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Background Purpose Methods Results Conclusions Many thyroid nodules are detected incidentally with the widespread use of sensitive imaging techniques; however, only a fraction of these nodules are malignant, resulting in unnecessary medical expenditures and anxiety. The major challenge is to differentiate benign thyroid nodules from malignant ones. The application of dual‐energy computed tomography (DECT) and radiomics provides a new diagnostic approach. Studies applying radiomics from primary tumours on iodine maps to differentiate malignant from benign thyroid nodules are still lacking.To determine the ability of an iodine map‐based radiomic nomogram in the venous phase for differentiating malignant thyroid nodules from benign nodules.A total of 141 patients with thyroid nodules who underwent DECT were enrolled and randomly assigned to the training and test cohorts between January 2018 and January 2019. The radiomic score (Rad‐score) was derived from nine quantitative features of the iodine maps. Stepwise logistic regression analysis was used to develop radiomic, clinical and combined models. Age, normalized iodine concentration (NIC), and cyst changes were used to construct the clinical model. Receiver operating characteristic (ROC) curve analysis, sensitivity and specificity were performed to analyse the ability of the models to predict malignant thyroid nodules. Calibration analysis was used to test the fitness of the models. Decision curve analysis (DCA) and nomogram construction were also performed.According to the clinical model, age (0.989 [0.984, 0.995]; p < 0.001), NIC (0.778 [0.640, 0.995]; p = 0.01), and cyst changes (0.617 [0.507, 0.751]; p < 0.001) were independently associated with malignant thyroid nodules. According to the combined model, age (0.994 [0.989, 0.999]; p = 0.01), NIC (0.797 [0.674, 0.941]; p = 0.008), cyst changes (0.786 [0.653, 0.947]; p = 0.01), and the rad‐score (1.106 [1.070, 1.143]; p < 0.001) were independently associated with malignant thyroid nodules. The combined model achieved satisfactory discrimination in predicting malignant thyroid nodules and had greater predictive value in the training (AUC [areas under the curve], 0.96 vs. 0.87; p = 0.01) and test (AUC, 0.90 vs. 0.79; p = 0.04) cohorts than did the clinical model.The radiomics nomogram based on iodine maps is useful to distinguish malignant thyroid nodules from benign thyroid nodules. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusions A small number of thyroid nodules cannot be clearly diagnosed using ultrasound‐guided fine needle aspiration biopsy. Contrast‐enhanced ultrasound (CEUS) has high diagnostic performance for thyroid nodules. We explored the value of CEUS for diagnosing thyroid nodules with indeterminate cytology.Between September 2019 and July 2022, 27,646 patients with thyroid nodule(s) underwent conventional ultrasound (CUS) in our hospital. From these patients, 597 nodules were subjected to CEUS and ultrasound‐guided fine needle aspiration biopsy and 116 thyroid nodules with indeterminate cytology diagnose were enrolled in this study. The independent risk factors for predicting malignancy were determined using univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curves were drawn for CUS, CEUS, and CEUS combined with CUS. The area under the curve (AUC) was calculated and compared.Of the 116 thyroid nodules, 40 (34.5%) were benign and 76 (65.5%) were malignant. Univariate analysis showed that the shape, echogenicity, margin, microcalcification, enhancement intensity, enhancement homogeneity, wash in, and wash out were significantly different between benign and malignant thyroid nodules (all p < 0.05). Multivariate logistic regression analysis showed that taller‐than‐wide, irregular margin, microcalcification, hypo‐enhancement, heterogeneity enhancement, synchronous/slower wash in, and synchronous/slower wash out were independent risk factors for malignancy (all p < 0.05). ROC curve analysis showed that the AUC of CUS and CEUS were 0.769 and 0.848, respectively. No significant difference was observed in the AUC between the two modalities (p > 0.05). However, the AUC (0.934) of the CUS combined with CEUS was significantly higher than that of CEUS or CUS alone (both p < 0.05).CEUS is helpful in diagnosing thyroid nodules with indeterminate cytology. CUS combined with CEUS is highly valuable for predicting malignancy. [ABSTRACT FROM AUTHOR]

With the widespread use of 18F‐fluorodeoxyglucose positron emission tomography (FDG PET/CT) in the investigation and staging of cancers, incidental discovery of FDG‐avid thyroid nodules is becoming increasingly common, with a reported incidence in the range 1%–4% of FDG PET/CT scans. The risk of malignancy in an incidentally discovered FDG avid thyroid nodule is not clear due to selection bias in reported retrospective series but is likely to be less than 15%. Even in cases where the nodule is found to be malignant, the majority will be differentiated thyroid cancers with an excellent prognosis even without treatment. If, due to index cancer diagnosis, age and co‐morbidities, it is unlikely that the patient will survive 5 years, further investigation of an incidental FDG avid thyroid nodule is unlikely to be warranted. We provide a consensus statement on the circumstances in which further investigation of FDG avid thyroid nodules with ultrasound and fine needle aspiration might be appropriate. [ABSTRACT FROM AUTHOR]

Background: The reported risk of malignancies (ROM) remains controversial for fine needle aspiration (FNA) of thyroid nodules in the African American (AA) population. Herein, the ROM along with frequency was assessed for each of the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) diagnostic categories. Materials and Methods: The electronic pathology archive of a large academic hospital was retrospectively searched for cytopathology reports of thyroid nodules in AA patients (2010–2019) and Non‐African American (NAA) control cases. The patients' demographic, thyroid nodule characteristics, FNA results using TBSRTC and surgical diagnoses were recorded, whenever available. Results: Three hundred ninety‐one cases were identified, 317 females (81.1%) and 74 males (18.9%) with median age 50.0 (SD = 14.4). The mean size of the nodules was 2.1 cm (SD = 1.4). The Bethesda categories were: 5.4% (I), 35.0% (II), 35.3% (III), 7.7% (IV), 3.3% (V) and 13.3% (VI). The overall ROM of thyroid nodules was 43.8% (89/203) on surgical follow‐up (203/391). The ROM in each Bethesda categories were: 33.3% (I), 11.6% (II), 35.2% (III), 15.8% (IV), 83.3% (V) and 100% (VI) on surgical follow‐up. The frequency of thyroid nodules was higher in AA females; however, the ROM was higher in AA males (48.3%) compared with AA females (41.2%). Conclusion: The ROM in Categories I, II and III was higher than those reported in the TBSRTC while being similar in Categories IV, V and VI. The overall risk of thyroid malignancy in our AA patient population was higher than those in the literature. The overall ROM of thyroid nodules in AA males was higher than of AA females. [ABSTRACT FROM AUTHOR]

