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Background: The aim was to investigate which of two different b values (b 500 s/mm² and b 800 s/mm²) are more effective in the differentiation of benign-malignant nodules using Diffusion-Weighted Magnetic Resonance Imaging (DW-MRI). Materials and methods: Patients presenting with a preoperative diagnosis of nodular goiter or multinodular goiter were included in this study. These patients underwent neck MRI examinations, and their cases were analyzed retrospectively. A total of 26 patients were included in the study. A total of 46 nodules meeting the study criteria were examined. Measurements were performed on Apparent Diffusion Coefficient (ADC) maps of patients at two different b values (b 500 s/mm² and b 800 s/mm²), and the results were compared with histopathological findings. Results: Out of a total of 46 nodules, 37 were identified as benign, and 9 as malignant based on histopathological analysis. The mean ADC value at b 500 was lower in malignant nodules (1259.65 ± 328.13) compared to benign nodules (19037.48 ± 472.74). Similarly, the mean ADC value at b 800 was lower in malignant nodules (1081.72 ± 200.23) compared to benign nodules (1610.44 ± 418.06). When a cut-off value of 1.1 × 10− 3 was accepted for the differentiation of pathology, the sensitivity for distinguishing pathology with ADC values at b 500 was 83.3%, with a specificity of 90.0%, and for ADC values at b 800, the sensitivity was 71.4%, with a specificity of 89.7%. Conclusion: DW-MRI without the need for contrast agent administration is a useful method in the differentiation of benign-malignant thyroid nodules. [ABSTRACT FROM AUTHOR]

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]

Background: The most popular technique for evaluating thyroid imaging is high-frequency ultrasonography; however, the TIRADS tool, intended to help with noninvasive risk assessment, has limitations in detecting thyroid cancerous nodules. The purpose of this article was to review the application of TIRADS in ultrasound radiomics and discuss its advantages and limitations. Main text: A novel approach to medical picture processing called radiomics can help identify these nodules more precisely. Radiomics involves obtaining high-quality imaging for planning or diagnostic reasons, identifying a macroscopic tumor, extracting quantitative imaging features, and ranking the most informative findings according to prominence, independence, and reproducibility. Conclusions: Radiomics combined with TIRADS has demonstrated strong potential in enhancing the accuracy of thyroid nodule malignancy predictions, though challenges such as the need for larger, diverse datasets, and thorough validation persist. Incorporating clinical data, using deep learning models, and standardized imaging protocols could improve diagnostic precision, and further research will, therefore, be essential for its implementation in routine clinical practice. [ABSTRACT FROM AUTHOR]

Background: Thyroid nodules diagnosed in children pose a greater risk of malignancy compared to those in adults. However, there is no ultrasound thyroid nodule evaluation system aimed at children. The objective of this research is to assess the diagnostic performance of the adult-based American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) and Chinese Thyroid Imaging Reporting and Data System (C-TIRADS) in pediatric thyroid carcinoma. Methods: The preoperative ultrasound images of 177 thyroid lesions in 136 pediatric patients aged 18 or younger who underwent thyroid surgery or fine needle aspiration (FNA) at our center from July 2017 to July 2022 were reviewed. The sonographic characteristics of pediatric thyroid carcinoma were compared and analyzed in contrast to benign nodules. All the nodules were evaluated by the ACR-TIRADS and the C-TIRADS respectively. Results: Ultrasound features such as solid composition (94.8%), hypoechogenicity or marked hypoechogenicity (94.8-95.7%) and microcalcification (78.3-84.3%) were more common in pediatric malignant nodules (P-values < 0.05). The areas under receiver operating characteristic curves (AUC) of the ACR-TIRADS and the C-TIRADS in diagnosing pediatric thyroid carcinoma were 0.903–0.906, 0.907–0.909 (P-value > 0.05). The interobserver agreement of both the ACR-TIRADS and the C-TIRADS was strong (weighted Kappa > 0.90). Conclusions: Both the C-TIRADS and the ACR-TIRADS owned great diagnostic performance and strong interobserver agreement in diagnosing pediatric thyroid carcinoma. However, a more complete and specific ultrasound evaluation system for pediatric thyroid nodules is still needed. [ABSTRACT FROM AUTHOR]

