A Rationale for Using Sonoelastography in Thyroid Nodular Pathology

Objective. To provide a rationale for using sonoelastography (SEG) in the differential diagnosis of thyroid cancer (TC).Material and methods. Thirty patients with thyroid nodules of various morphological structures were examined. The authors studied the data of SEG and immunohistochemistry (IHC) with monoclonal antibodies against types III and IV collagen (they evaluated the degree of the expressed collagen fibers). Analysis of variance, ROC analysis, and logistic regression were used (by comparing with the expression of collagens) to assess the predictive ability of ultrasound.Results. The study showed that irregular and uneven contours, microcalcifications, and “the height greater than the width” were most significant among the ultrasound signs in the diagnosis of TC. Cool colors prevailed when performing SEG in the pattern of thyroid cancer. Purple-blue hues were predominantly recorded (p<0.05 with regard to benign nodules), green ones were less frequently. ROC analysis of compression elastography showed that the area under the curve was 0.785 (95% CI 0.740-0.826), sensitivity 78.1%, specificity 79.0%. Comparison of the data of IHC and SEG revealed a direct correlation of tissue elasticity with the degree of a stromal component and with the presence of collagen-containing structures.Conclusion. SEG may suppose the probable nature of thyroid nodules on the basis of their morphological features. The low degree of the stromal component and the low content of types III and IV collagen make follicular colloid goiter and adenoma soft, which is recorded at SEG. TC is characterized by a high collagen level attributable to the characteristics of the metabolism of cancer cells, which makes them solid in the mode of SEG.

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Can sonographic features of microcalcification predict thyroid nodule malignancy? a prospective observational study

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00498-x ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Mehrdad Nabahati ◽

Rahele Mehraeen ◽

Zoleika Moazezi ◽

Naser Ghaemian

Keyword(s):

Thyroid Nodule ◽

Roc Analysis ◽

Thyroid Nodules ◽

Area Under The Curve ◽

Positive Association ◽

Needle Aspiration ◽

Northern Iran ◽

Significant Positive Association ◽

Irregular Margin ◽

Benign Nodules

Abstract Background The aim of this study was to investigate the diagnostic accuracy of microcalcification, as well as its associated sonographic features, for prediction of thyroid nodule malignancy. We prospectively assessed the patients with thyroid nodule, who underwent ultrasound-guided fine-needle aspiration during 2017–2020 in Babol, northern Iran. The ultrasonographic characteristics of the nodules, as well as their cytological results, were recorded. We used regression analysis to evaluate the relation between sonographic findings and nodule malignancy. A receiver operator characteristics (ROC) analysis was also used to estimate the ability of ultrasound to predict the characteristic features of malignancy, as estimated by the area under the curve (AUC). Results Overall, 1129 thyroid nodules were finally included in the study, of which 452 (40%) had microcalcification. A significant positive association was found between nodule malignancy and microcalcification in both univariate (OR=3.626, 95% CI 2.258–5.822) and multivariable regression analyses (OR=1.878, 95% CI 1.095–3.219). In the nodules with microcalcification, significant positive relations were seen between malignancy and hypoechogenicity (OR=3.833, 95% CI 1.032–14.238), >5 microcalcification number (OR=3.045, 95% CI 1.328–6.982), irregular margin (OR=3.341, 95% CI 1.078–10.352), and lobulated margin (OR=5.727, 95% CI 1.934–16.959). The ROC analysis indicated that AUC for hypoechogenicity, >5 microcalcification number, irregular margin, and lobulated margin were 60%, 62%, 55%, and 60%, respectively, in predicting malignant thyroid nodules. Conclusion The findings indicated that microcalcification can be a potential predictor of thyroid nodule malignancy. Also, the presence of irregular or lobulated margins, multiple intranodular microcalcification (>5 microcalcifications), and/or hypoechogenicity can improve the ability of microcalcification in distinguishing malignant from benign nodules.

