The diagnostic value of a nomogram based on multimodal ultrasonography for thyroid-nodule differentiation: A multicenter study

Abstract

ObjectiveTo establish and verify a nomogram based on multimodal ultrasonography (US) for the assessment of the malignancy risk of thyroid nodules and to explore its value in distinguishing benign from malignant thyroid nodules.MethodsFrom September 2020 to December 2021, the data of 447 individuals with thyroid nodules were retrieved from the multicenter database of medical images of the National Health Commission’s Capacity Building and Continuing Education Center, which includes data from more than 20 hospitals. All patients underwent contrast-enhanced US (CEUS) and elastography before surgery or fine needle aspiration. The training set consisted of three hundred datasets from the multicenter database (excluding Zhejiang Cancer Hospital), and the external validation set consisted of 147 datasets from Zhejiang Cancer Hospital. As per the pathological results, the training set was separated into benign and malignant groups. The characteristics of the lesions in the two groups were analyzed and compared using conventional US, CEUS, and elastography score. Using multivariate logistic regression to screen independent predictive risk indicators, then a nomogram for risk assessment of malignant thyroid nodules was created. The diagnostic performance of the nomogram was assessed utilizing calibration curves and receiver operating characteristic (ROC) from the training and validation cohorts. The nomogram and The American College of Radiology Thyroid Imaging, Reporting and Data System were assessed clinically using decision curve analysis (DCA).ResultsMultivariate regression showed that irregular shape, elastography score (≥ 3), lack of ring enhancement, and unclear margin after enhancement were independent predictors of malignancy. During the training (area under the ROC [AUC]: 0.936; 95% confidence interval [CI]: 0.902–0.961) and validation (AUC: 0.902; 95% CI: 0.842–0.945) sets, the multimodal US nomogram with these four variables demonstrated good calibration and discrimination. The DCA results confirmed the good clinical applicability of the multimodal US nomogram for predicting thyroid cancer.ConclusionsAs a preoperative prediction tool, our multimodal US-based nomogram showed good ability to distinguish benign from malignant thyroid nodules.

Diagnostic value of qualitative and quantitative parameters of contrast-enhanced ultrasound for differentiating differentiated thyroid carcinomas from benign nodules

“…According to the Guidelines for the Diagnosis and Treatment of Adult Thyroid Nodules and Differentiated Thyroid Cancer issued by the American Thyroid Association (ATA) in 2015, unclear edge on conventional US was an important indicator for the diagnosis of malignant nodules (24,42). Yi et al (17) reported that unclear margin after CEUS was also an independent risk factor for malignant thyroid tumors. In this study, the proportion of unclear margins after CEUS in malignant nodules (47.4%) was also significantly higher than that of benign nodules (6.1%).…”

“…Wash-in and wash-out patterns referred to the enhancement that appeared or disappeared earlier, equal to, or later than the peri-nodular tissue (16). Margin after CEUS was divided into clear and unclear (17). Ring enhancement was defined as an enhanced rim of peritumoral tissue that appeared in the early phase and became more distinct in the late phase, and it was divided into absent and present.…”

Diagnostic value of qualitative and quantitative parameters of contrast-enhanced ultrasound for differentiating thyroid carcinoma nodules from benign thyroid nodules

“…According to the Guidelines for the Diagnosis and Treatment of Adult Thyroid Nodules and Differentiated Thyroid Cancer issued by the American Thyroid Association (ATA) in 2015 and the Chinese Guidelines for the Ultrasonic Malignancy Risk Strati cation of Thyroid Nodules (C-TIRADS) issued by China in 2020, irregular or unclear edges in conventional ultrasound are important indicators for the diagnosis of malignant nodules [24,25]. Yi et al [12] found that unclear margins after contrast enhancement are an independent risk factor for malignant thyroid tumors. Consistent with this study, the proportion of unclear margins after contrast ultrasound in DTC (47.4%) was also signi cantly higher than that of benign nodules (6.1%).…”

“…Wash-in and Wash-out refered to enhancement that appeared or disappeared earlier, at the same time, or later than the perinodular tissue. The morphology of nodules after perfusion can be divided into clear and unclear [12]. Ring enhancement was de ned as an enhanced rim of peritumoral tissue that appears in the early phase and becomes more distinct in the late phase.…”