TI-RADS Classification Research Articles

7847 Radiomic Ultrasound Checkup of Thyroid Nodules Before Radiodiodine Therapy

Abstract Disclosure: A.A. Trukhin: Grant Recipient; Self; Russian Science Foundation (project N 22-15-00135). A.V. Manaev: Grant Recipient; Self; Russian Science Foundation (project N 22-15-00135). S.M. Zakharova: Grant Recipient; Self; Russian Science Foundation (project N 22-15-00135). M.S. Sheremeta: None. E.A. Troshina: Grant Recipient; Self; Russian Science Foundation (project N 22-15-00135). Background: Over 83 years radioiodine therapy (RIT) of autonomous thyroid nodules still have uncovered pages, according to its complexity and thyroid nodules variety. There are two main criteria to allow RIT – no malignancy and presence of iodine uptake, the last one could be checked by Tc-99m-pertachnetate or I-123, I-131 iodine scintigraphy. Case with thyroid nodules first undergo ultrasound (US) TI-RADS classification, then fine needle aspiration stratification according to the Bethesda system. Publications applied such algorithm shows 75-85% accuracy in malignancy determination, that in 15-25% can lead to improper RIT application. Aim: Method development for thyroid nodules ultrasound checkup before I-131 administration and I-131 24h uptake prognosis. Methods: Study includes 150 nodules (65 benign, 60 malignant, 25 autonomous benign thyroid nodules). Both US longitudinal and transversal thyroid nodule projections were obtained via GE Voluson E8 (36% benign cases / 27% malignant cases) and GE Logiq E (64% benign cases / 73% malignant cases) in cinematic loop regime. Autonomous thyroid nodules underwent I-131 pharmacokinetics examination with 24h uptake determination and RIT. Statistical textural features were obtained through spatial adjacency matrix. Results: Analysis of 16 statistical textural features shows weak correlation between 11 statistical textural features E (Energy), S (Entropy), LU (Local homogeneity), MP (Maximum probability), TR (Matrix trace), CORR (Correlation), IMC (information measure of correlation), DV (Difference variance), DE (Difference entropy), SE (Sum entropy), SA (Average value of the sum). ROC-analysis using 11 statistical textural features shows the best model for benign/malignance determination with AUC = 0.83, Se = 74%, Sp = 73%, PPV = 75%, NPV = 72%, Acc = 74%. I-131 pharmacokinetics examination shows strong correlation SA to I-131 24h uptake. Conclusions: The performed study demonstrates the possibility of using textural statistical features of ultrasound images as instrument for thyroid nodules ultrasound checkup before I-131 administration, for extra FNA prescription and prognosis the I-131 24h important in exact therapeutic I-131 activity calculation. Presentation: 6/2/2024

Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules smaller than 10 mm in the maximum diameter: the efficacy and its correlation with tirads classification

Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules smaller than 10 mm in the maximum diameter: the efficacy and its correlation with tirads classification

Positive Predictive Value of Thyroid Imaging, Reporting and Data System (TI-RADS) (3-5) When Compared to Fine Needle Aspiration Cytology Results

Abstract Background Thyroid nodules are a very common finding in the population. Evaluation of a patient with a thyroid nodule for possibility of malignancy could be challenging. Ultrasound is one tool that could be of help, several scoring systems are utilized to help differentiate benign from malignant nodules. One of the most used is TIRADS as proposed by ACR. Another invasive tool that could help is fine needle aspiration cytology. Objective Evaluating and comparing the accuracy of TI-RADS in the assessment of suspicious thyroid nodules by matching their results with the results of FNAC. Patients and Methods Our study was conducted on 72 adult patients with thyroid nodules and were referred to undergo FNA procedures in ‘Interventional radiology unit’ at the Radiology Department “Ain Shams University hospitals”, Cairo, Egypt. Results The present study concludes that TIRADS classification as proposed by ACR showed less statistical significance in predicting malignancy when compared to results of fine needle aspiration cytology. However, several components of the TIRADS scoring system were better predictors of malignancy than other components, namely the irregular margin, the taller than wider shape and the presence of calcifications within the nodule. Conclusion Our study concludes that better applying and implementing the TIRADS scoring system by the sonographer or using other scoring system available in evaluating thyroid nodules like ATA scoring system might result in more reliable ultrasound results decreasing the need to do fine needle aspiration.

