The Diagnostic Efficacy of the American College of Radiology (ACR) Thyroid Imaging Report and Data System (TI-RADS) and the American Thyroid Association (ATA) Risk Stratification Systems for Thyroid Nodules

Background. This study is aimed at evaluating the diagnostic efficacy of ultrasound-based risk stratification for thyroid nodules in the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) and the American Thyroid Association (ATA) risk stratification systems. Methods. 286 patients with thyroid cancer were included in the tumor group, with 259 nontumor cases included in the nontumor group. The ACR TI-RADS and ATA risk stratification systems assessed all thyroid nodules for malignant risks. The diagnostic effect of ACR and ATA risk stratification system for thyroid nodules was evaluated by receiver operating characteristic (ROC) analysis using postoperative pathological diagnosis as the gold standard. Results. The distributions and mean scores of ACR and ATA rating risk stratification were significantly different between the tumor and nontumor groups. The lesion diameter > 1 cm subgroup had higher malignant ultrasound feature rates detected and ACR and ATA scores. A significant difference was not found in the ACR and ATA scores between patients with or without Hashimoto’s disease. The area under the receiver operating curve (AUC) for the ACR TI-RADS and the ATA systems was 0.891 and 0.896, respectively. The ACR had better specificity (0.90) while the ATA system had higher sensitivity (0.92), with both scenarios having almost the same overall diagnostic accuracy (0.84). Conclusion. Both the ACR TI-RADS and the ATA risk stratification systems provide a clinically feasible thyroid malignant risk classification, with high thyroid nodule malignant risk diagnostic efficacy.

Construction of the Classification Model Using Key Genes Identified Between Benign and Malignant Thyroid Nodules From Comprehensive Transcriptomic Data

Thyroid nodules are present in upto 50% of the population worldwide, and thyroid malignancy occurs in only 5–15% of nodules. Until now, fine-needle biopsy with cytologic evaluation remains the diagnostic choice to determine the risk of malignancy, yet it fails to discriminate as benign or malignant in one-third of cases. In order to improve the diagnostic accuracy and reliability, molecular testing based on transcriptomic data has developed rapidly. However, gene signatures of thyroid nodules identified in a plenty of transcriptomic studies are highly inconsistent and extremely difficult to be applied in clinical application. Therefore, it is highly necessary to identify consistent signatures to discriminate benign or malignant thyroid nodules. In this study, five independent transcriptomic studies were combined to discover the gene signature between benign and malignant thyroid nodules. This combined dataset comprises 150 malignant and 93 benign thyroid samples. Then, there were 279 differentially expressed genes (DEGs) discovered by the feature selection method (Student’s t test and fold change). And the weighted gene co-expression network analysis (WGCNA) was performed to identify the modules of highly co-expressed genes, and 454 genes in the gray module were discovered as the hub genes. The intersection between DEGs by the feature selection method and hub genes in the WGCNA model was identified as the key genes for thyroid nodules. Finally, four key genes (ST3GAL5, NRCAM, MT1F, and PROS1) participated in the pathogenesis of malignant thyroid nodules were validated using an independent dataset. Moreover, a high-performance classification model for discriminating thyroid nodules was constructed using these key genes. All in all, this study might provide a new insight into the key differentiation of benign and malignant thyroid nodules.

Effectiveness of High-intensity Focused Ultrasound (HIFU) Therapy of Solid and Complex Benign Thyroid Nodules – A Long-term Follow up Two-center Study

Purpose To investigate the effectiveness of high-intensity focused ultrasound (HIFU) of solid and complex benign thyroid nodules. Methods Fifty-eight patients with benign thyroid nodules were treated with HIFU at two centers from 2014–2019. The device, EchoPulse (Teraclion, Malakoff, France), heats the nodes to 80–90 °C. Nodal volumes were measured by ultrasound at regular intervals before and up to 12 months after therapy. In a retrospective long-term two-center study, average volume reductions in relation to baseline volume were statistically analyzed by the Wilcoxon signed-rank test. Side effects were documented. Results In solid nodules, the average percent volume reductions at the 3, 6, 9, and 12-months follow-up were 49.98%, 46.40%, 65.77%, and 63.88%, respectively. The results were significant with p<0.05 in the Wilcoxon signed-rank test at the 3, 6, and 9-months follow-up. In complex nodules, the average percent volume reduction was 35.2% at 3 months, 36.89% at 6 months, and 63.64% at twelve months follow up. The results were significant with p<0.05 in the Wilcoxon signed-rank test at the 3- and 6-months follow-up. The complication rate was 5.2%. All complications occurred in patients with solid nodules. Conclusion The study showed that HIFU is an effective treatment method for both solid and complex nodules. The complication rate is relatively high at 5.2%. No long-term complications occurred. The solid nodules responded better to HIFU than complex nodules.

