Malignancy risk in Bethesda class IV thyroid nodules in an iodine deficient region
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PROVIDER: S-EPMC10506119 | biostudies-literature | 2023 Jul
REPOSITORIES: biostudies-literature
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| S-EPMC10660176 | biostudies-literature
Project description:Thyroid nodules are a common disease, and fine needle aspiration cytology (FNAC) is the primary method to assess their malignancy. For the diagnosis of follicular thyroid nodules, however, FNAC has limitations. FNAC can classify them only as Bethesda IV nodules, leaving their exact malignant status and pathological type undetermined. This imprecise diagnosis creates difficulties in selecting the follow-up treatment. In this retrospective study, we collected ultrasound (US) image data of Bethesda IV thyroid nodules from 2006 to 2022 from five hospitals. Then, US image-based artificial intelligence (AI) models were trained to identify the specific category of Bethesda IV thyroid nodules. We tested the models using two independent datasets, and the best AI model achieved an area under the curve (AUC) between 0.90 and 0.95, demonstrating its potential value for clinical application. Our research findings indicate that AI could change the diagnosis and management process of Bethesda IV thyroid nodules.
| S-EPMC10589877 | biostudies-literature
Project description:PurposeMalignancy prediction in indeterminate thyroid nodules is still challenging. We prospectively evaluated whether the combination of ultrasound (US) risk stratification and molecular testing improves the assessment of malignancy risk in Bethesda Category IV thyroid nodules.MethodsNinety-one consecutively diagnosed Bethesda Category IV thyroid nodules were prospectively evaluated before surgery by both ACR- and EU-TIRADS US risk-stratification systems and by a further US-guided fine-needle aspiration cytology (FNAC) for the following molecular testing: BRAFV600E, N-RAS codons 12/13, N-RAS codon 61, H-RAS codons 12/13, H-RAS codon 61, K-RAS codons 12/13, and K-RAS codon 61 point-mutations, as well as PAX8/PPARγ, RET/PC1, and RET/PTC 3 rearrangements.ResultsAt histology, 37% of nodules were malignant. No significant association was found between malignancy and either EU- or ACR-TIRADS. In total, 58 somatic mutations were identified, including 3 BRAFV600E (5%), 5 N-RAS 12/13 (9%), 13 N-RAS 61 (22%), 7 H-RAS 12/13 (12%), 11 H-RAS 61 (19%), 6 K-RAS 12/13 (10%), 8 K-RAS 61 (14%) mutations and 2 RET/PTC1 (4%), 0 RET/PTC 3 (0%), 3 PAX8/PPARγ (5%) rearrangements. At least one somatic mutation was found in 28% and 44% of benign and malignant nodules, respectively, although malignancy was not statistically associated with the outcome of the mutational test. However, the combination of ACR-, but not EU-, TIRADS with the presence of at least one somatic mutation, was significantly associated with malignant histology (P = 0.03).ConclusionUS risk stratification and FNAC molecular testing may synergistically contribute to improve malignancy risk estimate of Bethesda category IV thyroid nodules.
| S-EPMC8572191 | biostudies-literature
Project description:The diagnosis and management of Bethesda III and IV thyroid nodules remain clinical dilemmas. Current guidelines from academic societies suggest active surveillance or diagnostic lobectomy. However, the extent of surgery is often inappropriate, and a considerable percentage of patients experience under- or over-treatment. Thermal ablation has gained popularity as a safe and effective alternative treatment option for benign thyroid nodules. This review explores the feasibility of thermal ablation for Bethesda III or IV thyroid nodules, aiming to preserve the thyroid organ and avoid unnecessary surgery. It emphasizes individualized management, the need to consider factors including malignancy risk, clinical characteristics, and sonographic features, and the importance of supplemental tests such as repeat fine needle aspiration cytology, core needle biopsy, molecular testing, and radioisotope imaging.
