Types Of Thyroid Nodules Research Articles

Incorporation of CEUS and SWE parameters into a multivariate logistic regression model for the differential diagnosis of benign and malignant TI-RADS 4 thyroid nodules.

To investigate the diagnostic value of contrast-enhanced ultrasound (CEUS) quantitative analysis parameters combined with shear wave elastography (SWE) quantitative parameters in the differentiation of benign and malignant ACR TI-RADS category 4 thyroid nodules and to provide a more effective reference for clinical work. We analyzed 187 category 4 nodules, including 132 nodules in the development cohort and 55 nodules in the validation cohort, divided the development cohort into benign and malignant groups, and analyzed the differences in all CEUS and SWE quantitative parameters between the two groups. We selected the highest AUC of the two parameters, performed binary logistic regression analysis with the ACR TI-RADS score and constructed a diagnostic model. ROC curves were applied to evaluate their diagnostic efficacy. 1) The diagnostic model had an AUC of 0.926, sensitivity of 87.5%, specificity of 86.8%, diagnostic threshold of 3, accuracy of 87.12%, positive predictive value of 86.15%, and negative predictive value of 88.06%. 2) The diagnostic model had an AUC of 0.890 in the validation cohort, sensitivity of 81.5%, specificity of 79.6%, and accuracy of 80.00%. The combined multiparameter construction of the nodule diagnostic model can effectively improve the diagnostic efficacy of 4 types of thyroid nodules and provide a new reference index for clinical diagnostic work.

Dense Swin Transformer for Classification of Thyroid Nodules.

As an early sign of thyroid cancer, thyroid nodules are the most common nodular lesions. As a non-invasive imaging method, ultrasound is widely used in the diagnosis of benign and malignant thyroid nodules. As there is no obvious difference in appearance between the two types of thyroid nodules, and the contrast with the surrounding muscle tissue is too low, it is difficult to distinguish the benign and malignant nodules. Therefore, a dense nodal Swin-Transformer(DST) method for the diagnosis of thyroid nodules is proposed in this paper. Image segmentation is carried out through patch, and feature maps of different sizes are constructed in four stages, which consider different information of each layer of features. In each stage block, a dense connection mechanism is used to make full use of multi-layer features and effectively improve the diagnostic performance. The experimental results of multi-center ultrasound data collected from 17 hospitals show that the accuracy of the proposed method is 87.27%, the sensitivity is 88.63%, and the specific effect is 85.16%, which verifies that the proposed algorithm has the potential to assist clinical practice.

Gender-Specific Associations Between Metabolic Disorders and Thyroid Nodules: A Cross-Sectional Population-Based Study from China.

Background: Metabolic disorders (MDs) and the metabolic syndrome (MetS) may be associated with thyroid diseases. The aim of this study was to investigate the relationship between MDs and various types of thyroid nodules (TNs), according to gender. Methods: We analyzed cross-sectional data from the Thyroid Disorders, Iodine Status, and Diabetes Epidemiological (TIDE) survey in China. A total of 56,729 subjects ≥18 years of age were included. Thyroid gland morphology was assessed by thyroid standardized ultrasonography. A multivariate logistic regression model was used to explore the odds ratio (OR) and confidence intervals [CIs] for any associations between MDs and TNs. Subgroup analyses were conducted according to gender and TN type (solitary, S-TN; multiple, M-TNs). Results: The prevalence of TNs was increased in several MDs, and was higher in women than men regardless of whether they suffered from MDs (22.0%, CI [21.6-22.5%] vs. 15.7%, CI [15.3-16.7%], p < 0.001). TNs were associated with the presence of MDs (OR = 1.189, CI [1.107-1.278], p < 0.001), hypercholesterolemia (OR = 1.235, CI [1.177-1.296], p < 0.001), high low-density lipoprotein cholesterol (LDL-C; OR = 1.249, CI [1.186-1.316], p < 0.001), and hyperuricemia (OR = 1.206, CI [1.126-1.293], p < 0.001). MDs and MetS were, respectively, significantly associated with TNs, S-TNs, and M-TNs in men, while MDs were significantly associated with the three TN profiles in women. With respect to dyslipidemia, hypercholesterolemia and high LDL-C had the strongest association with TNs, whereas hypertriglyceridemia had no effect. Conclusions: TNs (especially M-TNs) may be associated with MDs and their various components, and there appear to be some gender-specific associations.