Introduction: This study explored the clinical value and application of ultrasound contrast imaging technology in the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) TR4 benign and malignant thyroid nodules. Methods: We retrospectively analyzed data from the medical records of 40 patients who met the inclusion criteria between January 2020 and December 2023. Each patient was evaluated using the ACR TI-RADS classification and contrast-enhanced ultrasound (CEUS). The agreement between pathological outcomes and ultrasound indicators and the diagnostic value and significance of each parameter were assessed. Results: The diameters did not differ between benign and malignant nodules (P = 0.324). Ring enhancement was closely associated with benign thyroid nodules, with a negative predictive value of 100%. Homogeneous enhancement and enhancement intensity showed good diagnostic value for pathological results, with an area under the curve (AUC) > 0.8. This parameter showed a high diagnostic value for serial and parallel combinations of homogeneous enhancement and enhancement intensity, with a sensitivity of 77.8% and specificity of 85.7% for the serial combination and 100% and 71.4%, respectively. for the parallel combination. Conclusion: Among ACR TI-RADS TR4 nodules, diameter 1.0–1.5 cm was not significantly correlated with a benign or malignant nature. Nodules featuring ring enhancement with ring-enhancing features should be considered benign. Similarly, nodules showing no, homogeneous, or high enhancement with clear borders on CEUS imaging may be benign. However, nodules with uneven low enhancement or unclear borders may be malignant. Therefore, uneven and low enhancement on CEUS imaging may have a high diagnostic value for malignant nodules. Moreover, the combination of these features may have even higher specificity. [ABSTRACT FROM AUTHOR]

Background: The increased utilization of computed tomography (CT) has led to a higher detection rate of thyroid incidentalomas. Currently, there are no widely agreed-upon guidelines for managing these incidentalomas. This study aims to investigate the prevalence, follow-up practices, and malignancy rates of thyroid incidentalomas detected by CT. Methods: We conducted a comprehensive search of PubMed, Embase, and Cochrane databases to identify relevant studies published before April 12, 2024 (PROSPERO #42024535501). Studies reporting on the prevalence, follow-up, and risk of malignancy (ROM) of thyroid incidentalomas detected by CT were included. Combined outcomes were analyzed using pooled proportion with a random-effects model. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2) and the Newcastle–Ottawa Scale tool. Subgroup analyses were conducted based on characteristics including size of the incidentaloma, CT area, and age of the study population. Results: Thirty-eight studies involving 195,959 patients were included in the prevalence analysis, revealing a prevalence of thyroid incidentalomas on CT of 8.3% (confidence interval [CI], 7.4–9.3). The prevalence was higher in neck CT (16.5%, CI, 11.0–22.1) compared with chest CT (6.6%, CI, 5.3–7.9). Multiple incidentalomas were found in 27.0% (CI, 12.9–41.1) of patients. Of the nodules, 46.3% (CI, 32.3–60.3) were ≥1 cm, and 28.6% (CI, 19.9–37.3) were ≥1.5 cm. Thyroid ultrasounds, biopsies, and surgeries were performed in 34.9% (CI, 26.1–43.7), 28.4% (CI, 19.9–36.9), and 8.2% (CI, 2.1–14.4) of cases, respectively. Additionally, 25 studies with 6272 patients reported a ROM of 3.9% (CI, 3.0–4.9) for thyroid incidentalomas detected on CT. A higher ROM was observed in incidentalomas ≥1 cm (11.7%, CI, 3.9–19.4) and ≥1.5 cm (24.9%, CI, 0–52.7) compared with those <1 cm (0.1%, CI, 0–0.8) and <1.5 cm (0%, CI, 0–0.2). Conclusions: Most thyroid incidentalomas identified on CT are benign. Implementing a collaborative protocol between radiologists and thyroid specialists to manage high-risk thyroid incidentalomas can ensure appropriate follow-up and optimal patient care. [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]