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Diagnostic Value of Real-Time Shear Wave Elastography in Diagnosing Thyroid Cancer

Revista de Chimie ◽

10.37358/rc.17.12.5985 ◽

2018 ◽

Vol 68 (12) ◽

pp. 2818-2822

Author(s):

Maria Cristina Oprea ◽

Mihaela Vlad ◽

Ioana Golu ◽

Ioan Sporea ◽

Lazar Fulger

Keyword(s):

Shear Wave ◽

Predictive Value ◽

Thyroid Nodules ◽

Imaging Techniques ◽

Area Under The Curve ◽

Thyroid Volume ◽

Shear Wave Elastography ◽

Maximum Diameter ◽

Diagnostic Tools ◽

Tissue Elasticity

Thyroid nodules are a common pathology found in 50 to 60% of otherwise healthy people. Diagnostic imaging techniques are help discriminating between benign and malignant nodules, while fine needle aspiration is still a gold standard. Shear wave elastography, a recent imaging technique, holds the promise to become reliable diagnostic tools and is currently used in combination with ultrasound. We here report data obtained in a series of 52 thyroid nodules analysed by means of elastography, as well as conventional and Doppler ultrasound. We found no differences in age, nodule and thyroid volume, length, width, thickness and maximum diameter between benign and malignant lesions. Several sonographic patterns are considered to be predictive of malignancy, out of which we only found the intranodular blood flow to be statistically significant. By the means of shear wave elastography we have first assessed tissue elasticities, which are shown in a range of colours, depending on tissue elasticity/stiffness. Then, we have measured and recorded four parameters automatically displayed by the system, namely SWE-mean, SWE-max, SWE-SD and SWE-ratio. Data analysis showed all these quantitative parameters had good sensitivity, specificity, positive predictive value, negative predictive value and area under the curve, as calculated by the ROC curve. As with these parameters, the cut-off points were lower than in literature, still able to indicate reliable diagnoses, which were confirmed by histopathological exam. Our conclusion is that shear wave elastography has great potential for reliably and accurately diagnosing thyroid malignancies.

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Predictive value of relative fat mass algorithm for incident hypertension: a 6-year prospective study in Chinese population

BMJ Open ◽

10.1136/bmjopen-2020-038420 ◽

2020 ◽

Vol 10 (10) ◽

pp. e038420

Author(s):

Peng Yu ◽

Teng Huang ◽

Senlin Hu ◽

Xuefeng Yu

Keyword(s):

Prospective Study ◽

Fat Mass ◽

Chinese Population ◽

Predictive Power ◽

Roc Analysis ◽

Statistical Significance ◽

Area Under The Curve ◽

Predictive Ability ◽

Incident Hypertension ◽

Auc Value

ObjectivesIndividuals with obesity especially excessive visceral adiposity have high risk for incident hypertension. Recently, a new algorithm named relative fat mass (RFM) was introduced to define obesity. Our aim was to investigate whether it can predict hypertension in Chinese population and to compare its predictive power with traditional indices including body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR).DesignA 6-year prospective study.SettingNine provinces (Hei Long Jiang, Liao Ning, Jiang Su, Shan Dong, He Nan, Hu Bei, Hu Nan, Guang Xi and Gui Zhou) in China.ParticipantsThose without hypertension in 2009 survey and respond in 2015 survey.InterventionLogistic regression were performed to investigate the association between RFM and incident hypertension. Receiver operating characteristic (ROC) analysis was performed to compare the predictive ability of these indices and define their optimal cut-off values.Main outcome measuresIncident hypertension in 2015.ResultsThe prevalence of incident hypertension in 2015 based on RFM quartiles were 14.8%, 21.2%, 26.8% and 35.2%, respectively (p for trend <0.001). In overall population, the OR for the highest quartile compared with the lowest quartile for RFM was 2.032 (1.567–2.634) in the fully adjusted model. In ROC analysis, RFM and WHtR had the highest area under the curve (AUC) value in both sexes but did not show statistical significance when compared with AUC value of BMI and WC in men and AUC value of WC in women. The performance of the prediction model based on RFM was comparable to that of BMI, WC or WHtR.ConclusionsRFM can be a powerful indictor for predicting incident hypertension in Chinese population, but it does not show superiority over BMI, WC and WHtR in predictive power.