Тиреоїдні вузли в населення України, протокол діагностики та лікування в період після аварії на Чорнобильській АЕС (огляд літератури та власні дані)

У статті описані сучасні уявлення про патогенез виникнення різних типів вузлових утворень щитоподібної залози (ЩЗ). Наданий алгоритм діагностики захворювань ЩЗ, що спрямований на верифікацію морфологічної структури зоба до початку лікування, із метою прийняття правильного рішення щодо показань до хірургічного лікування та його обсягу. Розглянуті основні методи як консервативного, так і хірургічного лікування вузлової патології ЩЗ. Визначені питання особливостей лікувальної тактики вагітних із вузловими утвореннями ЩЗ.

Ultrasound-Guided Fine-Needle Aspiration with or without Negative Pressure for Different Types of Thyroid Nodules.

ObjectTo evaluate the effects of ultrasound-guided fine-needle aspiration with or without negative pressure (FNA+P or FNA-P) on diagnosis of thyroid nodules.MethodsA prospective randomized study was performed. Patients (n=1374, female=1094, 79.6%, male=280, 20.4%, age=48.7±12.5 yr) with thyroid nodules were randomly divided into FNA-P (n=774, 56.3%) and FNA+P (600, 43.7%) groups. Thyroid nodules were diagnosed by FNA-P or FNA+P, in the left (n=640, 46.6%) and right (n=734, 53.4%).ResultsThe thyroid nodules were diagnosed as microcalcification (n=751, 54.7%), coarse calcification (n=404, 29.4%), peripheral calcification (n=101, 7.4%) and mixed micro + coarse calcification (n=118, 8.6%). Based on Bethesda classification criteria, the thyroid nodules were cataloged as type I (n=217,15.8%), II (n=467, 34.0%), III (n=151, 11.0%), V (n=333, 24.2%), and VI (n=206, 15.0%). There were no significant differences between experimental groups diagnosed by FNA-P or FNA+P.ConclusionThe results suggest that fine-needle aspiration with or without negative pressure does not significantly affect the sensitivity of thyroid nodule diagnosis.

Differences in the dielectric properties of various benign and malignant thyroid nodules.

This experiment was conducted to investigate the dielectric properties of different types of thyroid nodules. Our goal was to find a simple and fast method to detect thyroid diseases at different stages from the dielectric properties of thyroid nodules. We used the open-ended coaxial line method to measure the dielectric permittivities of thyroid tissues from 155 patients at frequencies ranging from 1 to 4000MHz. Tissues that were investigated included normal thyroid tissue and benign and malignant thyroid nodules (nodular goiter, follicular adenoma, papillary carcinoma, and follicular carcinoma), as determined from pathological reports. Differences in dielectric properties were measured between each nodule and the surrounding 1cm of tissue. The analysis results revealed that the dielectric permittivity and conductivity values were positively correlated with the degree of malignancy of the nodule (normal<benign<malignant; all differences P<0.05). This was more obvious at frequencies within 20~70MHz, following the order normal tissue<nodular goiter<follicular adenoma<papillary carcinoma<follicular carcinoma. A significant difference (P<0.05) in dielectric permittivity and conductivity was found when comparing these nodules with the surrounding 1cm of tissue. Normal, benign, and malignant nodules were successfully distinguished from one another, and dielectric permittivity was found to be a more sensitive parameter than conductivity. In particular, different disease types can be distinguished at a stimulation frequency of 20~70MHz, which shows that dielectric properties have application prospects for the detection and diagnosis of cancer. At the same time, the dielectric parameter differences between the surrounding 1cm of tissue and the diseased nodule can distinguish the tumor and its surrounding tissues in real time during surgery to determine the tumor boundary.

