Complications of ultrasound-guided thermal ablation of thyroid nodules and associated risk factors: an experience from 9667 cases.

OBJECTIVES: To evaluate the safety of ultrasound-guided thermal ablation (UGTA) for thyroid nodules (TNs) by analysing complications and related risks. MATERIALS AND METHODS: This retrospective, single-centre study reviewed patients who underwent UGTA (microwave or radiofrequency ablation) between January 2018 and March 2023. The incidence of complications was recorded and assessed during and immediately after ablation,1-3 h later, and at 1 month, 3 months, and 6 months. Univariate and multivariate analyses were performed to identify risk factors for hoarseness and haemorrhagic complications. RESULTS: We reviewed 9667 cases in this study. Overall, 4494 (46.49%) cases underwent microwave ablation, while 5173 (53.51%) cases underwent radiofrequency ablation. The overall complication rate was 4.43%. The incidence of major complications was 1.94% (haemorrhage, 1.32%; hoarseness, 0.54%; and symptomatic aseptic necrosis, 0.08%). The incidence of minor complications was 2.45%. A large nodule volume, radiofrequency ablation, hyper-enhancing nodules, benign nodules, higher preoperative blood pressure, hyperthyroidism, and higher ablation power were independent risk factors for haemorrhage. Dorsal nodules and a higher ablation power were independent risk factors for hoarseness. All complications were resolved. CONCLUSION: This study suggests that UGTA is a safe treatment for TNs. Several risk factors for haemorrhage and hoarseness should be considered before performing UGTA. Different ablation modalities should be considered for patients with different conditions. CLINICAL RELEVANCE STATEMENT: Thermal ablation may be a safe treatment for eligible patients with TNs. KEY POINTS: We analysed the complications and risk factors associated with UGTA in 9667 cases. The complication rate was 4.43%; 1.94% were major complications. Risk factors of haemorrhage and hoarseness should be considered. UGTA was a safe method for the treatment of TNs.

Combing superb microvascular imaging with shear wave elastography for risk stratification of Thyroid Imaging Reporting and Data System (TI-RADS) 4 thyroid nodules.

Background: It is difficult to accurately assess the risk of Thyroid Imaging Reporting and Data System (TI-RADS) 4 thyroid nodules due to the overlap of benign and malignant conventional ultrasound (US) features of nodules. To reduce unnecessary needle biopsies and assist clinical decision-making, this study established a dynamic nomogram incorporating superb microvascular imaging (SMI) and shear wave elastography (SWE) for the risk evaluation of TI-RADS 4 thyroid nodules. Methods: A total of 248 patients who underwent US, SMI, and SWE with cytological or histopathological results were included in this retrospective study, and were randomly divided into training (174 patients) and verification (74 patients) cohorts. The clinical characteristics and US, SMI, and SWE features of patients were analyzed in the training cohort. The least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression were used to screen parameters and construct dynamic nomogram. The receiver operating characteristic (ROC) curves, calibration curve, and decision curve were used to evaluate the performance of the nomogram. Results: A dynamic nomogram was constructed based on age [odds ratio (OR) =0.954; P=0.005] , shape (OR =0.345; P=0.041), SMI (OR =9.511; P<0.001), and SWE (OR =3.670; P=0.001). The nomogram showed excellent discrimination both in the training [area under the curve (AUC): 0.848; 95% confidence interval (CI): 0.784-0.911] and validation (AUC: 0.862; 95% CI: 0.780-0.944) cohorts, and better than US, SMI, and SWE alone in all cohorts (P<0.05). The Nomo-score of each patient was calculated and the cut-off value was 0.607 which can be used to distinguish high-risk and low-risk patients. Conclusions: The SMI and SWE show added predictive value on risk stratification in patients with TI-RADS 4 thyroid nodules and a dynamic nomogram was constructed to screen high-risk individuals and assist the clinical decision-making.

Case Report: Plummer's adenoma in Prader-Willi syndrome.