Metabolic Profile Characterization of Different Thyroid Nodules Using FTIR Spectroscopy: A Review

Thyroid cancer’s incidence has increased in the last decades, and its diagnosis can be a challenge. Further and complementary testing based in biochemical alterations may be important to correctly identify thyroid cancer and prevent unnecessary surgery. Fourier-transform infrared (FTIR) spectroscopy is a metabolomic technique that has already shown promising results in cancer metabolome analysis of neoplastic thyroid tissue, in the identification and classification of prostate tumor tissues and of breast carcinoma, among others. This work aims to gather and discuss published information on the ability of FTIR spectroscopy to be used in metabolomic studies of the thyroid, including discriminating between benign and malignant thyroid samples and grading and classifying different types of thyroid tumors.

Giá trị của siêu âm sử dụng bảng phân loại ACR - TIRADS 2017 trong chẩn đoán nhân giáp

TÓM TẮT Đặt vấn đề: Bệnh lý nhân giáp là một bệnh lý phổ biến, đặc biệt là ở phụ nữ và người lớn tuổi. Siêu âm tuyến giáp, được xem như là một phương tiện đầu tay, là phương pháp chẩn đoán hình ảnh có những khả năng vượt trội như tương đối đơn giản, rẻ tiền, không xâm lấn, có thể lặp lại nhiều lần để chẩn đoán bệnh, và có khả năng phát hiện được những tổn thương rất nhỏ. Nghiên cứu này nhằm xác định xác giá trị của siêu âm sử dụng bảng phân loại ACR-TIRADS 2017 trong chẩn đoán nhân giáp. Phương pháp: Thiết kế nghiên cứu mô tả cắt ngang, với cỡ mẫu 169 bệnh nhân được phẫu thuật nhân giáp. Trước phẫu thuật, bệnh nhân được siêu âm tuyến giáp bằng máy GE (LOGIQ S7 Pro, LOGIQ E9 …) với đầu dò linear tần số 7,5 - 12 MHz. Kết quả siêu âm bảng phân loại TI-RADS theo ACR 2017 so sánh với tiêu chuẩn vàng là kết quả giải phẫu bệnh. Kết quả: Siêu âm áp dụng bảng phân loại ACR-TIRADS 2017 trong phân biệt nhân giáp lành tính và ác tính: Độ nhạy 97,9%, độ đặc hiệu 82,6%, giá trị tiên đoán dương 95,8%, giá trị tiên đoán âm 90,5%, và độ chính xác 94,9%. Diện tích dưới đường cong ROC (AUC) của phân loại ACR-TIRADS trong chẩn đoán nhân giáp ác tính là bằng 0,953 (p < 0,001). Điểm cắt (cut - off) được chọn là TIRADS 4. Diện tích dưới đường cong ROC (AUC) của điểm số của hạt giáp theo phân loại ACR- là 0,967 (p < 0,001). Điểm cắt (cut - off) được chọn là 5 điểm. Kết luận: Siêu âm áp dụng bảng phân loại ACR-TIRADS 2017 có giá trị trong chẩn đoán phân biệt nhân giáp lành tính và ác tính với độ nhạy và độ đặc hiệu cao. ABSTRACT THE USE OF THYROIDULTRASOUND WITH ACR - TIRADS 2017 CLASSIFICATION IN THE DIAGNOSIS OF THYROID NODULES Backgrounds: Thyroid disease is very common, especially in women and the elderly. Thyroid ultrasound, as a first - line tool, is an imaging modality with outstanding capabilities such as being relatively simple, inexpensive, non - invasive, and repeatable for diagnosis of thyroid diseases, and can detect very small lesions. This study aims to determine the use of thyroid ultrasound with ACR-TIRADS 2017 classification in the diagnosis of thyroid nodules. Methods: A cross - sectional descriptive study was conducted in 169 patients undergoing thyroidectomy. All patients had been preoperatively performed thyroid ultrasound using a GE machine (LOGIQ S7 Pro, LOGIQ E9 ...) with a linear transducer frequency of 7.5 - 12 MHz. The ultrasound results using the 2017 ACR-TIRADS classification compared with pathological findings as the gold standard diagnostics. Results: Thyroid ultrasound using the 2017 ACR-TIRADS classification could distinguish benign and malignant thyroid nodules with the sensitivity of 97.9%, specificity 82.6%, positive predictive value 95.8%, negative predictive value 90.5%, and accuracy of 94.9%. The area under the ROC curve (AUC) of the ACRTIRADS classification in the diagnosis of malignant thyroid nodules was 0.953 (p < 0.001). The cut - off point was selected as TIRADS 4. The area under the ROC curve (AUC) of the ACR - classification score of the armor particles was 0.967 (p < 0.001). The cut - off point is selected as 5 points. Conclusion: Thyroid ultrasound using the 2017 ACR-TIRADS classification is valuable in the differential diagnosis of benign and malignant thyroid nodules with high sensitivity and specificity. Keywords: Ultrasound, thyroid nodules, ACR-TIRADS 2017, benign, malignant.