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Diagnostic Value of Color Doppler Ultrasonography in Detecting Calcifications in Thyroid Nodules for Benign and Malignant Nodules

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2020.3082 ◽

2020 ◽

Vol 10 (7) ◽

pp. 1621-1630

Author(s):

Xia Liu ◽

Defeng Chang ◽

Dan Xie

Keyword(s):

Thyroid Cancer ◽

Doppler Ultrasound ◽

Doppler Ultrasonography ◽

Thyroid Nodules ◽

Color Doppler ◽

Color Doppler Ultrasound ◽

Diagnostic Value ◽

Color Doppler Ultrasonography ◽

Benign Nodules ◽

Coarse Calcification

Objective: To investigate the diagnostic value of color Doppler ultrasonography in detecting calcifications in thyroid nodules for benign and malignant thyroid nodules. Methods: This study selects 108 patients with thyroid nodules who underwent color Doppler ultrasonography at designated hospitals from June 2013 to June 2018 as study subjects, retrospectively analyzes their general patient data, preoperative color Doppler ultrasound data and postoperative pathological diagnosis results, and discusses the diagnostic value of calcification rate, calcification type and calcification characteristics for benign and malignant thyroid nodules. Results: The results show that preoperative color Doppler ultrasonography found 112 thyroid nodules in 108 patients, including 72 benign nodules and 40 malignant nodules; pathological analysis confirmed 124 thyroid nodules, including 78 benign nodules and 46 malignant nodules; the diagnostic coincidence rate of color Doppler ultrasound is 90.32% (112/124), the misdiagnosis rate is 9.68% (12/124), the specificity is 86.94%, and the sensitivity is 81.27%; in these 112 thyroid nodules, 89 nodules were calcified accounting for 79.46%; in 72 benign nodules, 13 nodules were calcified accounting for 18.06%; in 40 malignant nodules, 17 were calcified accounting for 42.50%; the calcification of malignant nodules was significantly higher than that of benign nodules; in 72 benign nodules, 6 cases is coarse calcification accounting for 8.33%, 3 cases is cyclic calcification accounting for 4.16%, and cyclic and coarse calcification are only 23.46% sensitive to thyroid cancer; in 40 malignant nodules, 3 cases is coarse calcification accounting for 7.5%, and 2 cases is cyclic calcification accounting for 5.00%. Conclusions: According to the analysis, the calcification in thyroid nodules has relatively high sensitivity and specificity for the diagnosis of benign and malignant nodules and it can be used as a specific index for screening thyroid cancer.

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ARFI ELASTOGRAPHY IN THE DIAGNOSIS OF THYROID NODULES

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2018.5.12 ◽

2018 ◽

Vol 8 (5) ◽

pp. 85-90

Author(s):

Hanh Dau Thi My ◽

Quan Nguyen Phuoc Bao ◽

Thao Nguyen Thanh

Keyword(s):

Strain Distribution ◽

Thyroid Nodules ◽

Radiation Force ◽

Acoustic Radiation Force Impulse ◽

Tissue Imaging ◽

Tissue Elasticity ◽

Arfi Elastography ◽

2D Ultrasound ◽

The Mean ◽

Benign Nodules

Objective: To describe the sonography characteritics of the thyroid nodules using Acoutic Radiation Force Impulse Imaging (ARFI), and to evaluate the role of ARFI technique combination with 2D Ultrasound in diagnosing thyroid nodules. Methods: 2D Ultrasound and ARFI Elatography were caried out in 63 patients who have thyroid nodules. Images of 2D Ultrasound were classified according to Russ G. (French TIRADS). ARFI Elastography was performed by 2 techniques: “ Virtual Touch tissue imaging” in order to image of strain distribution and “Virtual Touch tissue quantification Imaging” to measure the shear wave velocity (SWV) in the tissue. Strain distribution was classified according to Xu’s VTI grading method. SWV was measured in the solid portions or suspicious regions of a nodule, avoiding cystic portions or calcifications. According to the results of pathology, we determine and compare the value between 2D Ultrasound plus ARFI elastography and 2D Ultrasound alone. Results: 63 patients with thyroid nodules: 14 malignant nodules and 49 benign nodules. The mean SWV of benign nodules were 1.78±1.22 m/s, the mean SWV of malignant nodules were 7.09±2.87 m/s. The best cut-off point for SWV was 2.4 m/s. For VTI, grade IV was the best cut-off value in differentiation of benign and malignant thyroid nodules. 2D Ultrasound plus VTI and 2D Ultrasound plus VTQ: Se 100% and 100%, Sp 87.8% and 85.7%, PPV 70% and 66.7%, NPV 100% and 100%, Acc 90.5 % and 88.9% (K=0.761 and K=0.727). Conclusions: In addition to the morphologic characteristics of thyroid nodules, ARFI provides information about lesion’s tissue elasticity, which can be useful tool in diferential diagnosis of thyroid nodules. Key words: Acoustic Radiation Force Impulse Imaging (ARFI), thyroid nodules