Raman-based cytopathology: an approach to improve diagnostic accuracy in medullary thyroid carcinoma.

Medullary thyroid carcinoma (MTC) is a rare form of thyroid malignancy that can be diagnostically challenging on fine needle aspiration (FNA) cytology. Ancillary tests such as elevated serum or immunohistochemical positive calcitonin have been helpful, yet they can occasionally provide false positive results. In search for an alternative method to improve diagnostic accuracy (DA), we applied hyperspectral Raman spectroscopy to characterize the biochemical composition of single cells from MTC and compared their spectral information to cells from other types of thyroid nodules. Hyperspectral Raman images of 117 MTC single cells from digested tissue were obtained with a line-scan hyperspectral Raman microscope and compared to 127 benign and 121 classic variant of papillary thyroid carcinoma (CVPTC) cells. When principal component analysis and linear discriminant analysis were used to classify the spectral data, MTC cells were differentiated from benign and CVPTC cells with 97% and 99% DA, respectively. In addition, MTC cells exhibited a prominent Raman peak at 1003 cm-1, whose intensity is 84% and 226% greater on average than that observed in benign and CVPTC cells, respectively. When specifically utilizing only this peak as a spectral marker, MTC cells were separated from benign and CVPTC cells with 87% and 95% DA, respectively. As this peak is linked to phenylalanine, which is known to be associated with calcitonin release in thyroid parafollicular cells, the increased intensity further suggests that this Raman peak could potentially be a new diagnostic marker for MTC. Furthermore, preliminary data from MTC cells (n=21) isolated from a simulated FNA procedure provided similar Raman signatures when compared to single cells from digestion. These results suggest that "Raman-based cytopathology" can be used as an adjunct technique to improve the diagnostic accuracy of FNA cytopathology at a single cell level.

The diagnostic value of ultrasonography in detection of different types of thyroid nodules

BackgroundThis article discusses the importance of high frequency ultrasonography in detection of different types of thyroid nodules considering only the histopathological examination of the surgical specimens as the final diagnosis. We studied 50 patients referred to ENT clinic with a thyroid nodule. Ultrasonography and ultrasound-guided fine-needle aspiration biopsy were done to all the patients. Thyroid surgery was done according to FNAB results.ResultFrom 50 thyroid specimens, the US could predict the malignancy in 18 specimens. By histopathology, only 16 specimens were malignant, and 34 were benign thyroid disease. The sensitivity, specificity, and accuracy of US were 100%, 94.12%, and 96% respectively. The most suspicious ultrasongraphic feature was microcalcification followed by taller than wider (T ˃ W).ConclusionHigh frequency ultrasound is a very important tool to predict the malignant possibility during thyroid nodule evaluation.

Automated thyroid nodule detection from ultrasound imaging using deep convolutional neural networks

Thyroid cancer is the most common endocrine cancer and its incidence has continuously increased worldwide. In this paper, we focus on the challenging problem of nodule detection from ultrasound scans. In current clinical practice, this task is performed manually, which is tedious, subjective and highly depends on the clinical experience of radiologists. We propose a novel deep neural network architecture with carefully designed loss function regularization, and network hyperparameters to perform nodule detection without complex post-processing refinement steps. The local training and validation datasets consist of 2461 and 820 ultrasound frames acquired from 60 and 20 patients with a high degree of variability, respectively. The core of the proposed method is a deep learning framework based on multi-task model Mask R-CNN. We have developed a loss function with regularization that prioritizes detection over segmentation. Validation was conducted for 821 ultrasound frames from 20 patients. The proposed model can detect various types of thyroid nodules. The experimental results indicate that our proposed method is effective in thyroid nodule detection. Comparisons with the results by Faster R-CNN and conventional Mask R-CNN demonstrate that the proposed model outperforms the prior state-of-the-art detection methods.