Thyroid nodules in children are less common than in adults but they are approximately two- to three-fold more likely to be malignant in children. Among thyroid nodular diseases, Plummer's adenoma occurs very rarely in pediatrics, and currently, there is no literature providing evidence of this diagnosis in patients with Prader-Willi syndrome (PWS). We report the case of a 9-year-old Caucasian boy affected by PWS presenting with a rapidly growing palpable mass in the thyroid lodge associated with subclinical hyperthyroidism. Laboratory and other examinations (thyroid ultrasound, fine-needle aspiration of the nodule, and scintigraphy) were strongly suggestive for Plummer's adenoma; therefore, the patient underwent left hemithyroidectomy surgery, and anatomo-pathological examination confirmed the diagnosis. Our case describes the first evidence of an isolated follicular adenoma in children with PWS. Surgery is the only therapeutic option in younger children. Further evidence is needed to assess the possible correlation between these two conditions and the existence of potential risk factors.

Primary schwannoma of the thyroid gland: analysis of case characteristics and review of the literature.

BACKGROUND: To improve the characteristics of primary thyroid schwannomas (PTS) and to provide reference basis for clinical diagnosis and treatment. METHODS: PubMed was searched for case reports of PTS up to December 2022 using the search terms "Thyroid nerve sheath tumor" or "Thyroid schwannoma" or "Thyroid Neurilemmoma", respectively. 34 cases were screened. RESULTS: PTS can occur at any age, nodules averaged 3.9 cm. The most common symptoms were voice change and dysphagia. Fine needle aspiration cytology showing spindle-shaped cells should be considered for schwannoma. Most cases underwent thyroid lobectomy or nodule removal with a good prognosis. Tissue types with both Antoni A and Antoni B features are common. Positive immunohistochemical staining for S-100 protein, CD34 and waveform proteins helped confirm the diagnosis. CONCLUSIONS: Positive immunohistochemistry for S-100 and wave proteins helps confirm the diagnosis. Preoperative diagnosis is challenging, but pathology and immunohistochemical staining are the gold standard for diagnosis. The first choice of treatment is surgical resection of the nodules, the prognosis is good.

Parasitic colloid cyst: A diagnostic dilemma.

The pathologies of the neck are varied and at times may cause a diagnostic dilemma for the pathologist. In this report, we present a case of a 32-year-old man with a slow-growing nodular swelling in the right neck region, which was diagnosed as a simple colloid cyst arising in a parasitic thyroid nodule. Simple colloid cysts are cysts that develop due to impaired accumulation of thyroglobulin in inactive follicles. Most thyroid-related pathologies occur as midline swellings. However, the present case was unique due to its location with no connection to the thyroid gland. This case report describes the diagnostic process and adds insight into the pathology of a colloid cyst.

Benign Thyroid Nodule Interventions: A Review and Imaging Considerations for the Interventional Radiologist.

Thyroid radiofrequency ablation (RFA) is a minimally invasive procedure that can be used to treat patients with benign thyroid nodules and is a good alternative to thyroidectomy or radioactive iodine. Thyroid RFA is commonly performed with local lidocaine or minimal/moderate sedation and has a minimal risk profile and few side effects. The efficacy of thyroid RFA has been well documented in the literature, with a volume reduction rate of 67 to 75% at 1 year. Another emerging technique for nodule size reduction is thyroid artery embolization which is a minimally invasive procedure that may be performed in patients with nodular goiters, particularly with substernal thyroid nodule extension, and who are either poor surgical candidates or do not want surgery. This article reviews thyroid RFA, focusing on the relevant preprocedural, procedural, and postprocedural imaging, as well as a discussion on the emerging role of thyroid artery embolization.

Predictive Value of the Nomogram Model Based on Multimodal Ultrasound Features for Benign and Malignant Thyroid Nodules of C-TIRADS Category 4.

To explore the predictive value of the nomogram model based on multimodal ultrasound features for benign and malignant thyroid nodules of C-TIRADS category 4. A retrospective analysis was conducted on the general conditions and ultrasound features of patients who underwent thyroid ultrasound examination and fine needle aspiration biopsy (FNA) or thyroidectomy at the Affiliated Hospital of Zunyi Medical University from April 2020 to April 2023. Predictive signs for benign and malignant nodules of thyroid C-TIRADS category 4 were screened through LASSO regression and multivariate logistic regression analysis to construct a nomogram prediction model. The predictive efficiency and accuracy of the model were assessed through ROC curves and calibration curves. Seven independent risk factors in the predictive model for benign and malignant thyroid nodules of C-TIRADS category 4 were growth pattern, morphology, microcalcifications, SR, arterial phase enhancement intensity, initial perfusion time, and PE [%]. Based on these features, the area under the curve (AUC) of the constructed prediction model was 0.971 (p ＜ .001, 95% CI: 0.952-0.989), with a prediction accuracy of 93.1%. Internal validation showed that the nomogram calibration curve was consistent with reality, and the decision curve analysis indicated that the model has high clinical application value. The nomogram prediction model constructed based on the multimodal ultrasound features of thyroid nodules of C-TIRADS category 4 has high clinical application value.