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Receiver operating characteristic (ROC) movies, universal ROC (UROC) curves, and coefficient of predictive ability (CPA)

Machine Learning ◽

10.1007/s10994-021-06114-3 ◽

2021 ◽

Author(s):

Tilmann Gneiting ◽

Eva-Maria Walz

Keyword(s):

Receiver Operating Characteristic ◽

Roc Analysis ◽

Operating Characteristic ◽

Numerical Models ◽

Binary Classification ◽

Weather Prediction ◽

Area Under The Curve ◽

Predictive Ability ◽

Classification Problems ◽

Receiver Operating

AbstractThroughout science and technology, receiver operating characteristic (ROC) curves and associated area under the curve ($$\mathrm{AUC}$$ AUC ) measures constitute powerful tools for assessing the predictive abilities of features, markers and tests in binary classification problems. Despite its immense popularity, ROC analysis has been subject to a fundamental restriction, in that it applies to dichotomous (yes or no) outcomes only. Here we introduce ROC movies and universal ROC (UROC) curves that apply to just any linearly ordered outcome, along with an associated coefficient of predictive ability ($${\mathrm{CPA}}$$ CPA ) measure. $${\mathrm{CPA}}$$ CPA equals the area under the UROC curve, and admits appealing interpretations in terms of probabilities and rank based covariances. For binary outcomes $${\mathrm{CPA}}$$ CPA equals $$\mathrm{AUC}$$ AUC , and for pairwise distinct outcomes $${\mathrm{CPA}}$$ CPA relates linearly to Spearman’s coefficient, in the same way that the C index relates linearly to Kendall’s coefficient. ROC movies, UROC curves, and $${\mathrm{CPA}}$$ CPA nest and generalize the tools of classical ROC analysis, and are bound to supersede them in a wealth of applications. Their usage is illustrated in data examples from biomedicine and meteorology, where rank based measures yield new insights in the WeatherBench comparison of the predictive performance of convolutional neural networks and physical-numerical models for weather prediction.

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Thyroid Nodules: Pathophysiological Insight on Oncogenesis and Novel Diagnostic Techniques

Physiological Research ◽

10.33549/physiolres.932818 ◽

2014 ◽

pp. S263-S275 ◽

Cited By ~ 2

Author(s):

J. KRÁTKÝ ◽

H. VÍTKOVÁ ◽

J. BARTÁKOVÁ ◽

Z. TELIČKA ◽

M. ANTOŠOVÁ ◽

...

Keyword(s):

Thyroid Cancer ◽

Thyroid Nodules ◽

Thyroid Autoimmunity ◽

Fluid Pressure ◽

Diagnostic Techniques ◽

Molecular Diagnostic ◽

Therapeutic Approaches ◽

Follicular Thyroid Adenoma ◽

Benign Nodules ◽

Reparative Changes

Thyroid nodules are a very frequent pathology among common population. Despite the vast majority of them are of benign origin, the incidence of thyroid cancer is currently rather rising. Although there are several risk factors of thyroid cancer and several clinical, ultrasound, biochemical and molecular diagnostic markers, the exact mechanisms of thyroid oncogenesis and the linkage between thyroid nodule ultrasound appearance and its biological character remain unclear. While ionizing radiation is the only one well-known risk factor for thyroid cancer, the significance of some others remains unclear. The aim of our review was to discuss some not completely known pathophysiological mechanisms involved in thyroid oncogenesis as hypothyroidism, mutations of genes regulating cell proliferation, thyroid autoimmunity and pregnancy and to describe pathophysiological background of some ultrasound markers of thyroid cancer (size, echogenicity, vascularization, calcifications and stiffness). Better knowledge in this field is crucial for development of novel diagnostic techniques and therapeutic approaches. For example, the analysis of BRAF, RAS and other mutations in cytological samples may help to distinction between follicular thyroid carcinoma and follicular thyroid adenoma and may significantly decrease the number of unnecessary surgery among patients with thyroid nodules. Alternatively, the different malign cells growth, angiogenesis, destructions of thyroid follicles, reparative changes, growth retardation, fibrosis and increased interstitial fluid pressure implicate the typical ultrasound appearance of papillary thyroid cancer (hypoechogenicity, irregular vascularization, microcalcifications, stiffness) which is essential to catch the suspicious nodules on the basis of their ultrasound appearance among large amount of benign nodules.