Background: Fine‐needle aspiration cytology (FNAC) is a reliable method for preoperative evaluation of thyroid nodules particularly if ultrasound‐guided (USG‐FNAC). The main purpose of this study is to evaluate the efficacy of USG‐FNAC and its accuracy. Methods: We retrospectively studied 212 thyroidectomy cases with preoperative ultrasonography and FNAC data during the period 2015–2022 using TI‐RADS for final ultrasound diagnosis and Bethesda system for cytological diagnosis. Results: The studied cases were 200 females and 12 males. Thyroid cancer was more prevalent under 20 years old (78.5%). Papillary thyroid carcinoma comprises 84% of all cancer cases. Significant ultrasound features (p‐value <0.05) favour malignancy were hypoechogenicity (66%), mixed echogenicity (84%), irregular border (61%), microcalcification (68%) and rim halo (63.6%). Malignancy was found in 21% of TI‐RADS‐2, 65% of TI‐RADS‐4 and 100% of TI‐RADS‐5. There is a significant difference between different categories of Bethesda system. All cases in Cat‐VI were malignant (100%). Malignancy was also found in 81% of Cat‐V, 20% of Cat‐IV, 33% of Cat‐III, 16% of Cat‐II and 43% of Cat‐I. Cytological features consistent with malignancy were as follows: grooving (94%), nuclear irregularities (89%), nuclear pseudoinclusion (89%) and little colloid (82%). In our study, USG‐FNAC sensitivity was 83%, specificity 85%, PPV 85%, NPV 83% and accuracy 84%. Conclusion: Ultrasound features in favour of malignancy in thyroid nodules are hypoechoic or complex echogenicity, irregular border, punctuate calcification and presence of rim halo. Cytological features in favour of malignancy are grooving, nuclear irregularities, nuclear pseudoinclusion and little or absent colloid. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The evaluation of thyroid lesions is common in the daily practice of cytology. While the majority of thyroid nodules are benign, in recent decades, there has been increased detection of small and well‐differentiated thyroid cancers. Combining ultrasound evaluation with fine‐needle aspiration cytology (FNAC) is extremely useful in the management of thyroid nodules. Furthermore, the adoption of specific terminology, introduced by different thyroid reporting systems, has helped effectively communicate thyroid FNAC diagnoses in a clear and understandable way. In 1996, the Papanicolaou Society thyroid cytological classification was introduced. This was followed in 2005 by the first Japanese and then in 2007 by the Bethesda System for Reporting Thyroid Cytopathology, which subsequently underwent two revisions. Other international thyroid terminology classifications include the British, Italian, Australasian and other Japanese cytology systems. This review covers similarities and differences among these cytology classification systems and highlights key points that unify these varied approaches to reporting thyroid FNAC diagnoses. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to assess the diagnostic efficacy of Korean Thyroid imaging reporting and data system (K‐TIRADS), S‐Detect software and contrast‐enhanced ultrasound (CEUS) when employed individually, as well as their combined application, for the evaluation of thyroid nodules, with the objective of identifying the optimal method for diagnosing thyroid nodules. Methods: Two hundred and sixty eight cases pathologically proven of thyroid nodules were retrospectively enrolled. Each nodule was classified according to K‐TIRADS. S‐Detect software was utilized for intelligent analysis. CEUS was employed to acquire contrast‐enhanced features. Results: The area under curve (AUC) values for diagnosing benign and malignant thyroid nodules using K‐TIRADS alone, S‐Detect software alone, CEUS alone, the combined application of K‐TIRADS and CEUS, the combined application of S‐Detect software and CEUS were 0.668, 0.668, 0.719, 0.741, and 0.759, respectively (p < 0.001). The sensitivity rate of S‐Detect software was 89.9% (p < 0.001). It was the highest of the five diagnostic methods above. Conclusion: The utilization of S‐Detect software can be served as a powerful tool for early screening. Notably, the combined utilization of S‐Detect software with CEUS demonstrates superior diagnostic performance compared to employing K‐TIRADS, S‐Detect software, CEUS used individually, as well as the combined application of K‐TIRADS with CEUS. [ABSTRACT FROM AUTHOR]

Introduction Materials and Methods Results Discussion Conclusion Thyroid cancer is more commonly diagnosed in females, however recent research has challenged whether this finding is due to a true difference in biology or rates of diagnosis, with concerns that over‐diagnosis may be a factor in differences. The rates of symptomatic versus incidental diagnosis by males and females is not well known. This study used the Australian and New Zealand Thyroid Cancer Registry (ANZTCR) to explore whether symptomatic presentation varies between sexes.Retrospective analysis on ANZTCR data between 2017 and 2022 was performed. Symptomatic cases were those with thyroid compressing symptoms, toxic goiter, Graves' disease, or abnormal laryngoscopy. Cases with asymptomatic goiter or surgeries for a thyroid nodule were classified as incidental.Among 1082 patients with differentiated thyroid cancer, 32% of males and 38% of females presented with symptomatic thyroid disease (p = 0.06). A similar rate of presentation of advanced thyroid cancer (T3/4) was seen with male and female patients (n = 70, 47% vs. n = 79, 53%). Females exhibited a higher prevalence of low‐risk relapse cancers according to American Thyroid Association stratification (66.3% vs. 50.4%), whereas males exhibited a higher prevalence of high‐risk relapse cancers compared to females (27.3% vs. 15.3%, p < 0.001). Regression showed symptoms were associated with more advanced T stage (OR = 1.62, p = 0.02).Symptomatic presentation was similar between males and females, but symptomatic presentation was associated with larger cancers.This study highlights comparable rates of symptomatic detection between males and females with DTCs and symptomatic presentations were responsible for less than 40% of presentations. [ABSTRACT FROM AUTHOR]

Objective: Some correlations between thyroid disorders and insomnia have been found in previous studies; however, the causal relationship between them is unclear. The aim of this study was to investigate the causal relationship between insomnia and five thyroid disorders (hyperthyroidism, hypothyroidism, thyroiditis, thyroid nodules, and thyroid cancer). Methods: We assessed the causal relationship between insomnia and thyroid disorders using inverse variance weighted, weighted median, and Mendelian randomization (MR)‐Egger analyses in MR analyses and then used inverse MR analyses to assess the causal relationship between thyroid disorders and insomnia. Results: MR analysis showed that insomnia did not increase the risk of hyperthyroidism, hypothyroidism, thyroiditis, thyroid nodules, and thyroid cancer. However, reverse MR analysis showed that thyroid cancer increased the risk of insomnia (OR = 1.01, 95%CI: 1.00–1.02, p =.01), and the other four thyroid disorders had no direct causal relationship with insomnia. Sensitivity analyses indicated that the results were robust and no pleiotropy or heterogeneity was detected. Conclusion: This study did not find evidence of a bidirectional causal relationship between genetically predicted insomnia and hyperthyroidism, hypothyroidism, thyroiditis, and thyroid nodules. However, we found that although insomnia does not increase the risk of thyroid cancer, thyroid cancer does increase the risk of insomnia. [ABSTRACT FROM AUTHOR]

Thyroid nodules are a common endocrine system disorder for which accurate ultrasound image segmentation is important for evaluation and diagnosis, as well as a critical step in computer‐aided diagnostic systems. However, the accuracy and consistency of segmentation remains a challenging task due to the presence of scattering noise, low contrast and resolution in ultrasound images. Therefore, we propose a deep learning‐based CAD (computer‐aided diagnosis) method, STU3Net in this paper, aiming at automatic segmentation of thyroid nodules. The method employs a modified Swin Transformer combined with a CNN encoder, which is capable of extracting morphological features and edge details of thyroid nodules in ultrasound images. In decoding through the features for image reconstruction, we introduce a modified three‐layer U‐Net network with cross‐layer connectivity to further enhance image reduction. This cross‐layer connectivity enhances the network's capture and representation of the contained image feature information by creating skip connections between different layers and merging the detailed information of the shallow network with the abstract information of the deeper network. Through comparison experiments with current mainstream deep learning methods on the TN3K and BUSI datasets, we validate the superiority of the STU3Net method in thyroid nodule segmentation performance. The experimental results show that STU3Net outperforms most of the mainstream models on the TN3K dataset, with Dice and IoU reaching 0.8368 and 0.7416, respectively, which are significantly better than other methods. The method demonstrates excellent performance on these datasets and provides radiologists with an effective auxiliary tool to accurately detect thyroid nodules in ultrasound images. [ABSTRACT FROM AUTHOR]

Background: Radiofrequency ablation (RFA) for thyroid nodules has recently been introduced into the United States healthcare system landscape. Little is known about the process of incorporating this procedure into existing clinical practice. Methods: A retrospective chart review of a single institution was conducted to examine referral patterns and decision‐making after the introduction of RFA into an endocrine surgery‐focused practice. Patient demographics and thyroid‐specific data were recorded. Two reviewers abstracted and coded reasons for the noncompletion of RFA. Two‐sample t tests were used to compare groups; linear regression was used to assess trends and practice patterns. Results: Chart review identified 451 patients referred for consideration of RFA from January 2020 to December 2022. Only 255 (56.5%) went on to receive the treatment. There was no significant difference in nodule volume between treated and nontreated groups (18.5 vs. 14.9 cm3, p = 0.07). Concern for malignancy on genetic testing, size (too large/too small), recommendation for Ethanol ablation, and multinodular disease without target nodules were the most common reasons for physician deferral. Of patients who declined to proceed, 46% opted to undergo surgical excision. Linear regression showed that referral numbers significantly increased with time; however, the proportion of patients receiving treatment decreased yearly, primarily because of higher rates of physician deferral. Conclusions: This study reflects the complex decision‐making in offering minimally invasive thyroid nodule ablation. Despite a greater number of referrals over time, physician criteria became increasingly selective. Optimal candidacy in RFA is an evolving determination requiring patient and physician input to guide ideal practice patterns. [ABSTRACT FROM AUTHOR]