Diagnostic significance of DNA methylation of PTEN and DAPK in thyroid tumors.

DNA Methylation of the tumour suppressor gene leading to gene silencing plays an important role in thyroid tumour development. The purpose was to determine the DNA methylation status of phosphatase and tensin homolog (PTEN) and death-associated protein kinase (DAPK) in patients with thyroid nodules and to explore whether they can be used as molecular diagnostic tools to differentiate benign and malignant thyroid nodules. Thyroid tissue and blood samples were obtained from normal healthy individuals (controls) and patients suffering from clinically diagnosed thyroid nodular disease [papillary thyroid carcinoma (PTC), adenoma and nodular goitre]. DNA methylation level, mRNA expression and protein expression of PTEN and DAPK in the thyroid tissues and peripheral blood were detected using methylation-specific PCR, semi-quantitative reverse transcription PCR and Western blot, respectively. Diagnostic sensitivity, specific and accuracy of detection were evaluated between blood and thyroid tissue. There was a significant increase in the level of DNA methylation of PTEN and DAPK in PTC (P<.05) compared with controls and other types of thyroid nodules. Levels of the mRNA of both PTEN and DAPK were lower in PTC in both peripheral blood and tissue samples compared with controls, while there was concomitant decrease of both PTEN and DAPK protein expression in PTC tissues (P<.05). There was no significant difference in diagnostic specificity, sensitivity and accuracy between blood sample and thyroid tissues. Hypermethylated status of both PTEN and DAPK in peripheral blood and tissue samples can be useful biomarkers for clinical diagnosis and, distinguishing of benign and malignant thyroid nodules.

Differential diagnosis of thyroid nodules through a combination of multiple ultrasonography techniques: A decision-tree model.

The present study aimed to establish a decision tree (DT) model by combining the parameters of conventional gray-scale ultrasonography (US), elastosonography (ES), color Doppler US (CDUS) and contrast-enhanced US (CEUS) for the differential diagnosis of thyroid nodules. A single-center, retrospective study of 321 thyroid nodules was conducted. For 222 nodules, parameters of conventional gray-scale US, CDUS, ES and CEUS were evaluated using univariate logistic regression. Factors for with P<0.10 were further assessed using multivariate logistic regression. Significant factors (P<0.05) were used to establish a DT. The diagnostic accuracy of this DT was then evaluated by its application to the other 99 nodules. After univariate logistic analysis, factors including gender, number of nodules and diffuse disease were excluded, due to P>0.10. The results of multivariate logistic analysis determined that the following factors were required for the DT: Extent of blood flow determined by CDUS (P=0.002), area ratio determined by ES (P=0.033), peak phase patterns determined by CEUS (P<0.001) and micro-calcification determined by conventional gray-scale US (P=0.015). When compared to the pathological or cytological results of 99 nodules, the resulting DT had a sensitivity of 98.6%, specificity of 80.1%, positive predictive value of 93.5% and negative predictive value of 95.5%. These results suggested that a DT combining conventional gray-scale US, ES, CDUS and CEUS may be helpful for differentiating between types of thyroid nodules.

Choice of Thyroid Nodules Treatment

Introduction. Questions regarding indications and contraindications to the use of minimally invasive technologies in the treatment of various types of thyroid nodules remain still disputable. The objective of the research was to analyse the results of minimally invasive technologies use in the treatment of thyroid nodules and develop the indications for their use.Materials and methods. Results of treatment of 643 patients with thyroid nodules were analysed. Results. Indications to separate use of minimally invasive techniques and cases where they should be combined were determined. The absence of harmful effects of laser-induced interstitial thermotherapy and sclerotherapy with 70 % ethanol on paranodular tissue was proven. High efficiency of laser-induced interstitial thermotherapy in the treatment of functional autonomy of thyroid nodules with gradual achievement of clinical and laboratory stable euthyroidism was observed.Conclusions. When the indications to their use are observed, minimally invasive technologies result in the nodule replacement unit with the connective tissue in 98% of cases.