To explore the predictive value of the nomogram model based on multimodal ultrasound features for benign and malignant thyroid nodules of C-TIRADS category 4. A retrospective analysis was conducted on the general conditions and ultrasound features of patients who underwent thyroid ultrasound examination and fine needle aspiration biopsy (FNA) or thyroidectomy at the Affiliated Hospital of Zunyi Medical University from April 2020 to April 2023. Predictive signs for benign and malignant nodules of thyroid C-TIRADS category 4 were screened through LASSO regression and multivariate logistic regression analysis to construct a nomogram prediction model. The predictive efficiency and accuracy of the model were assessed through ROC curves and calibration curves. Seven independent risk factors in the predictive model for benign and malignant thyroid nodules of C-TIRADS category 4 were growth pattern, morphology, microcalcifications, SR, arterial phase enhancement intensity, initial perfusion time, and PE [%]. Based on these features, the area under the curve (AUC) of the constructed prediction model was 0.971 (p ＜.001, 95% CI: 0.952–0.989), with a prediction accuracy of 93.1%. Internal validation showed that the nomogram calibration curve was consistent with reality, and the decision curve analysis indicated that the model has high clinical application value. The nomogram prediction model constructed based on the multimodal ultrasound features of thyroid nodules of C-TIRADS category 4 has high clinical application value. [ABSTRACT FROM AUTHOR]

Objective: Optimal management of indeterminate nodules remains a controversial area of endocrine surgery. The purpose of this study is to compare observation, molecular testing, and immediate thyroid surgery for the management of Bethesda Classes III and IV nodules in patients age 50 to 90 years. Study Design: A decision analysis was performed from April 22, 2021, to September 29, 2023, using a Markov model constructed with TreeAgePro 2023. Model variables and ranges were selected based on literature review data. Setting: TreeAgePro. Methods: A 1‐way sensitivity analysis was performed to evaluate the age threshold at which each management pathway, immediate thyroid surgery, additional molecular testing, or observation, would be favored. A Monte Carlo probabilistic sensitivity analysis was performed 5 times with model patients assigned starting ages of 50, 60, 70, 80, and 90 years to assess how age at diagnosis would impact model results. Outcomes were measured with quality‐adjusted life‐years and accounted for perioperative complications including permanent recurrent laryngeal nerve injury, permanent hypoparathyroidism, and medical complications. Results: In the study models, molecular testing was more beneficial than surgery and observation across all ages. The age threshold at which observation became more beneficial than surgery as the next best option was 83.1 years. However, the clinical difference between all 3 treatment algorithms was relatively minimal. Conclusions: Decision‐making regarding indeterminate thyroid nodules is complex. Given the clinically similar results across all 3 treatment algorithm, this study reinforces that treatment modalities should be individually tailored and based on shared physician‐patient decision making. [ABSTRACT FROM AUTHOR]

Purpose: Ectopic parathyroid carcinoma (EPC) is a rare clinical entity with multiple diagnostic pitfalls, making surgical cures challenging. We assessed the clinicopathological spectrum and outcome of EPCs. Methods: In this retrospective cohort study, 24 EPCs were identified from 133 PC patients treated at a tertiary referral center. The relationship between clinicopathological findings and locations was analyzed. Results: The locations of EPCs were predominantly intrathyroidal (62.5%), followed by 16.7% in the mediastinum, 8.3% in the retropharyngeal space, 8.3% in the carotid sheath, and 4.2% in the upper neck. Intrathyroidal EPC patients experienced higher serum calcium (p = 0.020), a higher rate of vascular invasion (p = 0.040), and a slightly higher incidence of non-R0 initial resection (p = 0.092) than those in other ectopic locations. Intrathyroidal EPC patients also suffered a trend of higher upper aerodigestive tract (UAT) invasion rate (p = 0.070) and higher risks of distant metastasis (p = 0.037) than the other PC patients. The 5-year disease-free survival rate after surgery was slightly compromised at 41.5% in intrathyroidal EPC patients compared with 77.8% among those in other ectopic locations (p = 0.143) and 59.7% among the other PC patients (log-rank = 3.194; p = 0.074), though without statistical significance. Conclusion: Intrathyroidal EPC might cause a more biochemically and invasively distinct PC picture compared with other PCs. Special caution should be exercised in the preoperative diagnosis and management of such cases. [ABSTRACT FROM AUTHOR]