Objective: Patient preferences regarding thyroid nodules are poorly understood. Our objective is to (1) employ a discrete choice experiment (DCE) to explore risk tradeoffs in thyroid nodule management, and (2) segment respondents into preference phenotypes. Study Design: DCE. Setting: Thyroid surgery clinic, online survey. Methods: A DCE including 5 attributes (cancer risk, voice concerns, incision/scar, medication requirement, follow‐up frequency) was refined with qualitative patient and physician input. A final DCE including 8 choice tasks, demographics, history, and risk tolerance was administered to participants with and without thyroid disease. Analysis was performed with multinomial logit modeling and latent class analysis (LCA) for preference phenotyping. Results: A total of 1026 respondents were included; 480 had thyroid disease. Risk aversion was associated with increasing age (P <.001), female gender (P <.001), and limited education (P =.038), but not previous thyroid disease. Cancer risk most significantly impacted decision‐making. Of the total possible utility change from thyroid nodule decision‐making, 47.8% was attributable to variations in cancer risk; 20.0% from medication management; 14.9% from voice changes; 12.7% from incision/scar; and 4.6% from follow‐up concerns. LCA demonstrated 3 classes with distinct preference phenotypes: the largest group (64.2%) made decisions primarily based on cancer risk; another group (18.2%) chose based on aversion to medication; the smallest group (17.7%) factored in medication and cancer risk evenly. Conclusion: Cancer risk and the need to take medication after thyroid surgery factor into patient decision‐making most heavily when treating thyroid nodules. Distinct preference phenotypes were demonstrated, reinforcing the need for individual preference assessment before the treatment of thyroid disorders. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion 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.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.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.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. [ABSTRACT FROM AUTHOR]

Fine‐needle aspiration (FNA) guided by ultrasound (US) has emerged as a highly precise diagnostic method for managing thyroid nodules, significantly diminishing unnecessary surgeries. The effectiveness of US‐guided FNA is high when a single specialist performs the FNA procedure and the microscopy. This paradigm has paved the way for the evolution of interventional cytopathology, a specialist with a pivotal role in the preoperative diagnostic process, encompassing patient history review, clinical examination, FNA execution under US guidance, preparation, and microscopic interpretation of cytological samples. As the landscape of precision medicine unfolds, molecular testing assumes greater importance in thyroid cytopathology, particularly in refining the risk of malignancy for indeterminate nodules. The updated Bethesda classification system underscores the clinical significance of molecular tests, emphasizing their role in refining diagnostic accuracy. With this evolving landscape, interventional cytopathologists must adapt by acquiring expertise in molecular technologies and addressing ongoing challenges in workflow harmonization and optimization. This paper delves into our decade‐long experience as interventional cytopathologists, focusing on recent endeavours to ensure adequate samples not only for microscopic diagnosis but also for molecular testing. Additionally, here we review the challenges of integrating next‐generation sequencing (NGS) technology into clinical practice, highlighting the importance of integrating clinically meaningful molecular data into comprehensive molecular cytology reports. [ABSTRACT FROM AUTHOR]

The incidence of thyroid tumors has been increasing yearly over the past decade, making it the fourth highest tumor in women. This places various biological burdens on those affected. Currently, thyroid tumors are primarily diagnosed using percutaneous fine needle aspiration and ultrasound. However, these methods are complex, expensive, and less accurate, and they may fail to detect some thyroid nodules. As an alternative, researchers are focusing on blood‐based biomarkers in addition to the traditional diagnostic methods, assisted predominantly by nanomaterials. Early identification of thyroid cancer is crucial as it is highly treatable. Various sensing systems have been developed using nanomaterial‐mediated approaches to enhance the detection system. Nanomaterials are effectively applied in biosensors for surface functionalization and are conjugated with biomolecules to improve the interaction with the target analyte. This review discusses nanomaterial‐assisted thyroid tumor detection, with a special focus on nanomaterial‐based biosensors. [ABSTRACT FROM AUTHOR]

Thyroid nodules are commonly diagnosed with ultrasonography, which includes internal characteristics, varying looks, and hazy boundaries, making it challenging for a clinician to differentiate between malignant and benign forms based only on visual identification. The advancement of AI, particularly DL, provides significant breakthroughs in the domain of medical image identification. Yet, there are certain obstacles to achieving accuracy as well as efficacy in thyroid nodule detection. The thyroid nodules in this study are detected and classified using an inventive hybrid deep learning‐assisted multi‐classification method. The median blur method is applied in this work to eliminate the salt and pepper noise from the image. Then MPIU‐Net‐based segmentation is utilized to segment the image. The LGBPNP‐based features are retrieved from the segmented image to obtain a single histogram sequence of the LGBP pattern in addition to other features like extraction of multi‐texton and LTP‐based features. After the feature extraction, the data augmentation process is applied and then the features are fed to the hybrid classification‐based nodule classification model that comprises Deep Maxout and CNN, this hybrid classification trains the features and predicts the thyroid nodule. Additionally, the TIRADS score classification is used for the projected malignant thyroid nodule coupled with statistical features collected from the segmented. The DBNAAF with transfer learning model is employed to classify the grading of malignant thyroid nodules, where the weights of the model are learned with transfer learning. The MCC of the Hybrid Model is 0.9445, whereas the DCNN is 0.6858, YOLOV3‐DMRF is 0.7229, CNN is 0.7780, DBN is 0.7601, Bi‐GRU is 0.7038, Deep Maxout is 0.7528, and RNN is 0.8522, respectively. [ABSTRACT FROM AUTHOR]

Objective: We aim to evaluate the safety and effectiveness of radiofrequency ablation (RFA) for benign thyroid nodules by ENT surgeons and to compare it to conventional hemithyroidectomy in the public healthcare, operating theater contained setting. Methods: 50 patients who underwent a single session of RFA for symptomatic benign thyroid nodules in Prince of Wales Hospital and Tseung Kwan O Hospital in Hong Kong from 2020 to 2022 were evaluated. Objective outcomes including nodule volume, volume reduction rate (VRR) and complications were recorded. Subjective response in the form of a 0–10 point scale for patient symptoms including obstructive, cosmetic, pain and satisfaction scores were collected. Results: Significant reduction in mean VRR was found at 3, 6 and 12 months post treatment, accompanied by a significant reduction in the mean obstructive and cosmetic symptom scores. Comparing with conventional hemithyroidectomy, the RFA group had a significantly shorter mean procedure time and lower rate of complications. Estimated cost to patient for RFA was found to be less than half of that of hemithyroidectomy. Conclusion: RFA is a safe and effective treatment modality for benign thyroid nodules by ENT surgeons with advantages of being a scarless local anesthetic procedure with shorter procedure time, lower complication rate and lower cost to patient compared to hemithyroidectomy. In Hong Kong, where most of the population is treated in the public sector, there are limited resources, often with high caseload burden and long operation waiting times. Therefore, RFA is an office‐based treatment that serves as a valuable alternative to hemithyroidectomy for benign nodules, especially in lower resource settings. Level of evidence: 3. [ABSTRACT FROM AUTHOR]

Objectives: To complete the task of automatic recognition and classification of thyroid nodules and solve the problem of high classification error rates when the samples are imbalanced. Methods: An improved k‐nearest neighbor (KNN) algorithm is proposed and a method for automatic thyroid nodule classification based on the improved KNN algorithm is established. In the improved KNN algorithm, we consider not only the number of class labels for various classes of data in KNNs, but also the corresponding weights. And we use the Minkowski distance measure instead of the Euclidean distance measure. Results: A total of 508 ultrasound images of thyroid nodules, including 415 benign nodules and 93 malignant nodules, were used in the paper. Experimental results show the improved KNN has 0.872549 accuracy, 0.867347 precision, 1 recall, and 0.928962 F1‐score. At the same time, we also considered the influence of different distance weights, the value of k, different distance measures on the classification results. Conclusions: A comparison result shows that our method has a better performance than the traditional KNN and other classical machine learning methods. [ABSTRACT FROM AUTHOR]