Prevalence of DICER1 variants in large multinodular goiter: thyroid function, clinical and imaging characteristics.

Mutations in DICER1 are found in differentiated thyroid carcinoma (DTC) and in multinodular goiter (MNG) at a younger age with other tumors, which characterizes DICER1 syndrome. DICER1 is one driver to DTC; however, it is also found in benign nodules. We speculated that patients with mutations in DICER1 may present long-lasting MNG. Our aim was to investigate the frequency of DICER1 variants in patients with MNG. Patients who submitted to total thyroidectomy due to large MNG with symptoms were evaluated. DICER1 hotspots were sequenced from thyroid nodule samples. To confirm somatic mutation, DNA from peripheral blood was also analyzed. Among 715 patients, 154 were evaluated with 56.2 ± 12.3 years old (28-79) and the thyroid volume was 115.7 ± 108 mL (16.2-730). We found 11% with six DICER1 variations in a homo or heterozygous state. Only rs12018992 was a somatic DICER1 variant. All remaining variants were synonymous and likely benign, according to the ClinVar database. The rs12018992 was previously described in an adolescent with DTC, measuring 13 mm. There were no significant differences according to gender, familial history of goiter, age, thyroid volume, TSH and TI-RADS classification between DICER1 carriers. Free T4 were lower in patients with DICER1 polymorphisms (13.77 ± 1.8 vs. 15.44 ± 2.4 pmol/L, p = 0.008), regardless of TSH levels. We conclude that germline DICER1 variants can be found in 11% of large goiters but no second-hit somatic mutation was found. DICER1 is one driver to thyroid lesion and a second-hit event seems unnecessary in the MNG development.

SRT: Swin-residual transformer for benign and malignant nodules classification in thyroid ultrasound images

With the advancement of deep learning technology, computer-aided diagnosis (CAD) is playing an increasing role in the field of medical diagnosis. In particular, the emergence of Transformer-based models has led to a wider application of computer vision technology in the field of medical image processing. In the diagnosis of thyroid diseases, the diagnosis of benign and malignant thyroid nodules based on the TI-RADS classification is greatly influenced by the subjective judgment of ultrasonographers, and at the same time, it also brings an extremely heavy workload to ultrasonographers. To address this, we propose Swin-Residual Transformer (SRT) in this paper, which incorporates residual blocks and triplet loss into Swin Transformer (SwinT). It improves the sensitivity to global and localized features of thyroid nodules and better distinguishes small feature differences. In our exploratory experiments, SRT model achieves an accuracy of 0.8832 with an AUC of 0.8660, outperforming state-of-the-art convolutional neural network (CNN) and Transformer models. Also, ablation experiments have demonstrated the improved performance in the thyroid nodule classification task after introducing residual blocks and triple loss. These results validate the potential of the proposed SRT model to improve the diagnosis of thyroid nodules' ultrasound images. It also provides a feasible guarantee to avoid excessive puncture sampling of thyroid nodules in future clinical diagnosis.

