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.
Highlights
Thyroid cancer, including papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC), and medullary thyroid carcinoma (MTC), is one of the least painful carcinoma, which develops into a solid malignant tumor
Previous studies suggest that marked hypoechogenicity is commonly associated with benign tumors and rarely observed in cases of malignancy (Nachiappan et al, 2014; Kim et al, 2002)
Using only ECHO as malignancy characteristics showed only low specificity. It is different with a previous study in which Remonti et al, (2015) reported that the absence of elasticity, with a sensitivity of 87.9% and a specificity of 86.2%, achieved the best diagnostic accuracy in a study of 52 patients (Remonti et al, 2015)
Summary
Thyroid cancer, including papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC), and medullary thyroid carcinoma (MTC), is one of the least painful carcinoma, which develops into a solid malignant tumor. The malignant rate of the thyroid nodule is more than 10% (Brito et al, 2014; Al Nofal et al, 2016; Singh Ospina et al, 2016). ECHO IRE TTW EF ITC CDFI MCAL Round AUR UPL. The characteristics include the following: 1) hypo-echogenicity (ECHO); 2) irregular or micro-lobulated margins (IRE); 3) taller-than-wide ratio >1 (TTW); 4) echogenic focus (EF); 5) invasion of the thyroid capsule (ITC); 6) blood flow by color Doppler flow imaging (CDFI); 7) microcalcification (MCAL); 8) round; 9) halo sign (AUR); and 10) up-location (UPL). As ultrasound assessment has wide availability, is not complex, and does not involve exposure to ionizing radiation, it has become a key diagnostic step to assess the risk of carcinoma in patients (Singh Ospina et al, 2016)
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