Purpose: To explore the diagnostic value of intralesional and perilesional radiomics based on multimodal ultrasound (US) images in predicting the malignant ACR TIRADS 4 thyroid nodules (TNs). Methods: A total of 297 cases of TNs in patients who underwent preoperative thyroid grayscale US and shear wave elastography (STE) were enrolled (training cohort: n = 150, internal validation cohort: n = 77, external validation cohort: n = 70). Regions of interests (ROIs) were delineated on grayscale US images and STE images, and then an isotropic expansion of 1.0, 1.5, 2.0, 2.5, and 3.0 mm was applied. Predictive models were established using recursive feature elimination‐support vector machines (RFE‐SVM) based on radiomics features calculated by random forest. Results: The perilesional ROI1.5mm expansion achieved the highest area under curve (AUC) (AUC: 0.753 for grayscale US, 0.728 for STE; 95% confidence interval (CI): 0.664–0.743, 0.684–0.739, respectively). The joint model had the highest AUC values of 0.936 in the training dataset, 0.926 in internal dataset, and 0.893 in external dataset. The calibration curve showed good consistency and the decision curve indicated a greater clinical net benefit of the joint model. Conclusion: Joint model containing perilesional radiomics (1.5 mm) had significant value in predicting the malignant ACR TIRADS 4 TNs. [ABSTRACT FROM AUTHOR]

Purpose: A well display of the spatial location of thyroid nodules in the thyroid is important for surgical path planning and surgeon‐patient communication. The aim of this study was to establish a three‐dimensional (3D) reconstruction method of the thyroid gland, thyroid nodule, and carotid artery with automatic detection based on two‐dimensional (2D) ultrasound videos, and to evaluate its clinical value. Methods: Ultrasound videos, including the thyroid gland with nodule, isthmus of thyroid gland, and ipsilateral carotid artery, were recorded. BC‐UNet, MTN‐Net, and RDPA‐U‐Net network models were innovatively employed for segmentation of the thyroid glands, the thyroid nodules, and the carotid artery respectively. Marching Cubes algorithm was used for reconstruction, while Laplacian smoothing algorithm was employed to smooth the 3D model surface. Using this model, 20 patients and 15 surgeons completed surveys on the effectiveness of this model for the pre‐surgery demonstration of nodule location as well as surgeon‐patient communication. Results: The thyroid gland with nodule, isthmus of gland, and carotid artery were reconstructed and displayed. With the 3D model, the understanding of the spatial location of thyroid nodules improved in all three surgeon groups, eliminating the influence of professional levels. In the patient survey, the patients' understanding of the thyroid nodule location and procedure for surgery were significantly improved. In addition, with the 3D model, the time for doctors to explain to patients was significantly reduced (16.75 vs. 8.85 min, p = 0.001). Conclusion: To our knowledge, this is the first report of constructing a 3D thyroid model using a deep learning technique for personalized thyroid segmentation based on 2D ultrasound videos. The preliminary clinical application showed that it was conducive to the comprehension of the location of thyroid nodules for surgeons and patients, with significant improvement on the efficiency of surgeon‐patient communication. [ABSTRACT FROM AUTHOR]

Whereas multifocality typically concerns papillary thyroid carcinoma (PTC) without specification of intrathyroidal metastatic or independent nature of tumor foci, the designation of the latter as Multi‐UniFocal (MUF) may be relevant for select cases. A case series involving multifocal thyroid lesions with divergent histopathological morphology and/or molecular profile, with molecular evaluation of multiple individual tumor foci per patient based on a next‐generation sequencing approach, was retrospectively reviewed. Twenty‐five patient cases with multifocal thyroid lesions suggestive of MUF, with 2–6 (median 3) tumor foci per patient, were described. Tumor lesions comprised diverse histopathology, including PTC, (E)FVPTC, NIFTP, FA, FTC, and oncocytic. Morphologically similar and/or diverse tumor foci harbored different molecular alterations (suggestive of non‐shared clonality); with(out) coexistent similar foci harboring identical molecular alterations; or (partly) shared molecular alterations. MUF was associated with chronic lymphocytic thyroiditis in almost half of the cases. The recognition of MUF may justify the independent clinical consideration per individual tumor focus; as separate lesions albeit within a multifocal context. The potential clinical relevance and prognostic value of MUF remain to be further established. [ABSTRACT FROM AUTHOR]

Objective: Thyroid fine‐needle aspiration (FNA) is a principal diagnostic procedure for thyroid nodules. A specific cytomorphological structure, known as the thyroid spherule, is often seen in FNA specimens. The clinical significance of these spherules in terms of diagnosis and prevalence remains largely unexplored. Methods: We performed a retrospective study on 310 thyroid FNA specimens and categorized them according to the Bethesda System for Reporting Thyroid Cytopathology. The presence, size and number of thyroid spherules in each specimen were examined and these data were subsequently correlated with the clinicopathological features. Results: Thyroid spherules were almost exclusively detected in benign cases, comprising 7.6% of all benign diagnoses. The average diameter of spherules in benign cases was 84.9 μm. Benign cases and cases with atypia of undetermined significance cases primarily exhibited low cellularity, while follicular neoplasms and malignant cases typically showed moderate to high cellularity. In the subgroup of FNA cases with moderate to high cellularity, spherules were identified in 12 (20%) of 59 benign FNA cases. Within this group, the sensitivity and specificity of thyroid spherules for detecting benign FNA cases were 20% and 100%, respectively. Conclusions: Our results suggest that the presence of thyroid spherules in FNA specimens can serve as a highly specific marker for benign thyroid conditions. The prevalence of spherule detection is strongly influenced by the cellularity. In cases with moderate to high cellularity, the identification of spherules can assist the cytopathologists in diagnosing thyroid FNA cases as benign. [ABSTRACT FROM AUTHOR]

Background: With innovative treatment options such as radiofrequency ablation (RFA) for thyroid nodules, new complications are being identified. It is important to define and delineate complications in order to counsel patients appropriately about treatment options and their associated risks and benefits. Methods: A 46‐year‐old male presented with a left thyroid nodule (6.5 cm). Fine needle aspiration results were benign. He started to develop intermittent dyspnea and underwent one RFA procedure. Approximately 6 days post‐RFA, the neck area was raised and red with blister. The skin overlying the blister underwent eventual dehiscence with fluid spillage. Several months later, MRI imaging showed substernal extension with tracheal deviation. Results: A left thyroid lobectomy was performed with cutaneous excision and successful closure of a fistula. Conclusions: This is the first reported case of a thyroid nodule rupture following RFA which manifested into a thyro‐cutaneous fistula and required surgical intervention. [ABSTRACT FROM AUTHOR]

Introduction: The aim of our study is to determine the value of Thyroid Imaging Reporting and Data Systems (TIRADS) scoring in predicting malignancy in thyroid nodules by examining its relationship with fine needle aspiration biopsy and postoperative histopathological results. Materials and Methods: In this study, patients who underwent surgery after ultrasonographic examination and fine needle aspiration biopsy for thyroid nodules at the General Surgery Clinic of Çukurova University Faculty of Medicine between January 2014 and November 2021 were retrospectively analyzed. The thyroid ultrasonography and fine needle aspiration biopsy of the included patients were performed by a clinician with 15 years of experience. The ultrasonographic features of the nodules were re‐evaluated by the same clinician, and the American College of Radiology (ACR) TIRADS score was determined. Fine needle aspiration biopsy results were grouped according to Bethesda criteria. Postoperative histopathological examination results were divided into two groups: benign and malignant. The ACR TIRADS score was compared with fine needle aspiration biopsy and histopathological results. The performance of the ACR TIRADS score in predicting malignancy was determined. Results: 79.8% of the 397 patients were female, and the mean age was 50.9 ± 12.8 years. The mean diameter of the nodules was 27.4 ± 15.8 mm. There was a significant, positive, but weak correlation between ACR TIRADS and Bethesda (p < 0.001) (r = 0.33). When the ACR TIRADS score was compared with histopathological results, it was found that the rate of malignancy increased as the TIRADS score increased (p < 0.001). The rates of malignancy diagnosis were 0% for TR1, 13.2% for TR2, 21.7% for TR3, 50.3% for TR4, and 72.4% for TR5. The area under the receiver operating characteristic curve for TIRADS in predicting malignancy was 0.747 (95% CI: 0.699–0.796, p < 0.001). TIRADS can distinguish malignancy with 75% accuracy. The optimal cutoff point was determined as TR4 with 80.3% sensitivity and 60.8% specificity. Conclusion: The ACR TIRADS scoring system is an effective risk classification system for thyroid nodules, providing 75% accuracy in predicting malignancy, with 80.3% sensitivity and 60.8% specificity values. [ABSTRACT FROM AUTHOR]