TIRADS ve bethesda sınıflandırmaları kullanılarak tiroid nodülünün ultrason ve sitolojik tanısının korelasyonu

Amaç: Tiroid nodülü olan bireylerin ilk değerlendirmesinde kullanılan iki tanı yöntemi TIRADS ve Bethesda sistemleri arasındaki uyumu değerlendirmektir.
 Gereç ve Yöntemler: Ocak 2020 ve Aralık 2022 yılları arasında tek bir girişimsel radyolog tarafından US kılavuzluğunda yapılan 414 tiroid nodüllü hastaya yapılan İİA biyopsileri retrosepektif olarak incelendi. Hastaların demografik bilgileri, nodüllerin boyutu, ekojenitesi ve kontur durumu, TIRADS ve BETHESDA skorları kaydedildi ve analiz edildi. 
 Bulgular: Çalışma popülasyonunun ortalama yaşı 50.4 ± 14.2 idi ve çoğunluğu kadın hastalardı (%74.9). Hastaların ortalama nodül boyutu 18.36 ± 12.96 mm olarak ölçüldü. Tiroid nodülleri TRIADS kriterlerine göre sınıflandırıldığında 29 (%7) hastada TIRADS TR2, 147 (%35.5) hastada TIRADS TR3, 166 (%40.1) hastada TR4 ve 72 (%17.4) hastada TR5 idi. TIRADS 2, 3, 4 ve 5 sınıflarında Bethesda Class V ve Class VI olasılığı sırasıyla %0, %3.4, 31.3 ve %66.7 idi. TIRADS kategori 2'de Bethesda Sınıf II olasılığı %100 iken, TIRADS 3, 4 ve 5 sınıfları için sırasıyla %81.6, %34.9 ve %25 idi.
 Sonuçlar: Çalışmamız, tiroid nodülü İİAS'nin Bethesda Sınıflandırması ile TIRADS sınıflandırmasını kullanan tiroid ultrason raporlaması arasında oldukça iyi bir korelasyon olduğunu göstermektedir. İki bulgunun doğru yorumlanması, klinisyenin tiroid kanseri gösterme olasılığı düşük olan hastalarda gereksiz invaziv prosedür riskini azaltmasına yardımcı olurken, yüksek kanser riski taşıyan hastaların belirlenmesini kolaylaştırır.

Role of Diffusion Weighted MRI, Sonography in Characterization of Thyroid Nodules Guided by TIRADS Classification

Role of Diffusion Weighted MRI, Sonography in Characterization of Thyroid Nodules Guided by TIRADS Classification

Influence of Hashimoto thyroiditis on diagnosis and treatment of thyroid nodules.

As the prevalence of Hashimoto's thyroiditis (HT) and thyroid cancer (TC) has been increasing dramatically in recent years, the association between the two diseases has been widely debated and studied. However, no consistent findings are available and the relationship remains controversial. In this study, we analyzed the influence of HT on the diagnosis and treatment of thyroid nodules and investigated the relationship between HT and TC. From Jan 2017 to Apr 2021, 4678 patients underwent thyroid surgery were collected. Of these patients, 440 were diagnosed with HT (242 nodular goiter (NG) with HT, 198 TC with HT). These patients were grouped when appropriate and the data from these patients were statistically analyzed by using SPSS and GraphPad Prism 6. HT occurred in 198 of 1089 (18.2%) TC patients and 242 of 3589 (6.74%) patients without TC (p=0.000). In terms of the ultrasonography features, in the NG with HT group, 33.1% (80/242) of patients had fine calcification and 45.9% (111/242) of patients whose TI-RADS classification were > Level 3. In the isolated PTC group, 32.3% (2343/7260) LN were metastasis-positive while in the NG with HT group, only 26.0% (504/1939) LN were metastasis-positive (P=0.000). The proportion of PTMC was significantly higher (P=0.000), while the proportion of multifocal carcinoma was significantly lower when coexisting with HT (P=0.029). When comparing the data from the two groups diagnosed as PTMC coexisting with HT or not, there was no significant difference in the composition ratio of tumor number, LN metastasis, LN dissection area, regional LN metastasis and number of negative/positive LN (P=0.614, P=0.051, P=0.139, P=0.350, P=1.000 and P=0.333 respectively). In the MPTC group, 42.2% (872/2065) LN were metastasis-positive while in the MPTC with HT group, only 23.6% (50/212) LN were metastasis-positive (P=0.000). Our data suggested that HT is associated with an increased risk of developing TC but may be a protective factor against PTC progression and metastasis. The coexistence of HT affects the judgment of thyroid nodules by ultrasonography.