Comparison of clinical and patient-reported outcomes in patients with benign euthyroid solitary nodules after ultrasound-guided percutaneous microwave ablation and endoscopic thyroidectomy.

BACKGROUND: Percutaneous ultrasound-guided microwave ablation (MWA) for benign solid thyroid nodules is the newest modality for treatment. However, the differences in treatment outcomes between MWA and endoscopic thyroidectomy vestibular approach (TOETVA) for patients with benign euthyroid solitary nodules remain unknown. We are sharing initial results from our prospective study. METHODS: Prospective study between January 2022 and December 2023 was conducted and data were noted at 3 time points in patients planned for treatment (Preoperative, 1 week, and 12 months). Main outcome measures were clinical outcome and comparison of thyroid-related quality of life using the ThyPRO-39hin and swallowing-related quality of life using the SWAL-QoL. RESULTS: Of the 36 included patients, 20 patients underwent TOETVA and 16 underwent MWA. Both the groups were comparable in terms of demographic and clinicopathological profiles. The nodule volume reduction rate of patients at 12 months after MWA was 75.10% and 100% for TOETVA. The mean preoperative ThyPRO-39hin and SWAL-QoL scores were comparable in all domains between the two groups. Mean ThyPRO-39hin and SWAL-QoL scores on postoperative day 7 were significantly better in the MWA group in domains impaired social life (p < 0.0001) and impaired daily life (p = 0.0002). However, at the end of 12 months, mean ThyPRO-39hin and SWAL-QoL scores became significantly better in the TOETVA group as compared to the MWA group. CONCLUSION: Our findings suggest that transoral endoscopic thyroidectomy results in significant superior clinical outcome, thyroid-related quality of life, and swallowing-related quality of life in the long term.

Individual Ultrasonographic Characteristics of Thyroid Nodules and Their Cytopathological Correlation to Determine Malignancy Risk.

Background Ultrasonographic evaluation of thyroid nodules is challenging due to their high frequency and low malignancy rate. The risk stratification system developed by the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) focuses on addressing the primary contemporary objectives for these lesions, aiming to decrease unnecessary biopsies while maintaining a similar specificity compared with other risk stratification systems. Generally, when indicative of malignancy by ultrasound findings, the next best step in management is an evaluation by fine needle aspiration biopsy (FNAB) and cytological analysis with The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) results that determine further evaluation requirements, actions that are based on the risk of malignancy (ROM) of the assigned category, which could include surgical intervention. Objectives To validate and analyze the individual impact of each ultrasonographic finding indicative of malignancy in the ACR TI-RADS guidelines based on their respective correlation with results obtained by TBSRTC. Materials and method Reports for 212 thyroid ultrasound-guided FNABs from 2018 to 2020 were assessed. Only 117 had both ACR TI-RADS and TBSRTC reports available and were analyzed. Nodules were divided into two groups: ROM < 5% (Bethesda 1, 2; n = 58), and ROM > 5% (Bethesda 3, 4, 5, 6; n = 59). Statistical analysis was performed using the x2 test and bivariate logistic regression model for each characteristic included in ACR TI-RADS. Results Individual ultrasound characteristics with a more pronounced distribution towards the Bethesda > 5% malignancy group were: solid or almost completely solid composition (n=53, 62.3%), very hypoechoic echogenicity (n=3, 75%), wider-than-tall shape (n=50, 50.5%), lobulated or irregular margin (n=23, 65.7%), punctate echogenic foci (n=18, 72%), and thyroid isthmus location (n=6, 75%). Statistically significant individual ultrasonographic characteristics indicative of malignancy included solid or almost completely solid (p = 0.005), very hypoechoic echogenicity (p = 0.046), margin lobulated or irregular (p = 0.031), and punctate echogenic foci (p = 0.015). No significant association was found in the taller-than-wide shape for differentiating malignant from benign lesions (p = 0.969). Conclusions Specific ultrasound characteristics identified in the ACR TI-RADS system demonstrate a stronger correlation with an increased risk of malignancy when compared with cytologic evaluation results. These characteristics include a solid composition, lobulated or irregular margins, punctate echogenic foci, and very hypoechoic echogenicity. Our findings revealed that the scale points for the taller-than-wide characteristic do not adequately represent its true influence on the risk of malignancy.