Background: The quality of segmentation of thyroid nodules in ultrasound images is a crucial factor in preventing the cancerization of thyroid nodules. However, the existing standards for the ultrasound imaging of cancerous nodules have limitations, and changes of the echo pattern of thyroid nodules pose challenges in accurately segmenting nodules, which can affect the diagnostic results of medical professionals. Purpose: The aim of this study is to address the challenges related to segmentation accuracy due to noise, low contrast, morphological scale variations, and blurred edges of thyroid nodules in ultrasound images and improve the accuracy of ultrasound‐based thyroid nodule segmentation, thereby aiding the clinical diagnosis of thyroid nodules. Method: In this study, the dataset of thyroid ultrasound images was obtained from Hunan Provincial People's Hospital, consisting of a total of 3572 samples used for the training, validation, and testing of this model at a ratio of 8:1:1. A novel SK‐Unet++ network was used to enhance the segmentation accuracy of thyroid nodules. SK‐Unet++ is a novel deep learning architecture that adds the adaptive receptive fields based on the selective kernel (SK) attention mechanisms into the Unet++ network. The convolution blocks of the original UNet++ encoder part were replaced with finer SK convolution blocks in SK‐Unet++. First, multiple skip connections were incorporated so that SK‐Unet++ can make information from previous layers of the neural network to bypass certain layers and directly propagate to subsequent layers. The feature maps of the corresponding locations were fused on the channel, resulting in enhanced segmentation accuracy. Second, we added the adaptive receptive fields. The adaptive receptive fields were used to capture multiscale spatial features better by dynamically adjusting its receptive field. The assessment metrics contained dice similarity coefficient (Dsc), accuracy (Acc), precision (Pre), recall (Re), and Hausdorff distance, and all comparison experiments used the paired t‐tests to assess whether statistically significant performance differences existed (p < 0.05). And to address the multi‐comparison problem, we performed the false discovery rate (FDR) correction after the test. Results: The segmentation model had an Acc of 80.6%, Dsc of 84.7%, Pre of 77.5%, Re of 71.7%, and an average Hausdorff distance of 15.80 mm. Ablation experimental results demonstrated that each module in the network could contribute to the improved performance (p < 0.05) and determined the best combination of parameters. A comparison with other state‐of‐the‐art methods showed that SK‐Unet++ significantly outperformed them in terms of segmentation performance (p < 0.05), with a more accurate segmentation contour. Additionally, the adaptive weight changes of the SK module were monitored during the training process, and the resulting change curves demonstrated their convergence. Conclusion: Our proposed method demonstrates favorable performance in the segmentation of ultrasound images of thyroid nodules. Results confirmed that SK‐Unet++ is a feasible and effective method for the automatic segmentation of thyroid nodules in ultrasound images. The high accuracy achieved by our method can facilitate efficient screening of patients with thyroid nodules, ultimately reducing the workload of clinicians and radiologists. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and safety of radiofrequency ablation (RFA) for benign nonfunctional thyroid nodules or functional lingual thyroid gland in a pediatric population. Methods: Four pediatric patients (four female; mean age 13.50 ± 4.04, range 8–17 years) with either benign thyroid nodules or mildly obstructive lingual thyroid glands were treated with RFA from 2020 to 2021 were evaluated. The inclusion criteria for RFA therapy were (i) age < 18 years; (ii) benign cytopathological results on ultrasound guided fine needle aspiration; (iii) pressure or pain symptoms caused by the thyroid nodules; (iv) dysphagia or obstruction caused by the lingual thyroid tissue; (v) follow up for >6 months with otolaryngology or endocrinology. Results: Two patients had benign non‐functioning thyroid nodules and two had mildly obstructive functioning lingual thyroid glands. Mean follow up was 10.75 ± 4.79 months. Each patient underwent one RFA session with no complications. For the patients with thyroid nodules, there was >74% reduction in nodule size at last follow up with improvement in neck swelling and pain. For the patients with lingual thyroid glands, both did not have any other functional thyroid gland identified. Both had visible decrease in size of the gland as visualized transorally with improvement in dysphagia and obstructive symptoms when lying flat. Conclusion: RFA is a safe and effective option for managing benign thyroid nodules and lingual thyroid glands in a pediatric patient population. Level of evidence: 4. [ABSTRACT FROM AUTHOR]

Background: In China, rapid intraoperative diagnosis of frozen sections of thyroid nodules is used to guide surgery. However, the lack of subspecialty pathologists and delayed diagnoses are challenges in clinical treatment. This study aimed to develop novel diagnostic approaches to increase diagnostic effectiveness. Methods: Artificial intelligence and machine learning techniques were used to automatically diagnose histopathological slides. AI‐based models were trained with annotations and selected as efficientnetV2‐b0 from multi‐set experiments. Results: On 191 test slides, the proposed method predicted benign and malignant categories with a sensitivity of 72.65%, specificity of 100.0%, and AUC of 86.32%. For the subtype diagnosis, the best AUC was 99.46% for medullary thyroid cancer with an average of 237.6 s per slide. Conclusions: Within our testing dataset, the proposed method accurately diagnosed the thyroid nodules during surgery. [ABSTRACT FROM AUTHOR]

This multi‐institutional study investigated non‐invasive follicular thyroid neoplasm with papillary‐like nuclear features (NIFTP) frequency and its diagnostic significance in Japan. We reviewed 4008 thyroid nodules resected in six institutions before NIFTP was proposed. Overall, 26 cases diagnosed as non‐invasive encapsulated follicular variant of papillary thyroid carcinoma (PTC) and 145 cases of follicular thyroid adenoma (FTA) were included. Of these nodules, 80.8% and 31.0%, respectively, were NIFTPs. In five institutions, NIFTPs were more commonly found in FTA than in PTC nodules. When NIFTP was included with PTC, the overall prevalence was 2.3%, with rates in five institutions below 5.0% (0.8%–4.4%). One NIFTP case with nuclear score 3 revealed nodal metastasis 2.5 years post‐resection, and the carcinoma cells were immunohistochemically positive for BRAF. FTAs or NIFTPs with nuclear score 2 did not metastasize. NIFTP was more common among FTA than among PTC nodules, possibly due to underdiagnosis of PTC on nuclear findings. Considering the clinical findings, molecular pathogenesis, and therapeutic strategy in Japan, NIFTP with nuclear score 2 is not different from FTA, and use of this entity terminology is not meaningful. In contrast, NIFTP with nuclear score 3 has potential for metastasis and BRAFV600E mutation. Therefore, in NIFTP cases, nuclear scores 2 and 3 should be separately reported. [ABSTRACT FROM AUTHOR]

The guidelines for the workup of thyroid nodules have been established in adult populations and secondarily applied to paediatric populations. In particular, The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is commonly applied to both adult and paediatric thyroid nodules. However, as paediatric nodules have distinct molecular drivers and behavioural trajectories, there is renewed interest in diagnostic and management strategies that are paediatric specific. Here, we review key differences between paediatric and adult thyroid cancer and recent literature evaluating the use of TBSRTC in paediatric populations. [ABSTRACT FROM AUTHOR]

Objective: To investigate the efficacy of the ultrasonic nodule to muscle gray scale ratio as a predictive tool for distinguishing between benign and malignant thyroid nodules. Methods: A retrospective study was undertaken at the First People's Hospital of Hangzhou, affiliated with the Zhejiang University School of Medicine, analyzing ultrasound and pathological data of patients with thyroid nodules between May 2020 and December 2022. The study extracted ultrasound features of nodules and employed univariate and multivariate logistic regression analyses to identify independent risk factors for malignant tumors in the nodules. Subsequently, a predictive model for distinguishing benign and malignant thyroid nodules was developed. Results: A total of 466 patients were included in this retrospective study, of which 275 cases were malignant tumors. Univariate and multivariate logistic regression analyses showed that the nodular‐muscle gray‐scale ratio, nodule diameter, margin status, aspect ratio, and calcification were closely related to thyroid malignant tumors. The area under the curve (AUC) of training group was 0.832, with a sensitivity, specificity, and accuracy of 85.5%, 67.4%, and 76.6%, respectively. The AUC of the external validation group was 0.819, with a sensitivity, specificity, and accuracy of 76.4%, 74.5%, and 75.7%, respectively. The calibration and decision curves showed that the model had good diagnostic value. Conclusion: The research findings indicate that ratio is significantly associated with the malignant nature of thyroid nodules. The application of a line chart model based on these parameters exhibits a high level of predictive performance. [ABSTRACT FROM AUTHOR]

