Establishment of an Ultrasound Malignancy Risk Stratification Model for Thyroid Nodules Larger Than 4 cm
BackgroundThe incidence and mortality of thyroid cancer, including thyroid nodules > 4 cm, have been increasing in recent years. The current evaluation methods are based mostly on studies of patients with thyroid nodules < 4 cm. The aim of the current study was to establish a risk stra...
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| Format: | Article |
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Frontiers Media S.A.
2021-06-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2021.592927/full |
| _version_ | 1823937831568932864 |
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| author | Xuehua Xi Ying Wang Luying Gao Yuxin Jiang Zhiyong Liang Xinyu Ren Qing Gao Xingjian Lai Xiao Yang Shenling Zhu Ruina Zhao Xiaoyan Zhang Bo Zhang |
| author_facet | Xuehua Xi Ying Wang Luying Gao Yuxin Jiang Zhiyong Liang Xinyu Ren Qing Gao Xingjian Lai Xiao Yang Shenling Zhu Ruina Zhao Xiaoyan Zhang Bo Zhang |
| author_sort | Xuehua Xi |
| collection | DOAJ |
| description | BackgroundThe incidence and mortality of thyroid cancer, including thyroid nodules > 4 cm, have been increasing in recent years. The current evaluation methods are based mostly on studies of patients with thyroid nodules < 4 cm. The aim of the current study was to establish a risk stratification model to predict risk of malignancy in thyroid nodules > 4 cm.MethodsA total of 279 thyroid nodules > 4 cm in 267 patients were retrospectively analyzed. Nodules were randomly assigned to a training dataset (n = 140) and a validation dataset (n = 139). Multivariable logistic regression analysis was applied to establish a nomogram. The risk stratification of thyroid nodules > 4 cm was established according to the nomogram. The diagnostic performance of the model was evaluated and compared with the American College Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS), Kwak TI-RADS and 2015 ATA guidelines using the area under the receiver operating characteristic curve (AUC).ResultsThe analysis included 279 nodules (267 patients, 50.6 ± 13.2 years): 229 were benign and 50 were malignant. Multivariate regression revealed microcalcification, solid mass, ill-defined border and hypoechogenicity as independent risk factors. Based on the four factors, a risk stratified clinical model was developed for evaluating nodules > 4 cm, which includes three categories: high risk (risk value = 0.8-0.9, with more than 3 factors), intermediate risk (risk value = 0.3-0.7, with 2 factors or microcalcification) and low risk (risk value = 0.1-0.2, with 1 factor except microcalcification). In the validation dataset, the malignancy rate of thyroid nodules > 4 cm that were classified as high risk was 88.9%; as intermediate risk, 35.7%; and as low risk, 6.9%. The new model showed greater AUC than ACR TI-RADS (0.897 vs. 0.855, p = 0.040), but similar sensitivity (61.9% vs. 57.1%, p = 0.480) and specificity (91.5% vs. 93.2%, p = 0.680).ConclusionMicrocalcification, solid mass, ill-defined border and hypoechogenicity on ultrasound may be signs of malignancy in thyroid nodules > 4 cm. A risk stratification model for nodules > 4 cm may show better diagnostic performance than ACR TI-RADS, which may lead to better preoperative decision-making. |
| first_indexed | 2024-12-17T02:36:40Z |
| format | Article |
| id | doaj.art-0c8e70dcc8694445bf89ed3f9cf89c5c |
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| language | English |
| last_indexed | 2024-12-17T02:36:40Z |
| publishDate | 2021-06-01 |
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| series | Frontiers in Oncology |
| spelling | doaj.art-0c8e70dcc8694445bf89ed3f9cf89c5c2022-12-21T22:06:50ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2021-06-011110.3389/fonc.2021.592927592927Establishment of an Ultrasound Malignancy Risk Stratification Model for Thyroid Nodules Larger Than 4 cmXuehua Xi0Ying Wang1Luying Gao2Yuxin Jiang3Zhiyong Liang4Xinyu Ren5Qing Gao6Xingjian Lai7Xiao Yang8Shenling Zhu9Ruina Zhao10Xiaoyan Zhang11Bo Zhang12Department of Ultrasound, China-Japan Friendship Hospital, Beijing, ChinaDepartment of Ultrasound, Peking Union Medical College Hospital, Beijing, ChinaDepartment of Ultrasound, Peking Union Medical College Hospital, Beijing, ChinaDepartment of Ultrasound, Peking Union Medical College