Background: The objective of the following retrospective review was to perform a cost-effectiveness analysis of the use of molecular testing of indeterminate thyroid nodules compared to current management practices in Nova Scotia, Canada. Methods: All cases of cytologically indeterminate thyroid nodules from January 1st, 2014 to December 31st, 2018 were reviewed. All interventions related to an indeterminate thyroid nodule were recorded. Patients were excluded if less than 18 years old if no further information regarding medical management was electronically available beyond the diagnosis of an indeterminate thyroid nodule, history of radiation, or previous thyroid surgery prior to diagnosis of an indeterminate thyroid nodule in the remaining lobe. Microcosting was performed to determine the cost of all relevant interventions including repeat fine needle aspiration biopsy, ultrasound, thyroid surgery(s), and molecular testing. Institution-specific transition state probabilities were calculated and used to build a cost-effectiveness analysis model. Model output was an incremental cost-effectiveness ratio, defined as the ratio of cost difference to effectiveness difference between routine molecular testing and the current management strategy, yielding cost per surgery avoided. Results: The mean effectiveness of the current management of indeterminate thyroid nodules in Nova Scotia based on the American Thyroid Association guidelines is 64% at a mean cost of $6431, while the simulated mean effectiveness of routine molecular testing is 89% at a mean cost of $8414. Differences in management strategies generated an incremental cost-effectiveness ratio of $7876 per surgery avoided. Conclusion: Routine molecular testing is the more effective strategy for the appropriate management of indeterminate thyroid nodules; however, it comes at a higher mean cost compared to the current management strategy. As the cost of molecular testing continues to decrease, and the cost of OR resources continues to rise, molecular testing is likely to become the optimal strategy in Nova Scotia. [ABSTRACT FROM AUTHOR]

Background: The management of benign symptomatic thyroid nodules until recent years has been limited to surgery, radioactive iodine treatment, or surveillance which is associated with the burden of morbidity of complications or symptom non-relief as well as cost. Laser ablation has emerged as a minimally invasive alternative, this uses laser energy to thermally ablate nodule tissue, leading to volume reduction and symptom relief. Long-term treatment response data is growing but remains limited in the United States. Our study aims to quantify the effectiveness of laser ablation in reducing the volume of thyroid nodules over a 12 to 18-month period. Materials and methods: Retrospective review of data was conducted for 63 adults with cytologically benign, solid symptomatic thyroid nodules ranging from 1.333 cm³ to 103.794 cm³ in volume. Ultrasound-guided laser thermal ablation was performed on all nodules using EchoLaser X4 Smart Interface device with 1064 nm diode laser to deliver total ablation energy (joules), calculated per device guidelines. Serial sonographic volume measurements were conducted 1 month, 3 -6 months, 6 - 12 months, and 12 to 18 months post-ablation intervals. Results: Study cohort was comprised of 63 thyroid nodules. reduction in nodule volume increased progressively over time, with median reductions of 46.05% [STD 21.8] at 1 month, 60.33% [STD 20.1] at 3-6 months, 68.69% [STD 18.8] at 6-12 months, and 64.04% [STD 19.27] at 12-18 months. A total of 62, 56, 42, and 17 nodules had available data for analysis at these respective intervals. Conclusion: This study demonstrated a marked progressive reduction of thyroid nodule volume following ablation. The treatment appears to be consistently effective in reducing symptoms across a wide range of nodule sizes, although the degree of volume reduction varies. The results of our study underscore the potential of laser ablation as a viable treatment option for thyroid nodules, with a sustained reduction in nodule volume observed over an extended postprocedure period. [ABSTRACT FROM AUTHOR]