Background: Ultrasound plays a critical role in the early screening and diagnosis of cancers. Although deep neural networks have been widely investigated in the computer‐aided diagnosis (CAD) of different medical images, diverse ultrasound devices, and image modalities pose challenges for clinical applications, especially in the recognition of thyroid nodules having various shapes and sizes. More generalized and extensible methods need to be developed for the cross‐devices recognition of thyroid nodules. Purpose: In this work, a semi‐supervised graph convolutional deep learning framework is proposed for the domain adaptative recognition of thyroid nodules across several ultrasound devices. A deep classification network, trained on a source domain with a specific device, can be transferred to recognize thyroid nodules on the target domain with other devices, using only few manual annotated ultrasound images. Methods: This study presents a semi‐supervised graph‐convolutional‐network‐based domain adaptation framework, namely Semi‐GCNs‐DA. Based on the ResNet backbone, it is extended in three aspects for domain adaptation, that is, graph convolutional networks (GCNs) for the connection construction between source and target domains, semi‐supervised GCNs for accurate target domain recognition, and pseudo labels for unlabeled target domains. Data were collected from 1498 patients comprising 12 108 images with or without thyroid nodules under three different ultrasound devices. Accuracy, Sensitivity and Specificity were used for the performance evaluation. Results: The proposed method was validated on six groups of data for a single source domain adaptation task, the mean Accuracy was 0.9719 ± 0.0023, 0.9928 ± 0.0022, 0.9353 ± 0.0105, 0.8727 ± 0.0021, 0.7596 ± 0.0045, 0.8482 ± 0.0092, which achieved better performance in comparison with the state‐of‐the‐art. The proposed method was also validated on three groups of multiple source domain adaptation tasks. In particular, when using X60 and HS50 as the source domain data, and H60 as the target domain, it can achieve the Accuracy of 0.8829 ± 0.0079, Sensitivity of 0.9757 ± 0.0001, and Specificity of 0.7894 ± 0.0164. Ablation experiments also demonstrated the effectiveness of the proposed modules. Conclusion: The developed Semi‐GCNs‐DA framework can effectively recognize thyroid nodules on different ultrasound devices. The developed semi‐supervised GCNs can be further extended to the domain adaptation problems for other modalities of medical images. [ABSTRACT FROM AUTHOR]

Introduction: Tumor enlargement is the most common parameter identifying disease progression during active surveillance, but the value and significance of the changes in tumor diameter and volume in the evaluation of tumor growth have not been compared. Methods: This cohort study included 468 patients with high-risk thyroid nodule, in whom nodule size change was monitored using ultrasound, to compare the changes in tumor diameter and volume in assessing tumor growth. Results: A total of 569 high-risk thyroid nodules were found in the 468 patients. A total of 14 nodules (2.5%) showed a diameter increase ≥ 3 mm. The number of nodules with a peak volume change exceeding 50% and 100% was 185 (32.5%) and 86 (15.1%), respectively. Among the 555 stable nodules, the number of nodules with volume fluctuations exceeding 50% and 100% was 171 (30.8%) and 72 (13.0%), respectively. Among 212 stable nodules at the baseline and in the first three follow-up, the percentage of peak volume fluctuations exceeding 50% (48.5% vs. 28.5%, p = 0.004) and 100% (26.5% vs. 8.3%, p < 0.001) in the nodules with the sum of three diameters (SOTDs) ≤ 1 cm was significantly higher than that of nodules with SOTDs > 1 cm. A statistically significant difference was also found in the range distribution of SOTDs ≤ 1 cm and SOTDs > 1 cm (p = 0.007). Conclusions: Volume is not an appropriate method for determining tumor growth. Tumor diameter measurement alone serves as a better surrogate for disease progression in sonographically high-risk thyroid nodules than volume. [ABSTRACT FROM AUTHOR]

To achieve accurate segmentation of thyroid nodule ultrasound images, obtain information on the physiological parameters of the lesion area and guide the clinical formulation of individualized treatment plan, an improved network based on the U2‐Net model is proposed in this paper. Thyroid images of 264 patients and 215 healthy volunteers at the First Hospital of Shanxi Medical University from February 2016 to June 2022 are studied, and the digital database thyroid image (DDTI) data set is proposed for data expansion. The experimental results show that the Dice coefficient on the test set was 80.58%, and the mean intersection over union was 81.21%. The improved U2‐Net model has the best segmentation accuracy compared with similar models, realizes the automatic segmentation of thyroid nodules, provides help for manual segmentation, and has good application prospects and clinical value. [ABSTRACT FROM AUTHOR]

Background: Radiofrequency ablation (RFA) is a minimally‐invasive ablative technique with an impressive safety profile used to manage thyroid nodules. Current reports with RFA describe the treatment of a single nodule in a single‐setting. We describe the first series of bilateral nodule RFA in a single‐setting. Methods: RFA was performed on patients with bilateral thyroid nodules in a single‐setting. A cohort of randomly selected patients undergoing RFA for bilateral thyroid nodules in a separate setting was reported as a control cohort. Results: A total of 12 patients were included in our series, included 6 patients in the single‐setting ablation cohort. For patients with bilateral nodules treated by RFA in a separate setting, the mean volume reduction rate (VRR) at 6 months of 63.79% ± 18.86%. There were no reports of complications in the separate setting cohort. For patients with bilateral nodules treated by RFA in a single‐setting, the mean VRR at 6 months was 64.% ± 18.97%. There were no reports of complications in the single‐setting cohort. Conclusions: Our work describes a novel use of RFA, providing preliminary insight into its use for appropriately selected patients with bilateral thyroid nodules. Future studies with larger sample sizes are warranted to corroborate and expand on our findings. [ABSTRACT FROM AUTHOR]

Background: Ultrasound risk stratification can improve the care of patients with thyroid nodules by providing a structured and systematic approach for the evaluation of thyroid nodule features and thyroid cancer risk. The optimal strategies to support implementation of high quality thyroid nodule risk stratification are unknown. This study seeks to summarise strategies used to support implementation of thyroid nodule ultrasound risk stratification in practice and their effects on implementation and service outcomes. Methods: This is a systematic review of studies evaluating implementation strategies published between January 2000 and June 2022 that were identified on Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane, Scopus, or Web of Science. Screening of eligible studies, data collection and assessment for risk of bias was completed independently and in duplicate. Implementation strategies and their effects on implementation and service outcomes were evaluated and summarised. Results: We identified 2666 potentially eligible studies of which 8 were included. Most implementation strategies were directed towards radiologists. Common strategies to support the implementation of thyroid nodule risk stratification included: tools to standardise thyroid ultrasound reports, education on thyroid nodule risk stratification and use of templates/forms for reporting, and reminders at the point of care. System based strategies, local consensus or audit were less commonly described. Overall, the use of these strategies supported the implementation process of thyroid nodule risk stratification with variable effects on service outcomes. Conclusions: Implementation of thyroid nodule risk stratification can be supported by development of standardised reporting templates, education of users on risk stratification and reminders of use at the point of care. Additional studies evaluating the value of implementation strategies in different contexts are urgently needed. [ABSTRACT FROM AUTHOR]

