Predicting malignancy in thyroid nodules: feasibility of a predictive model integrating clinical, biochemical, and ultrasound characteristics.

Justyna Witczak,John Geen,Jean-Marc Soukias,Gautam Das,Jason Chai,Brian P. Tennant,Onyebuchi E. Okosieme,Peter Taylor,Bethan Amphlett

doi:10.1186/s13044-016-0033-y

Abstract

BackgroundAlthough the majority of thyroid nodules are benign the process of excluding malignancy is challenging and sometimes involves unnecessary surgical procedures. We explored the development of a predictive model for malignancy in thyroid nodules by integrating a combination of simple demographic, biochemical, and ultrasound characteristics.MethodsRetrospective case-record review.We reviewed records of patients with thyroid nodules referred to our institution from 2004 to 2011 (n = 536; female 84 %, mean age 51 years). All malignancy was proven histologically while benign disease was either confirmed histologically, or on cytology with minimum 36-month observation period. We focused on the following predictors: age, sex, smoking status, thyroid hormones (FT4 and TSH) and nodule characteristics on ultrasound. Variables were included in a multivariate logistic regression and bootstrap analyses were used to confirm results.ResultsIndependent predictors of malignancy in the fully adjusted model were TSH (OR 1.53, 95 % CI 1.10, 2.12, p = 0.01), male gender (OR 3.45, 95 % CI 1.33, 8.92, p = 0.01), microcalcifications (OR 6.32, 95 % CI 2.82, 14.1, p < 0.001), and irregular nodule margins (OR 5.45, 95 % CI 1.61, 18.6, p = 0.006) Bootstrap analyses strengthened these associations and a parsimonious analysis consisting of these variables and age-group demonstrated an area under the curve of 0.77. A predictive score was sensitive (86.9 %) at low scores and highly specific (94.87 %) at higher scores for distinguishing benign from malignant disease.ConclusionsA predictive model for malignancy using a combination of clinical, biochemical, and radiological characteristics may support clinicians in reducing unnecessary invasive procedures in patients with thyroid nodules.Electronic supplementary materialThe online version of this article (doi:10.1186/s13044-016-0033-y) contains supplementary material, which is available to authorized users.

Highlights

The majority of thyroid nodules are benign the process of excluding malignancy is challenging and sometimes involves unnecessary surgical procedures
Patients We retrospectively reviewed the records of patients referred for evaluation of thyroid nodules at our institution between January 2004 and December 2011
We evaluated the following candidate predictors: age, gender, smoking status, thyroid hormone status i.e. serum free thyroxine (FT4) and serum Thyroid stimulating hormone (TSH), and thyroid ultrasound characteristics

Summary

Introduction

The majority of thyroid nodules are benign the process of excluding malignancy is challenging and sometimes involves unnecessary surgical procedures. We explored the development of a predictive model for malignancy in thyroid nodules by integrating a combination of simple demographic, biochemical, and ultrasound characteristics. Thyroid cancer is the most common endocrine malignancy accounting for more deaths than all other endocrine cancers combined [1]. The incidence of thyroid cancer has continued to increase worldwide, partly due to greater diagnostic activity, as well as a true increase in disease occurrence [2, 3]. Differentiated thyroid cancers generally carry a favourable prognosis affected individuals suffer considerable morbidity, both from the disease as well as from side effects of therapy. In most instances treatment with thyroidectomy and radioactive iodine ablation will incur the need for lifelong thyroid hormone therapy [5]

Methods

Results

Conclusion