Papillary Thyroid Cancer in a Patient With Graves' Disease and Hyperfunctioning (Hot) Thyroid Nodules: An Unexpected Presentation.

Hyperfunctioning (hot) nodules are considered benign while cold nodules are associated with a higher risk of thyroid cancer. In this case report, we present a patient diagnosed with Graves' disease and later found to have papillary thyroid carcinoma (Bethesda VI), confirmed by fine needle aspiration (FNA) biopsy, with regional metastasis to the neck and possible metastasis to the lungs. This paper demonstrates that hot nodules are not always benign, and could be associated with malignancy.

DAC-Net: A light-weight U-shaped network based efficient convolution and attention for thyroid nodule segmentation.

Recently, there has been a focused effort to improve the efficiency of thyroid nodule segmentation algorithms. This endeavor has resulted in the development of increasingly complex modules, such as the Transformer, leading to models with a higher number of parameters and computing requirements. Sophisticated models have difficulties in being implemented in clinical medicine platforms because of limited resources. DAC-Net is a Lightweight U-shaped network created to achieve high performance in segmenting thyroid nodules. Our method consists of three main components: DWSE, which combines depthwise convolution and squeeze-excitation block to enhance feature extraction and connections between samples; ADA, which includes Split Atrous and Dual Attention to extract global and local feature information from various viewpoints; and CSSC, which involves channel- scale and spatial-scale connections. This module enables the fusing of multi-stage features at global and local levels, producing feature maps at different channel and geographical scales, delivering a streamlined integration of multi-scale information. Combining these three components in our U- shaped design allows us to achieve competitive performance while also decreasing the number of parameters and computing complexity. Several experiments were conducted on the DDTI and TN3K datasets. The experimental results demonstrate that our model outperforms state-of-the-art thyroid nodule segmentation architectures in terms of segmentation performance. Our model not only reduces the number of parameters and computing expenses by 73x and 56x, respectively, but also exceeds TransUNet in segmentation performance. The source code is accessible at https://github.com/Phil-y/DAC-Net.

Combining Image similarity and Predictive AI Models to Decrease Subjectivity in Thyroid Nodule Diagnosis and Improve Malignancy Prediction.

OBJECTIVES: To evaluate the efficacy of combining predictive artificial intelligence (AI) and image similarity model to risk stratify thyroid nodules, using retrospective external validation study. METHODS: Two datasets were used to determine efficacy of the AI application. One was Stanford dataset ultrasound images of 192 nodules between April 2017 to May 2018 and the second was private practice consisting of 118 thyroid nodule images between January 2018 to December 2023. The nodules had definitive diagnosis by cytology or surgical pathology. The AI application was used to predict the diagnosis and American College of Radiology Thyroid Imaging and Data System (ACR TI-RADS) score. RESULTS: In the Stanford dataset, the AI application predicted malignancies with sensitivity of 1.0 and specificity of 0.55. Positive predictive value (PPV) was 0.18 and negative predictive value (NPV) was 1.0. The Area Under the Curve - Receiver Operating Characteristic (AUC-ROC) was 0.78. ACR TI-RADS based clinical recommendation had a polychoric correlation of 0.67. In the private dataset, the AI application predicted malignancies with sensitivity of 0.91 and specificity of 0.95. PPV was 0.8 and NPV was 0.98. AUC-ROC was 0.93 and accuracy was 0.94. ACR TI-RADS based score had a polychoric correlation of 0.94. CONCLUSION: The AI application showed good performance for sensitivity and NPV between the two datasets and demonstrated potential for 61.5% reduction in the need for fine needle aspiration (FNA) and strong correlation to ACR TI-RADS. However, PPV was variable between the datasets possibly from variability in image selection and prevalence of malignancy. If implemented widely and consistently among various clinical settings, this could lead to decreased patient burden associated with an invasive procedure and possibly to decreased health care spending.

