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Abstract
Physicians use sonographic characteristics as a reference for the possible diagnosis of thyroid cancers. The purpose of this study was to investigate whether physicians were more effective in their tentative diagnosis based on the information provided by a computer-aided detection (CAD) system. A computer compared software-defined and physician-adjusted tumor loci. A multicenter, multireader, and multicase (MRMC) study was designed to compare clinician performance without and with the use of CAD. Interobserver variability was also analyzed. Excellent, satisfactory, and poor segmentations were observed in 25.3%, 58.9%, and 15.8% of nodules, respectively. There were 200 patients with 265 nodules in the study set. Nineteen physicians scored the malignancy potential of the nodules. The average area under the curve (AUC) of all readers was 0.728 without CAD and significantly increased to 0.792 with CAD. The average standard deviation of the malignant potential score significantly decreased from 18.97 to 16.29. The mean malignant potential score significantly decreased from 35.01 to 31.24 for benign cases. With the CAD system, an additional 7.6% of malignant nodules would be suggested for further evaluation, and biopsy would not be recommended for an additional 10.8% of benign nodules. The results demonstrated that applying a CAD system would improve clinicians’ interpretations and lessen the variability in diagnosis. However, more studies are needed to explore the use of the CAD system in an actual ultrasound diagnostic situation where much more benign thyroid nodules would be seen.
Highlights
The results showed that with the computer-aided detection (CAD) system, an additional 7.6% of malignant nodules would be recommended to be further evaluated at a specificity of 0.95, and an additional 10.8% of benign nodules would be recommended to be spared from undergoing biopsy at a sensitivity of 0.95
The interobserver variability was decreased with CAD, and the readers were more confident with their tentative diagnoses, especially for benign cases
With CAD assistance, the results showed that the added information by CAD might improve the clinician’s biopsy recommendation to prevent 10.8% more benign nodules from unnecessary fine-needle aspiration (FNA), while 7.6% more malignant nodules would be suggested for FNA with the aid of CAD
Summary
The clinical importance of thyroid nodules lies primarily with the possibility of thyroid cancer, which occurs in approximately 8–15% of all thyroid nodules [1]. Accurate initial thyroid nodule work-up is key to identifying clinically significant thyroid cancer, and new diagnostic tools, such as Fourier transform infrared (FTIR) and Raman spectroscopy, are sought to complement the present medical procedures [2,3,4]. Advances in high-resolution ultrasonography (US) have led to an increased availability of information on thyroid nodules and to efficient and effective diagnosis of patients with malignant thyroid nodules [1]. There are a large number of studies about the role of grayscale (B-mode) US in the diagnosis of malignant
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