Background: The use of two-dimensional (2D) ultrasound for guiding radiofrequency ablation (RFA) of benign thyroid nodules presents limitations, including the inability to monitor the entire treatment volume and operator dependency in electrode positioning. We compared three-dimensional (3D)-guided RFA using a matrix ultrasound transducer with conventional 2D-ultrasound guidance in an anthropomorphic thyroid nodule phantom incorporated additionally with temperature-sensitive albumin. Methods: Twenty-four phantoms with 48 nodules were constructed and ablated by an experienced radiologist using either 2D- or 3D-ultrasound guidance. Postablation T2-weighted magnetic resonance imaging scans were acquired to determine the final ablation temperature distribution in the phantoms. These were used to analyze ablation parameters, such as the nodule ablation percentage. Further, additional procedure parameters, such as dominant/non-dominant hand use, were recorded. Results: Nonsignificant trends towards lower ablated volumes for both within (74.4 ± 9.1% (median ± interquartile range) versus 78.8 ± 11.8%) and outside of the nodule (0.35 ± 0.18 mL versus 0.45 ± 0.46 mL), along with lower variances in performance, were noted for the 3D-guided ablation. For the total ablation percentage, 2D-guided dominant hand ablation performed better than 2D-guided non-dominant hand ablation (81.0% versus 73.2%, p = 0.045), while there was no significant effect in the hand comparison for 3D-guided ablation. Conclusion: 3D-ultrasound-guided RFA showed no significantly different results compared to 2D guidance, while 3D ultrasound showed a reduced variance in RFA. A significant reduction in operator-ablating hand dependence was observed when using 3D guidance. Further research into the use of 3D ultrasound for RFA is warranted. Relevance statement: Using 3D ultrasound for thyroid nodule RFA could improve the clinical outcome. A platform that creates 3D data could be used for thyroid diagnosis, therapy planning, and navigational tools. Key Points: Twenty-four in-house-developed thyroid nodule phantoms with 48 nodules were constructed. RFA was performed under 2D- or 3D-ultrasound guidance. 3D- and 2D ultrasound-guided RFAs showed comparable performance. Real-time dual-plane imaging may offer an improved overview of the ablation zone and aid electrode positioning. Dominant and non-dominant hand 3D-ultrasound-guided RFA outcomes were comparable. [ABSTRACT FROM AUTHOR]

