AUTHOR=Xin Yuwei , Liu Feifei , Shi Yan , Yan Xiaohui , Liu Liping , Zhu Jiaan 

TITLE=A Scoring System for Assessing the Risk of Malignant Partially Cystic Thyroid Nodules Based on Ultrasound Features

JOURNAL=Frontiers in Oncology

VOLUME=Volume 11 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.731779

DOI=10.3389/fonc.2021.731779

ISSN=2234-943X

ABSTRACT=Objective:
To assess the US features of PCTNs and to establish a scoring system to further improve the diagnostic accuracy.
Methods:
A total of 277 consecutive nodules analyzed from September 2017 to March 2020 were included in a primary cohort to construct a scoring system. Moreover, 88 consecutive nodules were enrolled as an external independent validation cohort from May 2018 to August 2020. All nodules were determined to be benign or malignant according to the pathological results after surgery or ultrasound-guided fine-needle aspiration (US-FNA). The US images and demographic characteristics of the patients were analyzed. The ultrasound features of PCTNs were extracted from  primary cohort by two experienced radiologists. The features extracted were used to develop a scoring system using logistic regression analysis. Receiver operating characteristic (ROC) curves were applied to evaluate the diagnostic efficacy of the scoring system in both the primary cohort and external validation cohort. In addition, the radiologists evaluated the benign and malignant PCTNs of the external validation cohort according to the ACR TI-RADS guidelines and clinical experience, and the accuracy of their diagnoses were compared with that of the scoring system.
Results:
Based on the eight features of PCTNs, the scoring system showed good differentiation and reproducibility in both cohorts. The scoring system was based on eight features of PCTNs and showed good performance. The area under the curve (AUC) was 0.87 (95% CI, 0.824-0.907) in the primary cohort and 0.81 (95% CI, 0.709-0.883) in the external validation cohort. The optimal cutoff value of the scoring system for the diagnosis of malignant PCTNs was 4 points, with a good sensitivity of 76.32% and specificity of 82.59%. The scoring system (AUC=0.81) was superior to physicians (AUC= 0.70) in diagnosing PCTNs and is a promising method for clinical application.
Conclusions:
The scoring system described herein is a convenient and clinically valuable method that can diagnose PCTNs with relatively high accuracy. The use of this method to diagnose PCTNs, which have been previously underestimated, will allow PCTNs to receive reasonable attention, prevent the delay of intervention in patients with malignant PCTNs, and partially reduce the FNA invasive examination.