Bethesda system of reporting cytopathology of thyroid nodules in correlation with radiological and clinicopathological findings

Background: Thyroid nodules are common, affecting up to 76% of the population. One in every two patients with ultrasonography has a thyroid nodule. Aim of the study: To reporting cytopathological study of thyroid FNA nodules and to correlate it with radiological findings and to compare patient characteristics in low and high-risk groups. Materials and Methods: A retrospective study included FNA cytology of 100 patients with a total of 103 thyroid nodules. Slides were retrieved and reviewed, and Bethesda categories were recorded. Ultrasound reports with TIRADS classification and patients’ demographics were retrieved from archived patient notes. The data were tabulated and analyzed. Results: Most nodules were classified as low or moderately suspicious (TIRADS 2 and 3), with only 4 (3.8%) classified as very suspicious (TIRADS 5). Benign (Bethesda II) was reported in 52 (50.5%), follicular neoplasm (Bethesda IV) in 7 (6.8%), and papillary carcinoma (Bethesda V) in 3 (2.9%) of FNA assessed nodules. TIRADS 5 and cytological impressions agreed perfectly. TIRADS 1&2 and cytological impressions also agreed well. Conclusion: TIRADS improves thyroid carcinoma diagnosis and avoids needless interventions. The strong concordance of TIRADS II with Bethesda II demonstrates its reliability in detecting nodules that do not require FNA or further study.

A prospective comparison of ACR-TIRADS and EU-TIRADS in thyroid nodule assessment for FNA-US.

Prospective data on the accuracy of ultrasound (US) classification systems in thyroid nodules are still scarce. The aim of this study is to compare the accuracy of theAmerican College of RadiologyThyroid Imaging Reporting and Data System(ACR-TIRADS) and European(EU)-TIRADS classification systems. Consecutive patients with one or more thyroid nodule(s) who underwent fine-needle aspiration (FNA) under ultrasonographic guidance (FNA-US) were prospectively evaluated. Clinical evaluation and US data were collected. The reference standard used for this study was FNA-US cytology and histopathological diagnosis. A total of 186 thyroid nodules in 166 patients were evaluated, resulting in 168 nodules from 149 patients with conclusive benign or malignant results. Sensitivity, specificity, negative predictive value (NPV) and false negative (FN) were 100.0%, 28.7%, 100.0% and 0.0%, respectively, for ACR-TIRADS; and 90.0%, 19.1%, 96.8% and 9.1% (n = 1), respectively, for EU-TIRADS. The number of unnecessary FNA-US indicated by ACR-TIRADS was lower than EU-TIRADS (71.3% vs. 80.9%, p = .017), and the number of possibly avoided FNA-US was higher (26.7% vs. 17.8%). Using the same threshold of ACR-TIRADS to indicate FNA-US in EU-TIRADS 3 nodules (2.5 cm), there was an improvement in specificity (30.6%) and avoided FNA-US (28.6%). The best performance of both systems was demonstrated when FNA-US would be indicated only in highly suspicious nodules and/or in the presence of lymphadenopathy, with 85.7% and 89.3% of possibly avoided FNA-US for ACR-TIRADS and EU-TIRADS, respectively, without increasing FN. Both systems presented high sensitivity, but low specificity in selecting nodules for FNA-US. The use of nodular size for FNA-US selection is questioned.

S-Thyroid Computer-Aided Diagnosis Ultrasound System of Thyroid Nodules: Correlation Between Transverse and Longitudinal Planes.