| S-EPMC11532522 | biostudies-literature
Project description: Not available
| S-EPMC10798822 | biostudies-literature
Project description:ObjectivePatient-centered decision making is increasingly identified as a desirable component of medical care. To manage indeterminate thyroid nodules, patients are offered the options of surveillance, diagnostic hemithyroidectomy, or molecular testing. Our objective was to identify factors associated with decision making in this population.Study designThis is a retrospective cross-sectional study of patients with Bethesda III and IV thyroid nodules.SettingMulti-institutional.MethodsFactors of interest included age, sex, socioeconomic status (SES), nodule size, institution, attending surgeon, surgeon payment model, and hospital type. Our outcome of interest was the initial management decision made by patients.ResultsA total of 956 patients were included. The majority of patients had Bethesda III nodules (n = 738, 77%). A total of 538 (56%) patients chose surgery, 413 (43%) chose surveillance, and 5 (1%) chose molecular testing. There was a significant variation in management decision based on attending surgeon (proportion of patients choosing surgery: 15%-83%; P≤.0001). Fee-for-service surgeon payment models (odds ratio [OR], 1.657; 95% CI, 1.263-2.175; P < .001) and community hospital settings (OR, 1.529; 95% CI, 1.145-2.042; P < .001) were associated with the decision for surgery. Larger nodule size, younger patients, and Bethesda IV nodules were also associated with surgery.ConclusionWhile it seems appropriate that larger nodules, younger age, and higher Bethesda class were associated with decision for surgery, we also identified attending surgeon, surgeon payment model, and hospital type as important factors. Given this, standardizing management discussions may improve patient-centered shared decision making.
| S-EPMC8239982 | biostudies-literature
Project description:ObjectivesThis study aimed to explore the performance of a model based on Chinese Thyroid Imaging Reporting and Data Systems (C-TIRADS), clinical characteristics, and other ultrasound characteristics for the prediction of Bethesda III/IV thyroid nodules before fine needle aspiration (FNA).Materials and methodsA total of 855 thyroid nodules from 810 patients were included. All nodules underwent ultrasound examination before FNA. All nodules were categorized according to the C-TIRADS criteria and classified into two groups, Bethesda III/IV and non-III/IV thyroid nodules, using cytologic diagnosis as the gold standard. The clinical and ultrasonographic characteristics of the nodules in the two groups were compared, and independent predictors of Bethesda III/IV nodules were determined by univariate and multivariate logistic regression analyses, based on which a prediction model was constructed. The predictive efficacy of the model was compared with that of C-TIRADS alone by sensitivity, specificity, and area under the curve (AUC).ResultsOur study found that the C-TIRADS category, homogeneous echotexture, blood flow signal present, and posterior echo unchanged were independent predictors for Bethesda III/IV thyroid nodules. Based on multiple logistic regression, a predictive model was established: Logit (p)= - 4.213 + 0.965 × homogeneous echotexture+ 1.050 × blood flow signal present + 0.473 × posterior echo unchanged+ 2.859 × C-TIRADS 3 + 2.804 × C-TIRADS 4A + 1.824 × C-TIRADS 4B + 0.919 × C-TIRADS 4C. The AUC of the model among all nodules was 0.746 (95%CI: 0.710-0.782), 0.779 (95%CI: 0.730-0.829) among nodules with a diameter (D) > 10mm, and 0.718 (95%CI: 0.667-0.769) among nodules with D ≤ 10mm, which were significantly higher than that of the C-TIRADS alone.ConclusionWe developed a predictive model for Bethesda III/IV thyroid nodules that is better for nodules with D > 10mm FNA operators can choose the optimal puncture strategy based on the prediction results to improve the rate of definitive diagnosis of the first FNA of Bethesda III/IV nodules and thus reduce repeat FNA.
| S-EPMC11911163 | biostudies-literature
Project description:BackgroundThe prevalence of thyroid nodules (TNs) has been increasing rapidly. However, little is known about the drivers of its high prevalence and tendency of malignancy. This study aimed to analyze the factors influencing the prevalence and malignancy of TNs in the adult population.MethodsA multi-stage stratified cluster random sampling was used to conduct a cross-sectional survey of the population in different iodine uptake areas in Anhui Province. The areas with deficient, adequate, and excess iodine intake were grouped according to population's urine iodine. A questionnaire, laboratory examination and ultrasound diagnosis were conducted on the participants. Nodules were diagnosed and distinguished using ultrasonography. Spearman rank correlation, random forest importance ranking, ROC curve, and unconditional binary logistic regression analyses were used to screen for risk factors.ResultsA total of 1,697 participants (539 males and 1,158 females) aged 18-60 years were included, 355 of whom were diagnosed with TN. The prevalence of TNs was 20.9% and varied in different areas, with 21.9%, 25.8%, and 18.0% in the iodine deficient, adequate, and iodine excess areas, respectively. The prevalence of TNs in females was significantly higher than that in males (24.5% vs. 13.2%) and it increased with age. Female sex (OR, 1.67 [1.21-2.30]), old age (>41 years, OR, 2.00 [1.14, 3.50]) and smoking were risk factors for the development and deterioration of TNs.ConclusionsPatients with TNs should exercise caution when consuming goitrogens and adhere to a scientifically balanced diet. Given the high incidence of TNs in field setting, it is necessary to raise public health awareness among residents and perform regular thyroid ultrasound screening to facilitate early detection and treatment.