Objective To investigate the value of monocyte/high-density lipoprotein cholesterol (HDL-C) ratio (MHR) in the differential diagnosis of benign and malignant thyroid nodules in reproductive-aged women. Methods A total of 186 reproductive-aged women with single thyroid nodule were selected as the observation group, and were divided into the malignant subgroup (23 cases) and benign subgroup (163 cases) according to surgical and pathological results； in the same period，93 healthy subjects who came to the hospital for physical examination were used as the control group. The clinical data of the malignant subgroup and benign subgroup were collected and compared. The peripheral blood mononuclear cell and HDL-C were detected to calculate the MHR in each group. Multivariate Logistic regression was used to analyze the effect of MHR on the thyroid nodules in reproductive-aged women. Hosmer-Lemeshow goodness of fit test was used to determine the fit of the model. Receiver operating characteristic curve (ROC curve) was used to analyze the diagnostic efficacy of MHR in preoperative thyroid nodules in reproductive-aged women. Results The MHR of observation group was higher than that of control group, and the MHR of malignant subgroup was higher than that of benign subgroup (both P< 0. 05). The proportion of tea drinking, education level, sleep time, frequency of physical exercise, frequency of eating aquatic products/seafood and eggs in the malignant subgroup were lower than those in the benign subgroup, and the proportion of diabetes, uterine fibroids, life and work stress, anxiety and depression, anger frequency, and depression in the past 1 year were higher than those in the benign subgroup (all P<0. 05). Multilevel Logistic regression analysis was conducted. The results showed that when MHR was not included in model 1, life and work pressure, anxiety and depression, and anger frequency were independent risk factors for malignant thyroid nodules in reproductive-aged women (all P< 0. 05). When MHR was included in model 2, life and work pressure, anger frequency, and MHR were independent risk factors for malignant thyroid nodules in reproductive-aged women (all P<0. 05). Using the predicted probability of the Logistic regression analysis as the independent test variable, when MHR was not included, the AUC value of logit (P1) for differential diagnosis of thyroid nodules in reproductive-aged women was 0. 745； when MHR was included, the AUC value of logit (P2) for differential diagnosis of thyroid nodules in reproductive-aged women was 0. 925, which was greater than that without MHR (P<0. 01). Conclusion The MHR of malignant thyroid nodules increases in reproductive-aged women, MHR is an independent risk factor for malignant thyroid nodules in reproductive-aged women, and detection of MHR is helpful to distinguish benign and malignant thyroid nodules in reproductive-aged women. [ABSTRACT FROM AUTHOR]

Background: We explored the utility of a small multi-gene DNA panel for assessing molecular profiles of thyroid nodules and influencing clinical decisions by comparing outcomes between tested and untested nodules. Methods: Between April 2022 and May 2023, we prospectively performed fine-needle aspiration (FNA) with gene testing via DNA panel of 11 genes (BRAF, RAS [NRAS, HRAS, KRAS], EZH1, DICER1, EIF1AX, PTEN, TP53, PIK3CA, TERT promoter) in 278 consecutive nodules (panel group). Propensity score-matching (1:1) was performed with 475 nodules that consecutively underwent FNA without gene testing between January 2021 and December 2021 (control group). Results: In the panel group, positive call rate for mutations was 41.7% (BRAF 16.2%, RAS 12.6%, others 11.5%, double mutation 1.4%) for all nodules, and 40.0% (BRAF 4.3%, RAS 19.1%, others 15.7%, double mutation 0.9%) for indeterminate nodules. Benign call rate was 69.8% for all nodules, and 75.7% for indeterminate nodules. In four nodules, additional TP53 (in addition to BRAF or EZH1) or PIK3CA (in addition to BRAF or TERT) mutations were co-detected. Sensitivity, specificity, positive predictive value, and negative predictive value were 80.0%, 53.3%, 88.1%, 38.1% for all nodules, and 78.6%, 45.5%, 64.7%, 62.5% for indeterminate nodules, respectively. Panel group exhibited lower surgical resection rates than the control group for all nodules (27.0% vs. 52.5%, P<0.001), and indeterminate nodules (23.5% vs. 68.2%, P<0.001). Malignancy risk was significantly different between the panel and control groups (81.5% vs. 63.9%, P=0.008) for all nodules. Conclusion: Our panel aids in managing thyroid nodules by providing information on malignancy risk based on mutations, potentially reducing unnecessary surgery in benign nodules or patients with less aggressive malignancies. [ABSTRACT FROM AUTHOR]