Introduction: We compare the differences in the diagnostic results of S-thyroid, a computer-aided diagnosis (CAD) software, based on two mutually perpendicular planes. Methods: Initially, 149 thyroid nodules confirmed by surgical pathology were enrolled in our study. CAD in our study was based on the ACR TI-RADS lexicon. t test, rank-sum test, and Chi-square test were used. The interclass correlation coefficient and Cohen’s kappa were used to explore the correlation between CAD features. Receiver operating characteristic was plotted for different combinations of CAD features. Results: The patient’s age, transverse diameter, longitudinal diameter, shape, margin, echogenicity, echogenic foci, composition, TI-RADS classification, and risk probability of nodules in the transverse and longitudinal planes were related to thyroid cancer (p < 0.05). The AUC (95%CI) of TI-RADS classification in the transverse plane of CAD is better than that of the longitudinal plane [0.90 (0.84–0.95) vs. 0.83 (0.77–0.90), p = 0.04]. The AUC (95%CI) of risk probability of nodules in the transverse planes shows no difference from that in the longitudinal plane statistically [0.90 (0.85–0.95) vs. 0.88 (0.82–0.94), p = 0.52]. The AUC (95% CI), specificity, sensitivity, and accuracy [TI-RADS classification (transverse plane) + TI-RADS classification (longitudinal plane) + risk (transverse plane) + risk (longitudinal plane)] are 0.93 (0.89–0.97), 86.15%, 90.48%, and 88.59%, respectively. Conclusion: The diagnosis of thyroid cancer in the CAD transverse plane was superior to that in the CAD longitudinal plane when using the TI-RADS classification, but there was no difference in the diagnosis between the two planes when using risk. However, the combination of CAD transverse and longitudinal planes had the best diagnostic ability.

Analysis of Differential Diagnosis of Benign and Malignant Partially Cystic Thyroid Nodules Based on Ultrasound Characterization With a TIRADS Grade-4a or Higher Nodules

Partially cystic thyroid nodules (PCTNs) are a kind of thyroid nodule with both solid and cystic components, and are usually misdiagnosed as benign nodules. The objective of this study was to determine the ultrasound (US) characterizations with a TIRADS Grade-4a or higher partially cystic thyroid nodules (PCTNs) which are associated with being malignant or benign. In this study, 133 PCTNs with a TIRADS Grade-4a or higher were enrolled; 83 were malignant and 50 were benign. TI-RADS classification can detect malignant PCTNs, and its sensitivity, specificity, positive predictive value, negative predictive value, and accuracy are 39.8%, 96.0%, 94.3%, 49.0%, and 60.9%, respectively. Univariate analyses revealed that nodule shape, margin, and structure were related to PCTNs’ being benign and malignant, among which nodules taller-than-wide, with an irregular shape, non-smooth margin, eccentric sharp angle, or edge sharp angle were significantly associated with malignancy while ovoid to round nodules, smooth margins, multiple separation, and eccentric obtuse angle structures were significantly associated with a benign nature. For the solid part of PCTNs, its free margin, echo, and calcification are related to benign and malignant PCTNs. Among them, the free margin of the solid part is non-smooth, hypoechoic, and microcalcification, which are related to malignant PCTNs, while the free margin of the solid part is smooth, isoechoic, macrocalcification, non-calcification and are related to benign PCTNs. Calcification of solid part and free margin are important factors for predicting malignant PCTNs. In addition, nodules’ composition, blood flow signal, and other factors had nothing to do with PCTNs’ being benign or malignant. In the multivariate Logistic regression analysis, solid part calcification (OR: 17.28; 95%CI: 5.14~58.08) and free margin (OR: 3.18; 95%CI: 1.01~10.00) were revealed to be the strongest independent predictors for malignancy (P<0.05). Our study indicated that understanding the ultrasound characteristics of malignant PCTNs, to avoid misdiagnosed PCTNs patients, is important to make a precise diagnosis and prognosis of PCTNs.