Background and Aim: This study examines the comparison of ultrasound elastography and fine needle aspiration (FNA) in diagnosing thyroid cancers and investigates the use of elastography as the initial diagnostic test of thyroid cancers to avoid the need for invasive diagnostic tests. Methods: In this study, 28 patients with 48 thyroid nodules (TNs) who were candidates for FNA or surgery were examined within a period of 18 months. Cut‐off and subsequently sensitivity and specificity for elastography results, compared to pathology results as the gold standard, were calculated using the receiver operating characteristic curve (ROC). Results: Based on ROC, the cut‐off point differentiating the tissue stiffness between benign and malignant TNs was 25.400 kilopascal (kPa) (sensitivity of 90.9% and specificity of 78.4%). It was observed that age affects the tissue stiffness; therefore, the cut‐off was defined as 65.625 kpa for age groups under 50 years old (sensitivity of 100% and specificity of 100%) and 25.400 kpa for the age group above 50 years old (sensitivity of 88.9% and specificity of 70.4%). Conclusion: Based on the high sensitivity and specificity of shear wave elastography in the differentiation of benign and malignant TNs, it can be employed as a stand‐alone or in combination with other diagnostic techniques to reduce the need for inessential surgical operations. However, future studies or developments are needed on this promising diagnostic technique. [ABSTRACT FROM AUTHOR]

Molecular analysis of thyroid nodules can provide diagnostic and prognostic information as well as indicate opportunities for targeted therapy. Whole RNA exome analysis offers information that can be leveraged to predict tumor behavior. [ABSTRACT FROM AUTHOR]

Thyroid cancer is a rare disease that often goes undetected until it reaches advanced stages. This study presents a novel approach for identifying Thyroid Imaging Reporting and Data System (TI‐RADS) stages of thyroid nodules using a deep convolutional neural network (Deep‐CNN) model. Our method incorporates pre‐processing, segmentation and feature extraction using colour based fuzzy‐c‐means and K‐means clustering, followed by deep learning classification. We demonstrate the efficacy of our proposed approach by achieving a success rate of 87% for classifying TI‐RADS1, TI‐RADS2, TI‐RADS3, TI‐RADS4 and TI‐RADS5 stages, outperforming other state‐of‐the‐art models. Our study fills an important gap in the literature, as previous studies have mainly focused on the margins of thyroid nodules rather than their calcium flecks. Our results offer promise for improving the accuracy and efficiency of thyroid cancer detection and management. [ABSTRACT FROM AUTHOR]

Objective: The ACR‐TIRADS system for stratifying thyroid nodule malignancy risk has been widely promoted and implemented. We audited its introduction at a large public hospital in Auckland, New Zealand. Design: Audit of outcomes following thyroid nodule fine needle aspiration (FNA) before/after ACR‐TIRADS. Patients: Individuals undergoing thyroid FNA 2017−2019. Measurements: From medical records, we obtained details from the pre‐FNA ultrasound (nodule size, TIRADS points/levels, radiologist recommendation for FNA), Bethesda (B) cytology classification, histology and post‐FNA follow‐up. Results: Four hundred and twenty‐two individuals had 564 FNAs, 163 had surgery and 54 (13%) had cancer in the primary nodule. 37/54 (69%) cancers were papillary thyroid carcinoma (median size 25 mm, 87% ≥10 mm, 61% ≥20 mm). Following ACR‐TIRADS introduction, FNA recommendations increased greater than twofold, FNAs performed by 71%−83%, and the monthly rate of FNAs and operations by 60% and 40%, respectively. However, the proportion of cancers/FNA remained similar (9.9% post‐TIRADS vs. 8.7% pre‐TIRADS). The proportions of FNA results remained stable for B2−B4 categories, but doubled (11% vs. 5%) for B5−B6: 15 FNAs were needed to identify an additional B5/B6 lesion. TIRADS‐5 nodules had a higher proportion of B5/B6 (20%) and a lower proportion of B2 (30%) than TIRADS‐3 (2%, 57%, respectively) and TIRADS‐4 (9%, 56%) nodules. About 5 additional cancers/year were diagnosed, but they were more often small (49% vs. 8% <2 cm, 17% vs. 0% <1 cm). Conclusion: ACR‐TIRADS introduction increased workload (FNAs and operations), without increasing the proportion of cancers/FNA. It led to a few more cancers being diagnosed, but many were small and of uncertain clinical significance. [ABSTRACT FROM AUTHOR]

Background: The Gene Expression Classifier (GEC) and Genomic Sequencing Classifier (GSC) were developed to improve risk stratification of indeterminate nodules. Our aim was to assess the clinical utility in a European population with restrictive diagnostic workup. Methods: Clinical utility of the GEC was assessed in a prospective multicenter cohort of 68 indeterminate nodules. Diagnostic surgical rates for Bethesda III and IV nodules were compared to a historical cohort of 171 indeterminate nodules. Samples were post hoc tested with the GSC. Results: The GEC classified 26% as benign. Surgical rates between the prospective and historical cohort did not differ (72.1% vs. 76.6%). The GSC classified 59% as benign, but misclassified six malignant lesions as benign. Conclusion: Implementation of GEC in management of indeterminate nodules in a European country with restrictive diagnostic workup is currently not supported, especially in oncocytic nodules. Prospective studies with the GSC in European countries are needed to determine the clinical utility. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to compare the value of the AI‐SONIC ultrasound‐assisted diagnosis system versus contrast‐enhanced ultrasound (CEUS) for differential diagnosis of thyroid nodules in diffuse and non‐diffuse backgrounds. Methods: A total of 555 thyroid nodules with pathologically confirmed diagnosis were included in this retrospective study. The diagnostic efficacies of AI‐SONIC and CEUS for differentiating benign from malignant nodules in diffuse and non‐diffuse backgrounds were evaluated, with pathological diagnosis as the gold standard. Results: The agreement between AI‐SONIC diagnosis and pathological diagnosis was moderate in diffuse backgrounds (κ = 0.417) and almost perfect in non‐diffuse backgrounds (κ = 0.81). The agreement between CEUS diagnosis and pathological diagnosis was substantial in diffuse backgrounds (κ = 0.684) and moderate in non‐diffuse backgrounds (κ = 0.407). In diffuse backgrounds, AI‐SONIC had slightly higher sensitivity (95.7 vs 89.4%, P =.375), but CEUS had significantly higher specificity (80.0 vs 40.0%, P =.008). In non‐diffuse background, AI‐SONIC had significantly higher sensitivity (96.2 vs 73.4%, P <.001), specificity (82.9 vs 71.2%, P =.007), and negative predictive value (90.3 vs 53.3%, P <.001). Conclusion: In non‐diffuse backgrounds, AI‐SONIC is superior to CEUS for differentiating malignant from benign thyroid nodules. In diffuse backgrounds, AI‐SONIC could be useful for screening of cases to detect suspicious nodules requiring further examination by CEUS. [ABSTRACT FROM AUTHOR]

Key Clinical Message: When managing patients with differentiated thyroid cancers (DTC) and lytic bone lesions, physicians should consider etiologies other than DTC bony metastases when there is no biochemical and functional radiographic evidence of extensive DTC burden. Systemic mastocytosis (SM) is a clonal expansion of mast cells associated with an increased risk of solid malignancies. There is no known association between systemic mastocytosis and thyroid cancer. We report a young woman who presented with cervical lymphadenopathy, palpable thyroid nodule, and lytic bone lesions who was diagnosed with papillary thyroid cancer (PTC). The patient's post‐surgical thyroglobulin was lower than expected for metastatic thyroid cancer, and the lytic bone lesions did not demonstrate uptake of I123. Upon further evaluation, the patient was found to have SM. We report a case of co‐occurrence of PTC and SM. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Incidental sonographic discovery of thyroid nodules is an increasingly common event in clinical practice. Less frequently, patients with cytological benign thyroid nodules have suspicious cervical lymph nodes detected by ultrasound examination or by cytological exam. Here, we discuss an intriguing case of cervical lymph node metastasis with a probable thyroid origin in a 65‐year‐old asymptomatic male smoker. He underwent thyroidectomy and unilateral cervical lymphadenectomy. Despite a negative chest X‐ray, the postoperative histological examination revealed that the lymph node metastasis was actually from a lung carcinoma. Metastatic lesions in cervical lymph nodes from non‐thyroidal origins must be excluded when evaluating lesions in the region, especially when thyroid nodules subjected to fine needle aspiration biopsy yield negative results, or lymph node cytological evaluations are inconsistent with thyroid cytological findings and sonographic features. Thyroid and lung adenocarcinomas share some epithelial and mesenchymal markers. Thyroglobulin helps differentiate primary thyroid tumors from lung ones, but in cases of poor differentiation, distinguishing metastatic lesions in the thyroid gland can be challenging. Lung cancer (LC) is the leading cause of cancer mortality worldwide, and survival rates have only marginally improved over the last several decades. The ongoing clinical challenge is detecting LC at earlier stages of the disease. [ABSTRACT FROM AUTHOR]

