led to greater reliance on FNA as a first-line diagnostic tool for pediatric thyroid disease. This review article provides an overview of these recent developments and their impact on the diagnosis and management of thyroid nodules in children.

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“…A 200-patient pediatric Italian study which used its own, more nuanced, FNA reporting system, reported a total FNAB accuracy of 95% with a sensitivity and specificity of 92.3% and 92.6%, respectively [57]. A recent study examined the use of machine learning to better determine which pediatric thyroid nodules warrant FNA and surgical intervention, with the intent to avoid surgery for benign lesions [58]. The results are promising but additional data and refinements are needed before employing this methodology in clinical practice.…”

Section: Fine Needle Aspirationmentioning

confidence: 99%

Differences in the management of thyroid nodules in children and adolescents as compared to adults

Goldfarb

Dinauer

2022

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of reviewTo describe recent advances in the diagnosis and management of thyroid nodules in both children and adults, highlighting differences between the two groups. Recent findingsThyroid nodules are less common in children than adults but the risk of malignancy is higher. Screening recommendations for patients with certain genetic syndromes or specific risk factors for thyroid nodules and cancer continue to evolve ultrasound is the most appropriate imaging modality for evaluating thyroid nodules in all patients, but radiographic risk stratification systems validated in adults have not been extensively studied in children. Criteria for proceeding to fine needle aspiration (FNA) biopsy differ some between children and adults, with nodule size being less of a consideration in young patients. Molecular testing continues to improve the diagnostic capabilities of FNA for all age groups, but options for pediatric thyroid nodules are currently limited. In children, only oncogene panels are validated and their exact utility, along with miRNA classifiers, is an evolving area of study. For adults, data support selection of a specific molecular test based on ultrasound characteristics and pretest probability of malignancy. Multiple series have shown that fusion mutations are more common in pediatric thyroid nodules, while point mutations are seen more often in adult thyroid nodules. Molecular data help guide management recommendations regarding the need for surgery when FNA is indeterminate, but clinical use is still being refined. Radiofrequency ablation is a nonoperative approach that has gained significant traction for the treatment of symptomatic benign nodules in adults, but data are currently extremely limited in children. SummaryThere are difference in the diagnosis and treatment of thyroid nodules in adults and children, the nuances of which are important for clinical management.

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Predicting Malignancy in Pediatric Thyroid Nodules: Early Experience With Machine Learning for Clinical Decision Support

Cited by 9 publications

References 22 publications

Risk factors and diagnostic prediction models for papillary thyroid carcinoma

Risk factors and diagnostic prediction models for papillary thyroid carcinoma

The Complex Cyto-Molecular Landscape of Thyroid Nodules in Pediatrics

Differences in the management of thyroid nodules in children and adolescents as compared to adults

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