Intranodular and perinodular ultrasound radiomics distinguishes benign and malignant thyroid nodules: a multicenter study.

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Ultrasound based radiomics prediction model can improve the differentiation ability of benign and malignant thyroid nodules to avoid overtreatment. This study evaluates the role of predictive models based on intranodular and perinodular ultrasound radiomics in distinguishing between benign and malignant thyroid nodules. A total of 1,076 thyroid nodules were enrolled from three hospitals between 2016 and 2022, forming the training, validation and test cohorts. The clinical signature (Clinic_Sig) was developed based on clinical information and conventional morphological features of ultrasound. Expanding 1 pixel, 3 pixels, 5 pixels, 7 pixels, and 9 pixels outward from the thyroid nodule, six radiomics models were constructed using intranodular (intra) and combined radiomics (intranodular and perinodular: +p1,+p3,+p5,+p7,+p9) features. The model with the best area under the curve (AUC) was defined as radiomics signature (Rad_Sig). The combined model was constructed from Clinic_Sig and Rad_Sig. AUC and calibration curves were used to evaluate the predictive performance of the model. Decision curve analysis (DCA) was used to evaluate the clinical net benefit of the model. The intra+p1 radiomics model exhibited the highest efficacy (AUC =0.863) in the test cohort, which was combined with Clinic_Sig to construct the combined model. Compared with Clinic_Sig and Rad_Sig, the combined model showed the higher predictive performance, with AUCs of 0.942 (training), 0.894 (validation), and 0.933 (test). The calibration curve showed that the predicted probabilities of the combined model were in good agreement with the actual probabilities, and DCA indicated that it provided more net benefit than the treat-none or treat-all scheme. The combined model based on clinical signatures, intranodular and perinodular ultrasound radiomics has the potential to effectively predict benign or malignant thyroid nodules.