Modified Models for Predicting Malignancy Using Ultrasound Characters Have High Accuracy in Thyroid Nodules With Small Size

Abstract

To assess the malignancy risk of thyroid nodules, ten ultrasound characteristics are suggested as key diagnostic markers. The European Thyroid Association Guidelines (EU-TIRADS) and 2015 American Thyroid Association Management Guidelines (2015ATA) are mainly used for ultrasound malignancy risk stratification, but both are less accurate and do not appropriatetly classify high risk patients in clinical examination. Previous studies focus on papillary thyroid carcinoma (PTC), but follicular thyroid carcinoma (FTC) and medullary thyroid carcinoma (MTC) remained to be characterized. Thus, this study aimed to determine the diagnostic accuracy and establish models using all ultrasound features including the nodule size for predicting the malignancy of thyroid nodules (PTC, FTC, and MTC) in China. We applied logistic regression to the data of 1,500 patients who received medical treatment in Shanghai and Fujian. Ultrasound features including taller-than-wide shape and invasion of the thyroid capsule showed high odds ratio (OR 19.329 and 4.672) for PTC in this dataset. Invasion of the thyroid also showed the highest odds ratio (OR = 8.10) for MTC. For FTC, the halo sign has the highest odds ratio (OR = 13.40). Four ultrasound features revealed distinct OR in PTC nodule groups with different sizes. In this study, we constructed a logistic model with accuracy up to 80%. In addition, this model revealed more accuracy than TIRADS in 4b and 4c category nodules. Hence, this model could well predict malignancy in small nodules and classify high-risk patients.

Diagnostic value of thyroid imaging reporting and data system combined with BRAFV600E mutation analysis in Bethesda categories III–V thyroid nodules

“…We figured out that the maximum diameter of a benign nodule were larger than a malignant one ( p < 0.001), cohering with the Kwak’s study 21 . In our multiple logistic regression analysis, shape with taller than wide, lobulated or irregular margin, and punctate echogenic foci were independent risk factors ( p < 0.05), consistent with previous studies 22 – 24 . It was certain that the above-mentioned ultrasound signs could play a vital role in diagnosing indeterminate thyroid nodules.…”

Systematic review and meta-analysis: diagnostic value of different ultrasound for benign and malignant thyroid nodules

“…Clinically, there are a variety of methods to distinguish between benign and malignant thyroid nodules, including ultrasound, computer scanning technology, and nuclide scanning. Conventional ultrasound examination has many advantages, such as safety, low costs, simple to use, repeatable, and no radioactivity, and thus, has been widely used in clinical practice (10)(11)(12). Conventional ultrasound images of thyroid malignant nodules are characterized by irregular shape, unclear edge, non-uniformity, microcalcification, low echo, and aspect ratio greater than 1 (13).…”

Accuracy of Ultrasound Diagnosis of Benign and Malignant Thyroid Nodules: A Systematic Review and Meta-Analysis

“…Currently, the clinical techniques used to distinguish benign and malignant thyroid nodules mainly include ultrasound, computed tomography, and nuclear imaging. Traditional ultrasonography is widely used in clinical practice due to its advantages of safety, low cost, ready availability, and no radiation exposure [7][8][9]. e ultrasound images of malignant thyroid nodules have the characteristics of irregular shape, unclear edge, inhomogeneous, calcification, low echo, and aspect ratio greater than 1."…”