The difficulties of applying the classification of TI-RADS in the ultrasound examination of the thyroid gland

The article presents the experience of using the TIRADS classification (2020) in multiparametric ultrasound examination of the thyroid gland of 60 patients with subsequent morphological verification by fine needle aspiration biopsy. The article support the problems and difficulties that may arise in the ultrasound diagnostics doctor during the stratification of nodules and possible ways to solve this problems.

A Single-Center Retrospective Study of the Impact of Thyroid Cancer on the Malignant Risk of Contralateral TI-RADS 3 and 4 Nodules.

Background The incidence of thyroid nodules increases in the general population. Similarly, we have also seen a dramatic increase in the number of thyroid surgeries. However, the mortality rate of thyroid cancer remained stable or even decreased. The purpose of our study was to investigate whether thyroid cancer affects the malignant risk of the contralateral TI-RADS 3 and 4 nodules. Methods We conducted a retrospective cohort study in our institution for all thyroid procedures due to nodules from December 2018 to December 2019. All eligible patients were divided into the experimental group (bilateral nodules) and the control group (unilateral nodules) to assess whether the proportion of malignant nodules was different between the two groups. Multivariate logistic regression analysis was used to control potential confounding factors to investigate whether their differences were statistically significant. Results A total of 330 patients underwent thyroid surgery, of whom 137 were eligible, including 84 in the experimental group and 53 in the control group. The proportion of malignant nodules was significantly different between the experimental group and the control group (29.8% versus 58.5%, unadjusted OR 0.30, 95% CI: 0.17–0.82, p=0.001). However, after controlling for potential confounding factors, including age (p=0.004), gender (p=0.775), and TI-RADS classification (p ≤ 0.001), we found that the difference was not significant (adjusted OR 1.08, 95% CI: 0.39–3.01, p=0.886). Conclusion There is no evidence that thyroid cancer affects the malignant risk of the contralateral TI-RADS 3 and 4 nodules. This study has been registered with the Chinese Clinical Trial Registry (clinical trial registration number: ChiCTR2000038611, registration time: September 26, 2020).

The impact of TI-RADS in detecting thyroid malignancies: a prospective study.

Thyroid ultrasonography (US) is the first-step noninvasive and easily accessible diagnostic method widely used in the detection and characterization of nodular thyroid disease. We aimed to develop a TI-RADS, which is easy to apply and only relies on the counting of suspicious criteria. In order to measure the reliability of the system, we investigated its correlation with fine needle aspiration biopsy (FNAB) and post-surgery histological results. In this prospective study, 242 patients who had undergone FNAB with simultaneous cytopathologist in the radiology department between April and August 2016 were analyzed. Before FNAB, the thyroid gland was re-evaluated with US, and TI-RADS classification was made. Demographic characteristics, family thyroid cancer history and radiotherapy history to the neck region were noted. Of the 242 patients, 17.3% were male (42 males/200 females). US-guided FNAB was applied to all patients. Mean age was 50 ± 13years (min: 19, max: 82). Both FNAB and final post-surgery histology results showed that sex and age were not statistically significantly associated with malignancy (p = 0.193) TI-RADS criteria and FNAB results revealed a statistically significant association between irregular contours, the state of anteroposterior diameter being longer than transverse diameter, microcalcifications, marked hypoechogenicity, and malignancy (p < 0,05). Thirty patients were TI-RADS ≥ 4, 206 patients were TI-RADS ≤ 3 and there was a significant correlation between TI-RADS and Bethesda classification (p = 0.001). In addition, statistically significant associations were found between malignancy and family history of thyroid cancer (p = 0.035) and radiotherapy history to the neck region (p = 0.01). TI-RADS system after nodule identification is based only on the counting of suspicious criteria. It will be safe and effective to recommend follow-up with low score TI-RADS, benign characters and insufficient FNAB results, and thus, unnecessary thyroidectomy operations will be prevented. It will be easier for surgeons to recommend surgery and persuade the patients for it when patients have high TI-RADS scores. TI-RADS has high power in detecting malignancy by recommending biopsy of suspicious nodules.