Predictive value of the single most suspicious ultrasound feature in subcentimeter thyroid nodules: a retrospective observational cohort study.

PURPOSE: Proper management of subcentimeter thyroid nodules remains challenging for both clinicians and patients. Conducting extensive sonographic research using a safe and inexpensive tool for identifying thyroid nodules is necessary. The aim of this study was to identify whether having the highest-risk ultrasound (US) characteristic suggests that US-guided fine-needle aspiration (FNA) biopsy of subcentimeter nodules is more appropriate for the identification of malignancy than active surveillance (AS) or surgery. METHODS: The data of patients with highly suspicious subcentimeter thyroid nodules and US characteristic data who underwent surgery were retrospectively examined. RESULTS: Among a total of 556 subcentimeter nodules, 223 (40.1%) were benign, and 333 (59.9%) were malignant, with a mean maximal nodule size of 8.1 mm. In addition to age younger than 45 years, several US features were significantly associated with malignancy: irregular margins, the presence of microcalcifications, and taller-than-wide shapes (P < 0.001). Multivariate analysis also revealed that a taller-than-wide shape (OR = 8.988, P = 0.0015) was an independent factor associated with malignancy in subcentimeter thyroid nodules. The diagnostic performance of preoperative FNA was classified as a malignancy, with a sensitivity of 98.4%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 76.9%. CONCLUSIONS: This is one of the few reports based on actual data of the most suspicious US features in subcentimeter thyroid nodules. A taller-than-wide shape US feature is most significantly associated with malignancy. FNA is a simple, accurate, and reliable preoperative method for diagnosing malignant subcentimeter thyroid nodules with highly suspicious US characteristics. AS was less appropriate than FNA for subcentimeter nodules with a taller-than-wide shape, especially in patients ≤ 45 years of age.

Thyroid Fine-Needle Aspiration: The Current and Future Landscape of Cytopathology.

Thyroid cytology is a rapidly evolving field that has seen significant advances in recent years. Its main goal is to accurately diagnose thyroid nodules, differentiate between benign and malignant lesions, and risk stratify nodules when a definitive diagnosis is not possible. The current landscape of thyroid cytology includes the use of fine-needle aspiration for the diagnosis of thyroid nodules with the use of uniform, tiered reporting systems such as the Bethesda System for Reporting Thyroid Cytopathology. In recent years, molecular testing has emerged as a reliable preoperative diagnostic tool that stratifies patients into different risk categories (low, intermediate, or high) with varying probabilities of malignancy and helps guide patient treatment.

Outcomes of Differentiated Thyroid Cancer in Children and Adolescents at King Abdulaziz Medical City, Jeddah.

Objective Differentiated thyroid cancer (DTC) is rare in the pediatric population, with most data from the Western world. We aimed to describe the clinical presentation, treatment intervention, histopathological characteristics, complications, follow-up, and response to treatment in 17 patients with DTC at or below the age of 20 years. Interventions This was a retrospective cohort study at King Abdulaziz Medical City, Jeddah, Saudi Arabia. We included patients aged younger than 20 years with DTC. Total or near-total thyroidectomy was performed in 82% of the patients, central and/or lateral neck dissection in 35% of cases, and radioactive iodine (RAI) ablation in 76% of cases. Results The study included 17 patients (14 females), with a median age of 16 years at the time of diagnosis. Thyroid nodules were the main complaint in 88% of the patients. Thyroid ultrasonography was the main method for the initial evaluation. Papillary cancer was the most common type of tumor, and lymph node spread was found in 82% of the patients. Moreover, 40% of the patients exhibited excellent responses to therapy, with 35% showing indeterminate results. Only 23.5% of the patients developed hypocalcemia postoperatively. Conclusions Classical papillary thyroid carcinoma was the predominant histopathological type, and most patients showed excellent responses to therapy, followed by indeterminate in most of the cases. The most common presentation was a neck nodule, signifying the role of thorough physical neck examinations. Finally, recurrence occurred in a minority of patients. However, none of these patients died.