Hospital, Beijing, ChinaDepartment of Pathology, Peking Union Medical College Hospital, Beijing, ChinaDepartment of Pathology, Peking Union Medical College Hospital, Beijing, ChinaDepartment of Ultrasound, Peking Union Medical College Hospital, Beijing, ChinaDepartment of Ultrasound, Peking Union Medical College Hospital, Beijing, ChinaDepartment of Ultrasound, Peking Union Medical College Hospital, Beijing, ChinaDepartment of Ultrasound, Peking Union Medical College Hospital, Beijing, ChinaDepartment of Ultrasound, Peking Union Medical College Hospital, Beijing, ChinaDepartment of Ultrasound, Peking Union Medical College Hospital, Beijing, ChinaDepartment of Ultrasound, China-Japan Friendship Hospital, Beijing, ChinaBackgroundThe incidence and mortality of thyroid cancer, including thyroid nodules > 4 cm, have been increasing in recent years. The current evaluation methods are based mostly on studies of patients with thyroid nodules < 4 cm. The aim of the current study was to establish a risk stratification model to predict risk of malignancy in thyroid nodules > 4 cm.MethodsA total of 279 thyroid nodules > 4 cm in 267 patients were retrospectively analyzed. Nodules were randomly assigned to a training dataset (n = 140) and a validation dataset (n = 139). Multivariable logistic regression analysis was applied to establish a nomogram. The risk stratification of thyroid nodules > 4 cm was established according to the nomogram. The diagnostic performance of the model was evaluated and compared with the American College Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS), Kwak TI-RADS and 2015 ATA guidelines using the area under the receiver operating characteristic curve (AUC).ResultsThe analysis included 279 nodules (267 patients, 50.6 ± 13.2 years): 229 were benign and 50 were malignant. Multivariate regression revealed microcalcification, solid mass, ill-defined border and hypoechogenicity as independent risk factors. Based on the four factors, a risk stratified clinical model was developed for evaluating nodules > 4 cm, which includes three categories: high risk (risk value = 0.8-0.9, with more than 3 factors), intermediate risk (risk value = 0.3-0.7, with 2 factors or microcalcification) and low risk (risk value = 0.1-0.2, with 1 factor except microcalcification). In the validation dataset, the malignancy rate of thyroid nodules > 4 cm that were classified as high risk was 88.9%; as intermediate risk, 35.7%; and as low risk, 6.9%. The new model showed greater AUC than ACR TI-RADS (0.897 vs. 0.855, p = 0.040), but similar sensitivity (61.9% vs. 57.1%, p = 0.480) and specificity (91.5% vs. 93.2%, p = 0.680).ConclusionMicrocalcification, solid mass, ill-defined border and hypoechogenicity on ultrasound may be signs of malignancy in thyroid nodules > 4 cm. A risk stratification model for nodules > 4 cm may show better diagnostic performance than ACR TI-RADS, which may lead to better preoperative decision-making.https://www.frontiersin.org/articles/10.3389/fonc.2021.592927/fullthyroid nodulesthyroid cancerultrasoundrisk stratificationsize |
| spellingShingle | Xuehua Xi Ying Wang Luying Gao Yuxin Jiang Zhiyong Liang Xinyu Ren Qing Gao Xingjian Lai Xiao Yang Shenling Zhu Ruina Zhao Xiaoyan Zhang Bo Zhang Establishment of an Ultrasound Malignancy Risk Stratification Model for Thyroid Nodules Larger Than 4 cm Frontiers in Oncology thyroid nodules thyroid cancer ultrasound risk stratification size |
| title | Establishment of an Ultrasound Malignancy Risk Stratification Model for Thyroid Nodules Larger Than 4 cm |
| title_full | Establishment of an Ultrasound Malignancy Risk Stratification Model for Thyroid Nodules Larger Than 4 cm |
| title_fullStr | Establishment of an Ultrasound Malignancy Risk Stratification Model for Thyroid Nodules Larger Than 4 cm |
| title_full_unstemmed | Establishment of an Ultrasound Malignancy Risk Stratification Model for Thyroid Nodules Larger Than 4 cm |
| title_short | Establishment of an Ultrasound Malignancy Risk Stratification Model for Thyroid Nodules Larger Than 4 cm |
| title_sort | establishment of an ultrasound malignancy risk stratification model for thyroid nodules larger than 4 cm |
| topic | thyroid nodules thyroid cancer ultrasound risk stratification size |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2021.592927/full |
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