Variability in the interpretation of grey-scale ultrasound features in assessing thyroid nodules: A systematic review and meta-analysis

Liu, Huan; Ai-lin, MA; Zhou, Yingshi; Yang, Dinghong; Ruan, Jingliang; Luo, Baoming

doi:10.1016/j.ejrad.2020.109050

Cited by 18 publications

(22 citation statements)

References 22 publications

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“…Tumor morphology, microcalcifications, anteroposterior/ transverse diameter ratio, and echo intensity are important ultrasonographic features for the identification of PTMCs and MNGs (1-3). Among these features, echo intensity can be affected by the subjective assessment of an ultrasound physician (4,5). Quantification of echo intensity would improve the differential diagnosis of PTMCs and MNGs.…”

Section: Discussionmentioning

confidence: 99%

“…The diagnostic performance can also show differences. Even if the same TIRADS is used, the subjective assessment can lead to diagnostic differences (4), particularly in the thyroid gland, which differs in thickness from the strap muscle, and the echo intensity can vary between different sections of the same strap muscle. Assessment of the signal intensity in nodules and strap muscles is greatly influenced by subjective factors (5).…”

Section: Introductionmentioning

confidence: 99%

“…In addition, as the echo intensity of the thyroid nodule changes from weak to strong, the grayscale value changes from low to high and the image from black to white; the grayscale value is a continuous variable, theoretically, and different variables contribute to the diagnostic efficacy (5). Although a rough grading of 3-5 has been recognized by many scholars (1)(2)(3)(4)(5), the gray-scale value of the thyroid or strap muscle is not necessarily the optimal threshold for distinguishing benign and malignant nodules. Quantification of the echo intensity would facilitate the differential diagnosis of benign and malignant thyroid nodules.…”

Section: Introductionmentioning

confidence: 99%

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A Control Study on the Value of the Ultrasound Grayscale Ratio for the Differential Diagnosis of Thyroid Micropapillary Carcinoma and Micronodular Goiter in Two Medical Centers

Han

Feng

et al. 2021

Front. Oncol.

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ObjectiveTo investigate the value of ultrasound gray-scale ratio (UGSR) for the differential diagnosis of papillary thyroid microcarcinoma (PTMC) and micronodular goiter (MNG) in two medical centers.MethodsUltrasound images of 881 PTMCs from 785 patients and 744 MNGs from 687 patients in center A were retrospectively analyzed and compared with 243 PTMCs from 203 patients and 251 MNGs from 198 patients in center B. All cases were confirmed by surgery and histology. The grayscale values of thyroid lesions and surrounding normal tissues were measured, and the UGSR was calculated. The optimal UGSR threshold for identifying PTMCs and MNGs in two medical centers was determined by receiver operating characteristic (ROC) curve, and the area under the curve (AUC), optimal UGSR threshold, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were compared between the two medical centers.ResultsThe UGSR values of PTMCs and MNGs in medical center A were 0.5537 (0.4699, 0.6515) and 0.8708 (0.7616, 1.0123) (Z = -27.691, P = 0), respectively, whereas those in medical center B were 0.5517 (0.4698, 0.6377) and 0.8539 (0.7366, 0.9929) (Z = -16.057, P = 0), respectively. The UGSR of PTMCs and MNGs did not differ significantly between the two medical centers (Z = -0.609, P = 0.543 and Z = -1.394, P = 0.163, respectively). The AUC, optimal UGSR threshold, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the two medical centers were 0.898 vs. 0.918, 0.7214 vs. 0.6911, 0.881 vs. 0.868, 0.817 vs. 0.833, 0.851 vs. 0.834, 0.853 vs. 0.867, and 0.852 vs. 0.850, respectively.ConclusionsUGSR can quantify the echo intensity of PTMCs and MNGs and is therefore valuable for the differential diagnosis of the two diseases. The diagnostic efficacy was consistent between the two medical centers. This method should be widely promoted and applied.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Control Study on the Value of the Ultrasound Grayscale Ratio for the Differential Diagnosis of Thyroid Micropapillary Carcinoma and Micronodular Goiter in Two Medical Centers

Han

Feng

et al. 2021

Front. Oncol.