Accurate segmentation of thyroid nodules in ultrasound images is crucial for the diagnosis of thyroid cancer and preoperative planning. However, the segmentation of thyroid nodules is challenging due to their irregular shape, blurred boundary, and uneven echo texture. To address these challenges, a novel Mamba- and ResNet-based dual-branch network (MRDB) is proposed. Specifically, the visual state space block (VSSB) from Mamba and ResNet-34 are utilized to construct a dual encoder for extracting global semantics and local details, and establishing multi-dimensional feature connections. Meanwhile, an upsampling–convolution strategy is employed in the left decoder focusing on image size and detail reconstruction. A convolution–upsampling strategy is used in the right decoder to emphasize gradual feature refinement and recovery. To facilitate the interaction between local details and global context within the encoder and decoder, cross-skip connection is introduced. Additionally, a novel hybrid loss function is proposed to improve the boundary segmentation performance of thyroid nodules. Experimental results show that MRDB outperforms the state-of-the-art approaches with DSC of 90.02% and 80.6% on two public thyroid nodule datasets, TN3K and TNUI-2021, respectively. Furthermore, experiments on a third external dataset, DDTI, demonstrate that our method improves the DSC by 10.8% compared to baseline and exhibits good generalization to clinical small-scale thyroid nodule datasets. The proposed MRDB can effectively improve thyroid nodule segmentation accuracy and has great potential for clinical applications. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the impact of video sequences (cine-loops) on the interobserver agreement (IOA) using risk stratification systems (RSSs) for thyroid nodules (TNs). Methods: Twenty TNs were randomly selected from a large database and evaluated by twelve experienced observers using five different RSSs (Kwak-, ACR-, EU-, Korean-TIRADS, ATA Guidelines). In the first step, the evaluation was conducted based on static ultrasound (US) images in two planes ("static"). Six months later, these cases were reevaluated by the same observers using video sequences in two planes ("cine-loops"). Fleiss' kappa (κ) was calculated for the IOA analyses. Results: IOA on static was moderate with κ values of 0.46, 0.42, 0.40, 0.45, and 0.38 for the Kwak-, ACR-, EU-, Korean-TIRADS, and ATA Guidelines, respectively, while the IOA on cine-loops was fair with κ values of 0.41, 0.38, 0.37, 0.36, and 0.34 for the Kwak-, ACR-, EU-, Korean-TIRADS, and ATA Guidelines, respectively. The overall IOA was superior in static images versus cine-loops (p = 0.024). Among other findings, the subgroup analyses (related to age, gender, US certificates, number of thyroid US per week, and RSSs experience) particularly showed that the experience of the observers in using RSSs had a significant influence on the IOA. Conclusions: The overall IOA (all twelve observers and all five RSSs) was superior on static US images in comparison to cine-loops. Furthermore, the overall IOA of the five US features revealed superior κ values of the static images over cine-loops. However, this impact was significantly lower when the observers were highly experienced in the use of US RSSs of TNs. [ABSTRACT FROM AUTHOR]

To develop and validate a prediction model utilizing clinical and ultrasound (US) data for preoperative assessment of efficacy following US-guided thermal ablation (TA) in patients with benign thyroid nodules (BTNs) ≥ 2 cm. We retrospectively assessed 962 patients with 1011 BTNs who underwent TA at four tertiary centers between May 2018 and July 2022. Ablation efficacy was categorized into therapeutic success (volume reduction rate [VRR] > 50%) and non-therapeutic success (VRR ≤ 50%). We identified independent factors influencing the ablation efficacy of BTNs ≥ 2 cm in the training set using multivariate logistic regression. On this basis, a prediction model was established. The performance of model was further evaluated by discrimination (area under the curve [AUC]) in the validation set. Of the 1011 nodules included, 952 (94.2%) achieved therapeutic success at the 12-month follow-up after TA. Independent factors influencing VRR > 50% included sex, nodular composition, calcification, volume, and largest diameter (all p < 0.05). The prediction equation was established as follows: p = 1/1 + Exp∑[8.113 −2.720 × (if predominantly solid) −2.790 × (if solid) −1.275 × (if 10 mL < volume ≤ 30mL) −1.743 × (if volume > 30 mL) −1.268 × (if with calcification) −2.859 × (if largest diameter > 3 cm) +1.143 × (if female)]. This model showed great discrimination, with AUC of 0.908 (95% confidence interval [CI]: 0.868–0.947) and 0.850 (95% CI: 0.748–0.952) in the training and validation sets, respectively. A clinical prediction model was successfully developed to preoperatively predict the therapeutic success of BTNs larger than 2 cm in size following US-guided TA. This model aids physicians in evaluating treatment efficacy and devising personalized prognostic plans. [ABSTRACT FROM AUTHOR]