| S-EPMC11578705 | biostudies-literature
Project description:BackgroundFine-needle aspiration (FNA) is the most dependable tool to triage thyroid nodules for medical or surgical management. However, Bethesda class III cytology, namely "follicular lesion of undetermined significance" (FLUS) or "atypia of undetermined significance" (AUS), is a major limitation of the US-FNA in assessing thyroid nodules. As the most important imaging method, ultrasound (US) has a high efficacy in diagnosing thyroid nodules. This meta-analysis aimed to assess the role of US in evaluating Bethesda class III thyroid nodules.MethodsWith keywords "Undetermined Significance," "Bethesda Category III," "Bethesda system," "Cytological Subcategory," "AUS/FLUS," "Atypia of Undetermined Significance," and "Ultrasound/US," papers in PubMed, Cochrane Library, Medline, Web of Science, Embase, and Google Scholar from inception to December 2016 were searched. A meta-analysis of these trials was then performed for evaluating the diagnostic value of thyroid ultrasound in Bethesda Category III thyroid nodules.ResultsFourteen studies including 2405 nodules were analyzed. According to the criteria for US diagnosis of thyroid nodules in each article, with any one of suspicious features as indictors of malignancy, US had a pooled sensitivity of 0.75 (95% CI 0.72-0.78) and a pooled specificity of 0.48 (95% CI 0.45-0.50) in evaluating Bethesda Class III Nodules. The pooled diagnostic odds ratio was 10.92 (95% CI 6.04-19.74). The overall area under the curve was 0.84 and the Q* index was 0.77. With any 2 or 3 of US suspicious features as indictors of malignancy, the sensitivity and specificity were 0.77 (95% CI 0.71-0.83) and 0.54 (95% CI 0.51-0.58), 0.66 (95% CI 0.59-0.73) and 0.71 (95% CI 0.68-0.74), respectively.ConclusionsUS was helpful for differentiating benign and malignant Bethesda class III thyroid nodules, with the more suspicious features, the more likely to be malignant.
| S-EPMC5406060 | biostudies-literature
Project description:ObjectiveThis study aimed to evaluate the performance of an integrated risk stratification system (RSS) based on ultrasound (US) RSSs, nodule size, and cytology subcategory for diagnosing malignancy in thyroid nodules initially identified as Bethesda category III on fine-needle aspiration.Materials and methodsThis retrospective study was conducted at two institutions and included consecutive patients with Bethesda category III nodules, and final diagnoses confirmed by repeat biopsy or surgery. A total of 320 Bethesda category III nodules (≥1 cm) from 309 patients (223 female and 86 male; mean age, 50.9 ± 12.0 years) were included. The malignancy risk of Bethesda category III nodules and predictors of malignancy were assessed according to US RSSs, nodule size, and cytology subcategory. The diagnostic performances of US-size cytology (USC) RSS and US RSS alone for malignancy were compared.ResultsThe intermediate or high suspicion US category independently increased the malignancy risk in all US RSSs (P ≤ 0.001). Large nodule size (≥3 cm) independently increased the malignancy risk of low- or intermediate suspicion US category nodules. Additionally, the atypia of undetermined significance cytology subcategory independently increased the malignancy risk of low suspicion US category nodules in most US RSSs. The area under the receiver operating characteristic curve of the USC RSSs was greater than that of the US RSSs alone (P < 0.048). Malignancy was not found in the very low risk category of USC RSS.ConclusionThe diagnostic performance of USC RSS for malignancy was superior to that of US RSS alone in Bethesda category III nodules. Malignancy can be ruled out in the very low-risk category of USC RSS.
| S-EPMC11444854 | biostudies-literature