Transforming Growth Factor β1 Could Influence Thyroid Nodule Elasticity and Also Improve Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma

Ultrasound elastography has been a very useful tool in predicting the risk of malignant thyroid tumor for several years. The objective of this study was to determine if there is a correlation between strain ratio (SR), collagen deposition and transforming growth factor β1 (TGF-β1) expression in different types of thyroid nodules and if TGF-β1 is related to cervical lymph node metastasis. 102 nodules from 81 patients who underwent thyroid resection surgery in our hospital were retrospectively studied. All of these patients had undergone ultrasound elastography scanning before surgery. Masson staining and immunohistochemical staining were used to evaluate the ratio of expression of collagen deposition and TGF-β1. There was a significant difference between benign and malignant thyroid nodules in SR (8.913 ± 11.021 vs. 1.732 ± 0.727, p = 0.000), collagen content (0.371 ± 0.125 vs. 0.208 ± 0.057, p = 0.000) and TGF-β1 expression (0.336 ± 0.093 vs. 0.178 ± 0.071, p = 0.000). A cutoff of 2.99 for SR measurement was selected for the highest Youden index for predicting malignant thyroid nodules, which yielded 87.88% sensitivity, 100% specificity, 100% positive predictive value, 83.72% negative predictive value and 92.15% accuracy. Expression of collagen and TGF-β1 was positively correlated with SR measurements (coefficient = 0.839 for collagen and 0.855 for TGF-β1, p = 0.000). Among 61 nodules with papillary thyroid carcinoma, the average SR for the metastasis group was higher than that for the non-metastasis group (10.955 ± 13.805 and 7.852 ± 7.931, respectively), but without statistical significance (p = 0.287). Collagen deposition was significantly higher in the metastasis group than in the non-metastasis group (0.421 ± 0.091 vs. 0.353 ± 0.118, p = 0.011). TGF-β1 expression was also significantly higher in the metastasis group than in the non-metastasis group (0.378 ± 0.0.69 vs. 0.328 ± 0.091, p = 0.016). To conclude, TGF-β1 may contribute to thyroid nodule elasticity by promoting collagen deposition. In papillary thyroid carcinoma, overexpression of TGF-β1, as well as collagen deposition, may be a risk factor for cervical lymph node metastasis.

Efficacy of thyroid ultrasound elastography in differential diagnosis of small thyroid nodules

ObjectiveTo explore the efficacy of thyroid ultrasound (US) elastography in differential diagnosis of small thyroid nodules. MethodsThis HIPAA-compliant study was approved by the Institutional Review Board and all patients provided written informed consent. Thirty-five patients with 38 small thyroid nodules as seen on transverse ultrasound image formed our study population. An US examination and a separate thyroid elastography examination with pulsation from the carotid artery used as the compression source were performed before fine-needle aspiration. Baseband US data were acquired for off-line elastography processing, where a semi-quantitative index for each nodule was calculated. The Kruskal–Wallis nonparametric rank sum test was used to assess equality of population means among the different types of thyroid nodules. Maximum likelihood estimation of the curve parameters for a binomial receiver operating characteristic (ROC) curve was performed. ResultsElasticity contrast index calculated with elastography was effective in distinguishing between small papillary thyroid carcinomas (PTMC, n=8) and other lesions (n=30) in small thyroid nodules (p=0.0036). The area under the ROC curve for diagnosing PTMCs was 0.812 with a 95% confidence interval of 0.653–0.920. The cut-off value of ECI of 3.6 led to a sensitivity of 100% and a specificity of 60% for detecting PTMCs. ConclusionNoninvasive evaluation of small thyroid nodules is possible using thyroid US elastography with in vivo compression to pick out the most suspicious thyroid nodules for fine-needle aspiration (FNA) and avoid FNA in benign nodules.