Functional structure of a high resolution thyroid nodule unit. Economic impact and results of its implementation in an Endocrinology department.

BACKGROUND AND OBJECTIVE: The high incidence of nodular thyroid pathology has led to growing concern about the economic impact that this pathology represents on the healthcare system. There are conclusive data about the cost-effectiveness of high-resolution units for nodular thyroid pathology; however, their implementation is not homogeneous in the Endocrinology and Nutrition services of our country. The objective of the present study was to evaluate the economic impact of the implementation of the high-resolution thyroid nodule unit (HRTNU) in our center. PATIENTS AND METHODS: The present work is a prospective, observational and descriptive study carried out in 1314 patients (82% women, mean age 58 years ds = 11) evaluated at the HRTNU during the period of August 2022-August 2023. Demographic data (age and sex) were analyzed, referral center and consultation type, number of total consultations and neck ultrasound performed, number of fine needle aspiration (FNAB) performed, and cytology results were analyzed. RESULTS: In the period from August 2022 to August 2023, a total of 1314 patients were evaluated (neck ultrasound and clinical consultation) and a total of 133 FNAB were performed, of which only 2.26% were non-diagnostic. Compared to the percentage of unsatisfactory FNAB from the previous year August 2021-July 2022 of 25%, a mean saving of 9931.43 euros was estimated. 84.47% of the patients evaluated for the first time by the HRTNU were discharged, estimating a mean saving of 133,200 euros. CONCLUSIONS: The implementation of a HRTNU at the Endocrinology and Nutrition departments, coordinated with primary and specialized care, is a cost-effectiveness alternative, as it reduces the number of medical consultations and is accompanied by a higher rate of diagnostic FNAB.

Utilizing machine learning for early screening of thyroid nodules: a dual-center cross-sectional study in China.

Background: Thyroid nodules, increasingly prevalent globally, pose a risk of malignant transformation. Early screening is crucial for management, yet current models focus mainly on ultrasound features. This study explores machine learning for screening using demographic and biochemical indicators. Methods: Analyzing data from 6,102 individuals and 61 variables, we identified 17 key variables to construct models using six machine learning classifiers: Logistic Regression, SVM, Multilayer Perceptron, Random Forest, XGBoost, and LightGBM. Performance was evaluated by accuracy, precision, recall, F1 score, specificity, kappa statistic, and AUC, with internal and external validations assessing generalizability. Shapley values determined feature importance, and Decision Curve Analysis evaluated clinical benefits. Results: Random Forest showed the highest internal validation accuracy (78.3%) and AUC (89.1%). LightGBM demonstrated robust external validation performance. Key factors included age, gender, and urinary iodine levels, with significant clinical benefits at various thresholds. Clinical benefits were observed across various risk thresholds, particularly in ensemble models. Conclusion: Machine learning, particularly ensemble methods, accurately predicts thyroid nodule presence using demographic and biochemical data. This cost-effective strategy offers valuable insights for thyroid health management, aiding in early detection and potentially improving clinical outcomes. These findings enhance our understanding of the key predictors of thyroid nodules and underscore the potential of machine learning in public health applications for early disease screening and prevention.

[Diagnostic Value of Ultrasound for Thyroid Nodules With a Spoke-Wheel Blood Flow Pattern].

Objective To explore the diagnostic value of ultrasound for thyroid nodules with a spoke-wheel blood flow pattern.Methods The clinical data of the patients with thyroid nodules presenting a spoke-wheel blood flow pattern examined by ultrasound were collected,and the gray-scale ultrasound features of the nodules were recorded.The diagnostic performance of the Thyroid Imaging Reporting and Data System by American College of Radiology (ACR TI-RADS),Chinese Thyroid Imaging Reporting and Data System (C-TIRADS),and combined specific indicators for the thyroid nodules with a spoke-wheel blood flow pattern was evaluated by comparison with the pathological results,which was regarded as the gold standard.Results A total of 64 patients with thyroid nodules were finally included,including 47 patients with malignant nodules and 17 patients with benign nodules.In addition to the general ultrasound features,central scar mostly appeared in malignant nodules (χ2=5.968,P=0.015),while central coarse calcification was more common in benign nodules (χ2=10.899,P=0.001).After the combination of central scar and central gross calcification,the diagnostic performance of ACR TI-RADS and C-TIRADS was improved (both P<0.001).Conclusions When the thyroid nodule shows a spoke-wheel blood flow pattern,one should be cautious of the possibility of malignancy.Combining central scar and central coarse calcification can improve the accuracy of ultrasonic diagnosis.