TIRADS, SRE and SWE in INDETERMINATE thyroid nodule characterization: Which has better diagnostic performance?

PurposeTo assess Strain Ratio (SRE) and Shear Wave Elastography (SWE) accuracy alone and with TIRADS classification, for the risk stratification of indeterminate thyroid nodules.Materials and methods128 Patients with 128 indeterminate nodules candidates for thyroidectomy underwent preoperative staging neck ultrasound and were classified according to K-TIRADS score. After TIRADS evaluation, semi-quantitative (SRE) and quantitative (SWE expressed in kPa) elastosonography were performed and relative diagnostic performances, alone and in combination, were compared through ROC curves analysis. In order to maximize the SRE and SWE sensitivity and specificity, their cut-off values were calculated using the Liu test. Bonferroni test was used to evaluate statistically significant differences with a p value < 0.05.ResultsSensitivity, specificity, PPV and NPV were, respectively, 71.4%, 82.4%, 62.5%, 87.5% for K-TIRADS baseline US, 85.7%, 94.1%, 85.7%, 94.1% for SRE and 57.1%, 79.4%, 53.3%, 81.8% for SWE (kPa expressed). SRE evaluation showed the best diagnostic accuracy compared to the SWE (kPa expressed) (p < 0.05) and to the K-TIRADS (p > 0.05). The association of SRE with conventional ultrasound with K-TIRADS score increased sensitivity (92.9% vs 71.4%) but decreased the specificity than conventional US alone (76.5% vs 82.4%).ConclusionStrain Elastosonography can be associated with K-TIRADS US examination in the thyroid nodule characterization with indeterminate cytology; in fact, adding the SRE to K-TIRADS assessment significantly increases its sensitivity and negative predictive value. However, further multicenter studies on larger population are warranted.

997-P: Thyroid Safety in T2DM Patients Treated with Long-Term Administration of Liraglutide

Objective: It has prompted concerns about the risk of thyroid nodules and thyroid tumors with liraglutide treatment. Our study intends to provide clinical observations on thyroid nodules in T2DM patients treated with liraglutide. Methods: We collected T2DM patients treated with or without liraglutide from January 2015 to September 2020 in Shanghai Tenth People’s Hospital. Thyroid ultrasonography was available, including the size of thyroid nodule and TI-RADS classification. Results: A total of 268 T2DM patients were included in liraglutide group (L) and 328 T2DM in control group(C). Before liraglutide injection, 97 patients diagnosed of thyroid nodules in L group with an average size of 16.37±7.28mm, including 7 in TI-RADS 1, 15 in TI-RADS 2, and 75 in TI-RADS 3. There were 108 patients diagnosed of thyroid nodules in C group with an average size of 17.65±9.27mm, including 6 in TI-RADS 1, 22 in TI-RADS 2, and 80 in TI-RADS 3. After treating with liraglutide of 1.18±0.26mg/ day for 24.1±2.8 months, the average size of nodules in L group was 17.54±7.89mm, with 5 patients in TI-RADS 1, 13 in TI-RADS 2 and 79 in TI-RADS 3. The average size of nodules in C group was 18.19±8.52mm, with 5 patients in TI-RADS 1, 20 in TI-RADS 2, and 81 in TI-RADS 3. There was one patient with hyperthyroidism and one papillary thyroid carcinoma(PTC)in L group, and 2 PTC in C group. The nodules size was not significantly increased (P &amp;lt; 0.01). Conclusion: There was no significant changes of thyroid nodules size during the continuous administration of liraglutide in T2DM patients, and liraglutide was not considered associated with risk of thyroid tumor. However, the effect of liraglutide on thyroid function still needs further investigation. Disclosure M. Zhang: None. Y. Wang: None. J. Yin: None. X. Zha: None. C. Sheng: None. P. Yang: None. H. Li: None. S. Qu: None. Funding National Key Research and Development Project of China (2018YFC1314101); Shanghai Committee of Science and Technology (19DZ1910200, 18411951803, 17DZ1910603)