Objectives: This study evaluated the diagnostic value of artificial intelligence‐assistant diagnostic system combined with contrast‐enhanced ultrasound in The American College of Radiology Thyroid Imaging, Reporting and Data System (ACR TI‐RADS) 4 category thyroid nodules. Methods: Thyroid nodules that were evaluated as ACR TI‐RADS 4 by conventional ultrasound were selected, all of which had pathological or fine needle aspiration (FNA) results. All nodules were examined by contrast‐enhanced ultrasound (CEUS) and artificial intelligence (AI) analysis. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of AI, CEUS and their combined diagnosis were compared; Analyzed and compared the diagnostic efficiency of AI, CEUS and their combined diagnosis. Results: A total of 148 thyroid nodules were included in 140 patients, including 58 malignant nodules and 89 benign nodules. The sensitivity of combined diagnosis was significantly higher than that of AI or CEUS alone (P <.05). The NPV of AI, CEUS and combined diagnosis were statistically significant (P <.05). There was no significant difference in the diagnostic efficacy between AI and CEUS (P >.05), but there was a significant difference in NPV between AI and combined diagnosis (P <.05). The AUC of the combined diagnosis was 0.859, which was higher than that of AI, CEUS alone. Conclusions: AI has a high diagnostic efficiency, which was helpful for radiologists to make rapid assessment. AI combined CEUS can significantly improve the diagnostic sensitivity and NPV, which was beneficial for the early detection of malignant nodules. [ABSTRACT FROM AUTHOR]

Background: Active surveillance is propagated as an alternative for hemithyroidectomy in the management of Bethesda III thyroid nodules. Methods: A cross‐sectional survey questioned respondents on their willingness to accept risks related to active surveillance and hemithyroidectomy. Results: In case of active surveillance, respondents (129 patients, 46 clinicians, and 66 healthy controls) were willing to accept a risk of 10%–15% for thyroid cancer and 15% for needing more extensive surgery in the future. Respondents were willing to accept a risk of 22.5%–30% for hypothyroidism after hemithyroidectomy. Patients and controls were willing to accept a higher risk on permanent voice changes compared with clinicians (10% vs. 3%, p < 0.001). Conclusion: Real‐life risks associated which active surveillance and hemithyroidectomy for Bethesda III nodules are equivalent or less than the risks people are willing to accept. Clinicians accepted less risk for permanent voice changes. [ABSTRACT FROM AUTHOR]

Objective: Advances in our understanding of the molecular biology of thyroid tumours is being rapidly translated into their clinical management. This review summarizes the current use of molecular testing in thyroid tumours, focusing on their usefulness as diagnostic and prognostic tools to guide treatment with consideration of present limitations. Design: Considerations about molecular testing applications for the diagnosis and treatment of thyroid tumours are divided into four sections/roles: (1) evaluating cytologically indeterminate thyroid nodules; (2) guiding extent of surgery in indeterminate thyroid nodules; (3) completing histological characterization of thyroid tumours and (4) identifying actionable mutations in advanced progressive thyroid cancers. Results: Genomic testing can improve the presurgical malignancy risk assessment in indeterminate thyroid nodules. However, a prior in‐depth analysis of institutional quality and outcomes of sonographical, cytological and histological characterization of thyroid tumours is necessary. Presently, it remains uncertain whether knowing the molecular profile of a cytologically indeterminate thyroid nodule might be advantageous to modify the extent of initial surgery. Molecular characterization of thyroid tumours can be a valuable adjunct to morphological diagnosis in some challenging cases, such as in low‐risk follicular cell‐derived neoplasms, or rare tumours. Finally, as selective kinase inhibitors are available, molecular testing in locally advanced/metastatic progressive thyroid cancers should also be integrated into the institutional clinical management pathway to improve outcomes and limit toxicity. Conclusions: Molecular testing needs to be implemented into the local evidence‐based clinical management thyroid nodule/cancer pathways to improve its diagnostic and prognostic value and to optimize cost‐effectiveness. [ABSTRACT FROM AUTHOR]

Objective: To determine if the artificial intelligence‐based Thyroid Imaging, Reporting and Data System (AI TIRADS) would perform better than the American College of Radiology (ACR) TIRADS in monitoring malignant thyroid nodules not recommended for biopsy using follow‐up thresholds. Methods: A total of 3499 thyroid nodules with surgical histopathology and ultrasound features were retrospectively reviewed and categorized using ACR TIRADS and AI TIRADS. The recommendations for biopsy and follow‐up divided nodules into three groups 1) fine needle aspiration (FNA), 2) follow‐up ultrasound, and 3) no further evaluation. Results: Of the total 1608 malignant nodules in this study, 974 malignant nodules would not be biopsied in ACR TIRADS compared with 967 in AI TIRADS. While 60.0% (584/974) of these non‐biopsied malignancies could be followed‐up by ultrasound in ACR TIRADS and 62.8% (607/967) in AI TIRADS. For the malignancies of no further evaluation, 97.4% (380/390) were sized <10 mm in ACR TIRADS and 93.3% (336/360) in AI TIRADS. Compared with ACR TIRADS, AI TIRADS had lower unnecessary FNA rate and missing cancer rate (41.0% vs 47.8% and 22.8% vs 27.5%, P <.05, respectively) while having higher specificity and AUC as well as lower sensitivity (65.0% vs 57.9%, 0.895 vs 0.881, and 96.1% vs 97.8%, all P <.05). Conclusions: Using the follow‐up thresholds, more than half of the malignancies not being biopsied were monitored by ultrasound in both ACR TIRADS and AI TIRADS, and AI TIRADS had lower missing cancer rate. More than 90% of malignancies recommended for no further evaluation were <10 mm in diameter. [ABSTRACT FROM AUTHOR]

Neck masses are common in pediatric patients, with benign etiologies such as congenital or inflammatory lesions accounting most of these masses. Anatomic location (most important), clinical history, and the appearance in ultrasonography (US) are helpful clues to narrow down differential diagnosis. Because of widespread availability, lack of ionizing radiation, and no need for sedation or contrast administration, US is the preferred initial modality for the evaluation. Further evaluation with cross‐sectional imagings is needed for more extensive lesions with trans‐spatial extension or suspicion of intrathoracic or retropharyngeal extension. This review will focus on US appearance and clinical presentation of masses of the neck in children, to enable radiologist to arrive at a reasonable differential diagnosis. We also briefly discuss more complex pathologies that need to be evaluated with cross‐sectional modalities such as CT scan and magnetic resonance imaging. [ABSTRACT FROM AUTHOR]

Introduction: The 2015 American Thyroid Association guidelines recommend to de-escalate treatment such as Thyroid lobectomy instead of total thyroidectomy for 1–4 cm papillary thyroid cancer (PTC). Dutch guidelines endorse restricted work-up for thyroid incidentalomas recommending only fine needle aspiration in case of a 'palpable thyroid nodule'. This diagnostic work-up algorithm may result in the identification of less indolent PTCs and may lead to a patient population with relatively more aggressive PTCs. This study aims to retrospectively analyze recurrence rates of low-risk 1–4 cm PTC in the Netherlands. Methods: From the national cancer registry, patients with low-risk 1–4 cm PTC between 2005 and 2015 were included for analysis. Disease free survival (DFS) and overall survival were compared between patients who underwent TT ± RAI and TL without RAI. Post-hoc propensity score analysis was performed correcting for age, sex, T-stage, and N-stage. Results: In total 901 patients were included, of which 711 (78.9%) were females, with a median follow-up of 7.7 years. TT was performed in 893 (94.8%) patients. Recurrence occurred in 23 (2.6%) patients. Multivariable analysis showed no significant correlation between extent of surgery and DFS (p = 0.978), or overall survival (p = 0.590). After propensity score matching, multivariable analysis showed no significant difference on extent of surgery and recurrence. Conclusion: Low-risk PTC patients with 1–4 cm tumor who underwent TL showed similar recurrence rates as those who underwent TT ± adjuvant RAI, which suggests that TL can be sufficient in treating low-risk 1–4 cm PTC, possibly reducing morbidity of these patients in the Netherlands. [ABSTRACT FROM AUTHOR]