Evaluation and application of American College of Radiology Thyroid Imaging Reporting and Data System for improved malignancy detection in paediatric thyroid nodules.

OBJECTIVE: The American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) is a widely used method for the management of adult thyroid nodules. However, its use in paediatric patients is controversial because adult fine needle aspiration biopsy (FNAB) recommendations may lead to delayed diagnoses of cancer in children. The objectives of this study were to evaluate the performance of TI-RADS in paediatric thyroid nodules and to tailor FNAB recommendations for children. METHODS: Consecutive surgically resected paediatric thyroid nodules from two tertiary care centres between 2003 and 2021 were reviewed. Ultrasounds were blindly scored by radiologists according to TI-RADS. Management recommendations based on TI-RADS were evaluated. Various modelling methodologies were used to determine the optimal cutoff for FNAB in children. RESULTS: Of the 96 patients, 79 (82%) were female and the median age at surgery was 16.1 years. Fifty (52%) nodules were malignant on surgical pathology. The area under the receiver operating characteristic curve of TI-RADS for predicting malignancy was 0.78. Adult TI-RADS recommendations would have resulted in 4% of cancerous nodules being lost to follow-up. Modifications to TI-RADS (FNAB of all TR3 nodules ≥1.5 cm, FNAB of TR4 and TR5 nodules ≥0.5 cm, surveillance of nodules ≥1 cm, consider surgery for nodules >4 cm) reduced this missed malignancy rate to 0%. CONCLUSIONS: TI-RADS can risk-stratify paediatric thyroid nodules. However, the system requires modifications to reduce the missed malignancy rate in paediatric thyroid nodules. Our data suggest that lower size thresholds for FNAB are warranted in children.

Differentiation of benign and malignant lesions in Bethesda III and IV thyroid nodules via dual-energy computed tomography quantitative parameters and morphologic features.

Background: Thyroid nodules (TNs) cytologically defined as category Bethesda III and IV pose a major diagnostic challenge before surgery, demanding new methods to reduce unnecessary diagnostic thyroid lobectomies for patients with benign TNs. This study aimed to assess whether a model combining dual-energy computed tomography (DECT) quantitative parameters with morphologic features could reliably differentiate between benign and malignant lesions in Bethesda III and IV TNs. Methods: Data from 77 patients scheduled for thyroid surgery for Bethesda III and IV TNs (malignant =48; benign =29) who underwent DECT scans were reviewed. DECT quantitative parameters including normalized iodine concentration (NIC), attenuation on the slope of spectral Hounsfield unit (HU) curve, and normalized effective atomic number (Zeff) were measured in the arterial phase (AP) and venous phase (VP). DECT quantitative parameters and morphologic features were compared between the malignant and benign cohorts. The receiver operating characteristic curve was performed to compare the performances of significant DECT quantitative parameters, morphologic features, or the models combining the DECT parameters, respectively, with morphologic features. A nomogram was constructed from the optimal performance model, and the performance was evaluated via the calibration curve and decision curve analysis. Results: The areas under the receiver operating characteristic curve with 95% confidence interval (CI) of the NIC in the AP (AP-NIC), slope of spectral HU curve in the AP, and NZeff in the AP were 0.749 (95% CI: 0.641-0.857), 0.654 (95% CI: 0.530-0.778), and 0.722 (95% CI: 0.602-0.842), respectively. The model combining AP-NIC with enhanced blurring showed the highest diagnostic performance, with an area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of 0.808, 0.854, and 0.655, respectively; it was then used to construct a nomogram. The calibration curve showed that the discrepancy between the prediction of the nomogram and actual observations was less than 5%. The decision curve analysis indicated the nomogram had a positive net benefit in threshold risk ranges of 14% to 58% or 60% to 91% for malignant Bethesda III and IV TNs. Conclusions: The model combining AP-NIC with enhanced blurring could reliably differentiate between benign and malignant lesions in Bethesda III and IV TNs.