Thyroid nodules are a common incidental imaging finding and prone to overdiagnosis. Several risk stratification systems have been developed to reduce unnecessary work-up, with two of the most utilized including the American Thyroid Association 2015 (ATA2015) and the newer American College of Radiology Thyroid Imaging, Reporting and Data System (TIRADS) guidelines. The purpose of this study is to evaluate the cost-effectiveness of the ATA2015 versus the TIRADS guidelines in the management of incidental thyroid nodules. A cost-utility analysis was conducted using decision tree modeling, evaluating adult patients with incidental thyroid nodules < 4 cm. Model inputs were populated using published literature, observational data, and expert opinion. Single-payer perspective, Canadian dollar currency, five-year time horizon, willingness to pay (WTP) threshold of $50,000, and discount rate of 1.5% per annum were utilized. Scenario, deterministic and probabilistic sensitivity analyses were performed. The primary outcome was the incremental cost-effectiveness ratio (ICER) expressed as incremental cost per quality-adjusted life year (QALY) gained. For the base case scenario, TIRADS dominated the ATA2015 strategy by a slim margin, producing 0.005 more QALYs at $25 less cost. Results were sensitive to the malignancy rate of biopsy and the utilities of a patient with a benign nodule/subclinical malignancy or under surveillance. Probabilistic sensitivity analysis showed that TIRADS was the more cost-effective option 79.7% of the time. The TIRADS guidelines may be the more cost-effective strategy by a small margin compared to ATA2015 in most scenarios when used to risk stratify incidental thyroid nodules. [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate Doppler ultrasound (US) vascularity patterns compared to morphological, radiological, and pathological thyroid nodule features to predict malignancy. Materials and Methods: A total of 257 thyroid nodules (173 in women and 84 in men) were examined. The blood supply patterns of the nodules were categorized with color Doppler US. as (-); no vascularity (+); intranodular microvascular punctuate, (++); rod, or fine branching peripheral, (+++); intense intranodular and peripheral vascular blood supply. Results: The data indicated a tendency for higher TI-RADS categories to exhibit higher Bethesda results, which are indicative of a higher risk of malignancy. TIRADS 5 had the highest percentage in Beth-6. A statistically significant difference was found between vascularity and nodule diameter. Among those nodules with (+) and (++) vascularity, the percentage of nodule diameters between 11 mm and 20 mm was the highest, while among those with (+++), the percentage of those >20 mm was the highest. The data indicated that even nodules with low vascularization (negative) could belong to higher TI-RADS categories. TI-RADS 5 nodules were evident in intranodular vascularity group. The percentage of those in the Bethesda 2 group according to vascularity was the highest. Bethesda 6 nodules had prominent intranodular vascularity among others. A statistically significant difference was found in all groups compared to vascularity (p<0.05). Conclusion: Along with other radiological findings, using Dopper US vascularity patterns in some nodule groups might elaborate the algorithm in predicting malignancy. This can accurately translate into better management planning, whether conservative, surgery, or invasive. [ABSTRACT FROM AUTHOR]

Thyroid nodules are a prevalent health issue in society. Interventional radiological methods are successfully applied for both the diagnosis and treatment of nodules. Diagnostically, a fine-needle aspiration biopsy and a core needle biopsy can be performed to ascertain the benign or malignant nature of a lesion. In recent years, imaging-guided percutaneous treatment methods have become popular in the treatment of thyroid nodules. Aspiration, ablation, and embolization are techniques employed in the treatment process. In this study, we aimed to discuss the current role of interventional radiology in the diagnosis and treatment of thyroid nodules, which occupy an important place in clinical practice. [ABSTRACT FROM AUTHOR]