Differential Diagnosis of Thyroid Nodules with US Elastography Using Carotid Artery Pulsation

To explore the sensitivity and specificity of ultrasonographic (US) elastography using carotid arterial pulsation as the compression source for differential diagnosis of thyroid nodules. This HIPAA-compliant study was approved by the ethics committee of the institution, and all patients provided written informed consent. Fifty-eight patients (13 men and 45 women [mean age, 51 years; range, 20-76 years]) were enrolled. A short US examination and elastography with pulsation of the carotid artery used as the thyroid compression source were performed before fine-needle aspiration. Baseband US data were downloaded for off-line analysis. Elastographic maps and the thyroid stiffness index were calculated. The Kruskal-Wallis nonparametric rank sum test was used to assess equality of population medians among the different types of thyroid nodules; the R software environment was used for statistical computing and graphics (http://www.r-project.org/). Thyroid stiffness index calculated with elastography using carotid arterial pulsation as the compression source was effective in helping distinguish between papillary carcinomas (n = 10) and other lesions (n = 43) because papillary carcinomas were stiffer than other lesions (P < .0039). It is possible to distinguish between papillary carcinomas and other lesions with the thyroid stiffness index calculated from US elastography using carotid arterial pulsation.

Screening study of the thyroid gland within the scope of color-coded duplex ultrasound of brain-supplying arteries

We undertook this study to establish whether thyroid diseases influence colour-coded Duplex sonography of cerebral arteries and whether colour-coded Duplex sonography is superior to B-mode sonography in detecting pathological changes of the thyroid. In 154 patients the thyroid gland as well as the cerebral arteries were examined by colour-coded Duplex sonography. In 13% of the examined carotid arteries, stenosis or occlusion was detected. Thyroid diseases were found in 21% of the examined patients. In patients with a goitre, carotid arteries were often severely displaced and thyroid vessels exhibited a low resistance waveform, easily to be confused with cerebral arteries. Colour-coded Duplex sonography provides useful information on thyroid vascularisation: however, differentiation between different types of thyroid nodules seems impossible. Investigation of the thyroid gland during colour-coded Duplex sonography of neck vessels is easy to perform. It is not time-consuming and may yield useful additional information that may help to explain the patient's complaints.

Thyroid Nodules in the Population Living Around Semipalatinsk Nuclear Test Site: Possible Implications for Dose-Response Relationships Study

The risk of radiation-induced nodules is higher than the risk for radiation-induced cancer. Risk factors and specific modifiers of the dose-response relationship may vary among different populations and not be well recognized. Many thyroid studies have considered thyroid nodularity itself, but not specific morphological types of thyroid nodules. There are many specific types of thyroid nodules which follow a morphological classification of thyroid lesions, including some congenital and tumor-like conditions. Modern equipment and technique can help us to identify particular specific types of thyroid nodules. In this study we report some results of a clinically applicable approach to materials derived from three studies. From 1999 through 2002, we have screened 571 current residents from 4 exposed and 1 control village near the Semipalatinsk Nuclear Test Site area, who were of similar ages (<20) at the time of major radiation fallout events at the SNTS. Prevalent nodules were identified by ultrasound and fine-needle aspiration biopsy, cytopathology results. Analysis of ultrasound images and cytopathology of thyroid lesions among exposed and non-exposed population allowed us to distinguish some interesting ultrasound features for specific types of thyroid nodules. We believe that it would be interesting and possibly more informative for thyroid dosimetry studies to consider specific morphological types of thyroid nodules. We need more detailed research to clarify the feasibility of applying these findings for study of the dose-response relationship.

Thyroid nodules and cancer

PREVIEWThyroid nodules sometimes cause diagnostic confusion that can lead to unnecessary surgical intervention. Fortunately, about 95% of thyroid nodules are benign, but how do you decide when to simply watch and when to refer for possible surgery? In this article, Drs Castro and Gharib discuss the epidemiology, evaluation, and treatment of various types of thyroid nodules and outline the appropriate diagnostic steps.