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Ultrasound Microvascular Blood Flow Evaluation: A New Tool for the Management of Thyroid Nodule?

International Journal of Endocrinology ◽

10.1155/2019/7874890 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Carlo Cappelli ◽

Ilenia Pirola ◽

Elena Gandossi ◽

Fiorella Marini ◽

Alessandra Cristiano ◽

...

Keyword(s):

Thyroid Cancer ◽

Thyroid Nodules ◽

Univariate Analysis ◽

Power Doppler ◽

Needle Aspiration ◽

Microvascular Blood Flow ◽

Microvascular Flow ◽

Multivariate Logistic Model ◽

Needle Aspiration Cytology ◽

Benign Nodules

Background. Toshiba Medical System has developed a new Doppler technique [Superb Microvascular Imaging (SMI)] that has improved microvascular flow imaging. SMI depicts perinodular and intranodular thyroid microvascular flow in higher detail compared to standard colour Doppler (CD) and power Doppler (PD) imaging. Objective. Assess the nodular microvascular architecture by SMI compared to CD and PD features in a series of thyroid nodules submitted to fine needle aspiration cytology, in order to evaluate the potential of SMI in detecting thyroid cancer. Materials and Methods. From April 2016 to July 2017, 254 patients with thyroid nodules, evaluated as at high risk for malignancy in agreement with AACE/ACE/AME guidelines, were submitted to cytology. All nodules were previously submitted to ultrasound grayscale, CD, PD, and SMI evaluation. Benign and malignant nodules were stratified in accordance to the number of vessels visualised by SMI: score 1 with a maximum of two blood vessels and score 2 with three or more vessels. Results. Score 1 was found in 59.6% of benign nodules and in 17.9% of malignant nodules, whereas score 2 was found in 40.4% and in 82.1%, respectively (sensitivity 81.7%; specificity 60.5%, p<0.001). Variables significantly associated with malignancy in the univariate analysis were gender (OR, 0.18; 95% CI, 0.08-0.37; p<0.001), vascularity (OR, 1.91; 95% CI, 1.65-3.89; p<0.001), and SMI (OR, 6.72; 95% CI, 3.89-11.59; p<0.001); multivariate logistic model confirmed SMI score 2 as an independent risk factor for malignancy (OR, 6.99; 95% CI, 3.46-12.09; p<0.001). Conclusions. This prospective pilot study showed that SMI can depict intranodular flow in higher detail compared to CDI and PDI, thus improving thyroid cancer detection.

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Reappraisal of shear wave elastography as a diagnostic tool for identifying thyroid carcinoma

Endocrine Connections ◽

10.1530/ec-19-0324 ◽

2019 ◽

Vol 8 (8) ◽

pp. 1195-1205 ◽

Cited By ~ 2

Author(s):

Kristine Zøylner Swan ◽

Steen Joop Bonnema ◽

Marie Louise Jespersen ◽

Viveque Egsgaard Nielsen

Keyword(s):