Using TI-RADS classification increased accuracy of Thyroid cancer diagnosis

Using TI-RADS classification increased accuracy of Thyroid cancer diagnosis

Ultrasound features of medullary thyroid cancer as predictors of biological behavior

BackgroundMedullary thyroid cancer (MTC) has more aggressive behavior and poor prognosis. Ultrasound (US) has facilitated the qualitative diagnosis of thyroid nodules, however, some MTC may be diagnosed as a benign nodule on ultrasound because ultrasound features of malignancy are lacking. The aim of the study was to investigate the association between ultrasound features and biological behavior of MTC.MethodsUltrasound findings and medical records of patients with MTC between Jan 2015 to Jun 2017 were retrospectively reviewed at Tianjin Medical University Cancer Institute and Hospital. MTC were categorized using modified TI-RADS classification, then were classified as “malignant” (m-MTC) or “US-low-suspicious” (l-MTC). We compared the biological behavior between the two groups, and further analyzed the risk factors for the recurrence.ResultsA total of 78 patients were enrolled, of which 55 m-MTC (70.5%) and 23 l-MTC (29.5%) were identified. The N staging of the m-MTC was significantly higher than that of l-MTC(P = 0.000). The preoperative serum Ct level in m-MTC were significantly higher than that of l-MTC(P = 0.035). Biochemical cure were more frequent in l-MTC than that of m-MTC (P = 0.002). Disease recurrence rates were 19.7% (14 of 71). Disease recurrence was more frequent in m-MTC than that of l-MTC (P = 0.013). Disease recurrence was positively associated with extrathyroid extension (P = 0.047), N staging (P = 0.003), preoperative serum Ct level (P = 0.009) and negatively associated with biochemical cure(P = 0.000). In multivariable Cox regression analysis, extrathyroid extension and biochemical cure were independent risk factors for recurrence of MTC.ConclusionsL-MTC has a more indolent character than m-MTC. The extrathyroid extension and biochemical cure were independent risk factors for recurrence of MTC.

Agreement Between Ti-RADS Classification and Bethesda Cytopathological Findings from Thyroid Nodules in Young Adults.

Thyroid nodules are common in young adults. We sought to compare the sonographic characteristics (thyroid imaging reporting and data system [Ti-RADS] classification) with the reported cytological results (Bethesda categories) from thyroid nodules in young recruits and examine the efficiency of our unique multidisciplinary clinic. In this retrospective cohort, we identified young recruits (18-25years) who underwent needle biopsies for asymptomatic thyroid nodule(s), with cytology reports of Bethesda categories II-V, performed in our "Rapid Diagnostic Service" at a large Israeli Defense Forces Medical Corps healthcare facility, between 2013 and 2018. We studied the concordance rates between their Ti-RADS and Bethesda grades, and the preoperative Bethesda grades accuracy versus final pathology results, and the time period needed for their thyroid nodules workup. A total of 81 patients were included who contributed 91 nodules. A fair agreement was found between the Ti-RADS classifications and the Bethesda grades (Cohen's κ=0.238) that was more noticeable in males than in females. The agreement rate was 87.5% in males (21 of 24), but only 77.6% in females (59 of 67) [P=.029]. Of the 5 operated benign cases, all had low Ti-RADS, and 2 had low Bethesda. Of the 8 operated malignant cases, 6 had high Ti-RADS, and 5 had high Bethesda. On average, 37.64days elapsed between the first visit to the ultrasound study, and 24.2days elapsed until biopsy was performed. Despite an overall fair agreement between the sonographic features and cytological findings in young adults, we recommend a more aggressive approach and repeated biopsies despite reported benign pathology, because of a high false-negative rate.