Abstract
Computer-aided diagnosis (CAD) techniques have emerged to complement qualitative assessment in the diagnosis of benign and malignant thyroid nodules. The aim of this review was to summarize the current evidence on the diagnostic performance of various ultrasound CAD in characterizing thyroid nodules. PUBMED, EMBASE and Cochrane databases were searched for studies published until August 2019. The Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Review 2 (QUADAS-2) tool was used to assess the methodological quality of the studies. Reported diagnostic performance data were analyzed and discussed. Fourteen studies with 2232 patients and 2675 thyroid nodules met the inclusion criteria. The study quality based on QUADAS-2 assessment was moderate. At best performance, grey scale CAD had a sensitivity of 96.7% while Doppler CAD was 90%. Combined techniques of qualitative grey scale features and Doppler CAD assessment resulted in overall increased sensitivity (92%) and optimal specificity (85.1%). The experience of the CAD user, nodule size and the thyroid malignancy risk stratification system used for interpretation were the main potential factors affecting diagnostic performance outcomes. The diagnostic performance of CAD of thyroid ultrasound is comparable to that of qualitative visual assessment; however, combined techniques have the potential for better optimized diagnostic accuracy.
Highlights
Thyroid nodules are a common finding in symptomatic and asymptomatic patients and have a malignancy risk rate of about 5–15% [1]
285 papers were unrelated to thyroid ultrasound computer-aided diagnosis
Because the scope of this review was limited to human populations with thyroid nodules, two studies were excluded with one being a mouse model study [30] and the other a human cell line study [31]
Summary
Thyroid nodules are a common finding in symptomatic and asymptomatic patients and have a malignancy risk rate of about 5–15% [1]. The incidence of thyroid cancer is rising due to the increased sensitivity in diagnostic imaging tools such as ultrasound [2,3]. Current thyroid management guidelines recommend ultrasound for the primary investigation of all suspected thyroid nodules and FNAC being reserved for further investigation of suspicious or equivocal ultrasound findings [5,6]. The primary goal in the diagnosis of thyroid nodules is to limit unnecessary FNAC procedures and unwarranted thyroid surgery on benign nodules which may lead to cost and quality of life implications. Ultrasound is an operator-dependent imaging modality whose results are prone to subjective interpretation. Subjective assessment in grey scale thyroid ultrasound is dependent on the presence
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