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“…Another limitation of the study was the numerical difference of lesions with malignant potential qualified for the analysis, moreover, there were no sufficient data related to the comparative analysis using K-TIRADS and EU-TIRADS. Also noteworthy is the limitation due to the incompatibility of ultrasound results obtained by different investigators and by the same investigator (interobserver and intra-observer variability) (27) . Conclusions from the presented meta-analysis emphasize the clinical usefulness and confirm the validity of recommending the use of TIRADS classification in estimating the malignancy potential of focal thyroid lesions, with an emphasis on the highest accuracy of the method for ACR-TIRADS.…”

Section: Eu-tirads 82 90mentioning

confidence: 99%

Summary of meta-analyses of studies involving TIRADS classifications (EU-TIRADS, ACR-TIRADS, and K-TIRADS) in evaluating the malignant potential of focal lesions of the thyroid gland

et al. 2022

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Numerous scientific societies around the world have published their TIRADS (Thyroid Imaging Reporting and Data System) classifications that evaluate the risk of malignancy of focal thyroid lesions, presenting different ultrasound features for each category and lesion size thresholds to determine eligibility for biopsy. The use of such risk estimation systems in focal thyroid lesions facilitates the reporting of thyroid ultrasound findings and improves the qualification of focal lesions for fine-needle aspiration biopsy (FNAB). In this publication, the three most popular TIRADS classifications, European – EU-TIRADS, Korean – K-TIRADS, and developed by the American Society of Radiology – ACR-TIRADS, are presented and discussed based on a literature review. The results of available head-to-head statistical analyses comparing the classifications are also presented. The advantage of the EU-TIRADS and K-TIRADS systems is that they include only the most important ultrasound features, so their application is not time-consuming, and the scores are easy to incorporate into clinical practice. ACR-TIRADS, unlike other scales, is based on a unique classification system and represents the most comprehensive classification. Each of the five categories of ultrasound features – morphology, echogenicity, shape, margins, microcalcifications – are evaluated and assigned a score from 0 to 3, with a higher score being associated with a higher risk of cancer. Based on the available data, the greatest benefit has been demonstrated for the ACR-TIRADS classification, which also has implications for minimising the number of unnecessary FNABs. However, limitations related to the heterogeneity of the groups analysed in the study, including differences in the populations studied, inclusion criteria, proportions of patients of either sexes, and the number of malignant lesions analysed, should also be taken into account.

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“…Secondly, there is great instability in using the echogenicity intensity of the neck strap muscle as a reference, which is susceptible to various factors, such as the evenness of the strap muscle thickness, and the percentages of muscle bers, tendons and adipose tissues. Thirdly, subjective differences in the judgment of echogenicity intensity between observers are inevitable [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound Gray Scale Ratio for the Differential Diagnosis of Papillary Thyroid Microcarcinoma and Benign Micronodule in Patients with Hashimoto’s Thyroiditis

Han¹,

Xie²,

Wei³

et al. 2021

Preprint

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Purpose To investigate the diagnostic value of ultrasound gray scale ratio (UGSR) for differentiating papillary thyroid microcarcinomas (PTMCs) and benign micronodules (BMNs) in patients with HT.Methods The ultrasound images of 285 PTMCs (in 247 patients) and 173 BMNs (in 140 patients) in the HT group, as well as 461 PTMCs (in 417 patients) and 234 BMNs (in 197 patients) in the non-HT group were retrospectively analyzed. All cases were confirmed by histological examinations. The gray scale values of the nodules and surrounding thyroid tissues were measured and subsequently the UGSR was calculated. Receiver operating characteristic curve was used for determining the area under the curve (AUC), optimal UGSR threshold, sensitivity and specificity in differentiating PTMCs and BMNs in the two groups.Results The UGSRs of PTMCs and BMNs were 0.52±0.12 and 0.85±0.24 (P<0.001) in the HT group and 0.57±0.13 and 0.87±0.20 (P<0.001) in the non-HT group, respectively. The differences in the UGSRs of PTMCs were significantly different between the two groups (P<0.001), whereas the difference in the UGSRs of BMNs was not significantly different between the two groups (P=0.416). The AUC, optimal UGSR threshold, sensitivity and specificity of UGSR for differentiating PTMCs and BMNs in the HT and non-HT groups were 0.901 and 0.890, 0.727 and 0.687, 82.05% and 77.46% and 90.67% and 91.23%, respectively.Conclusions UGSR exhibits important diagnostic value for differentiating PTMCs from BMNs in both HT and non-HT groups, and the USGR was lower in the HT group compared with that in the non-HT group.

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Variability in the interpretation of grey-scale ultrasound features in assessing thyroid nodules: A systematic review and meta-analysis

Cited by 18 publications

References 22 publications

A Control Study on the Value of the Ultrasound Grayscale Ratio for the Differential Diagnosis of Thyroid Micropapillary Carcinoma and Micronodular Goiter in Two Medical Centers

A Control Study on the Value of the Ultrasound Grayscale Ratio for the Differential Diagnosis of Thyroid Micropapillary Carcinoma and Micronodular Goiter in Two Medical Centers

Summary of meta-analyses of studies involving TIRADS classifications (EU-TIRADS, ACR-TIRADS, and K-TIRADS) in evaluating the malignant potential of focal lesions of the thyroid gland

Ultrasound Gray Scale Ratio for the Differential Diagnosis of Papillary Thyroid Microcarcinoma and Benign Micronodule in Patients with Hashimoto’s Thyroiditis

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