Diagnostic Accuracy ◽

Shear Wave ◽

Thyroid Nodules ◽

Area Under The Curve ◽

Region Of Interest ◽

Shear Wave Elastography ◽

Thyroid Malignancy ◽

Operating Characteristics ◽

Factors Affecting ◽

Benign Nodules

Thyroid nodular disease is common, but predicting the risk of malignancy can be difficult. In this prospective study, we aimed to assess the diagnostic accuracy of shear wave elastography (SWE) in predicting thyroid malignancy. Patients with thyroid nodules were enrolled from a surgical tertiary unit. Elasticity index (EI) measured by SWE was registered for seven EI outcomes assessing nodular stiffness and heterogeneity. The diagnosis was determined histologically. In total, 329 patients (mean age: 55 ± 13 years) with 413 thyroid nodules (mean size: 32 ± 13 mm, 88 malignant) were enrolled. Values of SWE region of interest (ROI) for malignant and benign nodules were highly overlapping (ranges for SWE-ROImean: malignant 3–100 kPa; benign 4–182 kPa), and no difference between malignant and benign nodules was found for any other EI outcome investigated (P = 0.13–0.96). There was no association between EI and the histological diagnosis by receiver operating characteristics analysis (area under the curve: 0.51–0.56). Consequently, defining a cut-off point of EI for the prediction of malignancy was not clinically meaningful. Testing our data on previously proposed cut-off points revealed a low accuracy of SWE (56–80%). By regression analysis, factors affecting EI included nodule size >30 mm, heterogeneous echogenicity, micro- or macrocalcifications and solitary nodule. In conclusion, EI, measured by SWE, showed huge overlap between malignant and benign nodules, and low diagnostic accuracy in the prediction of thyroid malignancy. Our study supports that firmness of thyroid nodules, as assessed by SWE, should not be a key feature in the evaluation of such lesions.

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MON-LB79 Do Ultrasound Patterns and Clinical Parameters Modify the Probability of Thyroid Cancer Predicted by Molecular Testing in Thyroid Nodules With Indeterminate Cytology?

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.2118 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

James J Figge ◽

William E Gooding ◽

Kenneth D Burman ◽

Sarah Mayson ◽

Randall P Scheri ◽

...

Keyword(s):

Thyroid Cancer ◽

Thyroid Nodules ◽

Predictive Ability ◽

Molecular Testing ◽

Positive Trend ◽

American Thyroid Association ◽

Clinical Parameters ◽

Increased Risk ◽

Indeterminate Cytology ◽

Risk Of Cancer

Abstract Background: Molecular testing (MT) is commonly used to refine cancer probability in thyroid nodules with indeterminate cytology. Whether or not ultrasound (US) patterns and clinical parameters can further modify the risk of cancer in nodules predicted to be positive or negative by molecular testing remains unknown. Aim: To test if clinical parameters, including age, gender, nodule size (by US), Bethesda category (III, IV, V), US pattern (American Thyroid Association [ATA] system vs American College of Radiology TIRADS), radiation exposure, and family history of thyroid cancer (TC) can modify the probability of TC or NIFTP predicted by MT in thyroid nodules with indeterminate cytology. Methods: We studied 257 thyroid nodules from 10 study centers with fine-needle aspiration (FNA) yielding indeterminate cytology and informative MT results using the ThyroSeq v3 genomic classifier (TSv3). Univariate and multivariate logistic regression were used for data analysis. Results: In this group of thyroid nodules, out of all parameters studied using univariate regression, patient gender, age, and Bethesda category were significantly associated with TC/NIFTP probability (P<0.05 for each). The ATA US patterns showed a positive trend (P=0.1211), whereas TIRADS was not predictive (P=0.3135). A multivariate regression model incorporating the four most informative covariates (gender, age, Bethesda category, and ATA US patterns) (model #1) yielded a C index=0.653; R2=0.108. Male gender and Bethesda category V significantly increased risk, and age demonstrated a nonlinear risk profile. When TSv3 was added to model #1, the C index increased to 0.888; R2=0.572. However, age (P=0.341), Bethesda category (P=0.272), and the ATA US patterns (P=0.264) had limited predictive ability in comparison with TSv3, which dominated the predictive performance (P<0.001). Gender was the only parameter showing tendency for significance beyond MT (P=0.095). The most parsimonious model incorporated gender and TSv3 (C index=0.889; R2=0.588). Conclusions: While often useful in selecting thyroid nodules for FNA, neither the ATA US nor the TIRADS scoring systems were informative in further predicting TC/NIFTP in thyroid nodules with indeterminate FNA cytology. Although age and Bethesda category were associated with TC/NIFTP probability on univariate analysis, they had limited incremental value above the high predictive ability of TSv3. Gender was the only parameter with potential contribution to predicting TC/NIFTP in addition to MT.

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