Gasless, endoscopic trans-axillary thyroid surgery: our series of the first 51 human cases

Background The safety of gasless endoscopic trans-axillary thyroid surgery is still undetermined. Methods Clinical findings and postoperative complications of patients who had undergone trans-axillary thyroid surgery due to thyroid cancer and thyroid nodules were retrospectively studied. The sensory change and paralysis results from this technique and patients’ satisfaction with the cosmesis were also studied. Results Fifty-one patients (49 females and 2 males) received operations by gasless, endoscopic trans-axillary approaches with one patient whose operation was converted to open surgery because of internal jugular vein injury. Only two patients developed temporary vocal cord paralysis and no patients developed other severe complications. The alleviation of the discomfort in the anterior neck area and sternocleidomastoid, and the cosmetic effect of gasless endoscopic trans-axillary thyroid surgery were acceptable. No evidence of recurrence was found during the follow-up period. Conclusions Gasless, endoscopic trans-axillary thyroid surgery is a feasible procedure with acceptable safety and better cosmetic results in strictly selected patients.

Value of Contrast-Enhanced Ultrasound in Adjusting the Classification of Chinese-TIRADS 4 Nodules

Objectives. To explore the value of applying contrast-enhanced ultrasound (CEUS) in adjusting the classification of category 4 nodules in the Chinese-Thyroid Imaging Report and Data System (C-TIRADS). Methods. The data of preoperative conventional ultrasound and CEUS examinations of 125 C-TIRADS 4 nodules in 109 patients were retrospectively analyzed. We divided the thyroid nodules into two groups based on whether recommend by the guide fine-needle aspiration (FNA). Group I included C-TIRADS 4A nodules with a maximum diameter ≤15 mm and C-TIRADS 4B and 4C nodules with a maximum diameter ≤10 mm, and Group II included C-TIRADS 4A nodules with a maximum diameter >15 mm and C-TIRADS 4B and 4C nodules with a maximum diameter >10 mm. In CEUS, thyroid nodules showing suspicious malignant features such as hypoenhancement or early washout were adjusted to a level higher in the C-TIRADS classification; thyroid nodules showing possible benign features such as iso- or hyperenhancement were adjusted to a level lower; and thyroid nodules showing no enhancement were adjusted to C-TIRADS 3. Taking the pathological results as the gold standard, the receiver operating characteristic (ROC) curves of the C-TIRADS classification before and after the adjustment based on CEUS were plotted, and the diagnostic efficiency was compared. Results. The sensitivity, specificity, accuracy, and positive and negative predictive values of the C-TIRADS classification for the diagnosis of thyroid nodule malignancy before the adjustment based on the CEUS results were 83.6%, 63.8%, 74.4%, 72.7%, and 77.1%, respectively, and these values were 91.0%, 82.8%, 87.2%, 85.9%, and 88.9%, respectively, after the adjustment. The area under the ROC curve (AUC) was 0.737 and 0.869, respectively, showing a significant difference (Z = 3.288, P = 0.001 ). The diagnostic efficiency of C-TIRADS classification after the adjustment based on the CEUS results in both groups was improved compared with the result before the adjustment, and the difference in Group II was significant (Z = 2.931, P = 0.003 ). Conclusions. CEUS significantly improved the diagnostic performance in the adjustment of C-TIRADS 4 nodule classification, especially for the nodules which needs FNA recommended by the C-TIRADS.