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Risk Stratification of Thyroid Nodule: From Ultrasound Features to TIRADS
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Risk Stratification of Thyroid Nodule: From Ultrasound Features to TIRADS

A special issue of Cancers (ISSN 2072-6694).

Deadline for manuscript submissions: closed (31 August 2021) | Viewed by 54664

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editor

Prof. Dr. Pierpaolo Trimboli

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Guest Editor
1. Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
2. Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
Interests: thyroid nodule; thyroid ultrasound; thyroid biopsy; thyroid cancer
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Since the 90s, ultrasound (US) has played a major role in the assessment of thyroid nodules and their risk of malignancy. During the last decade, the most eminent international societies have published their US-based systems for the risk stratification of thyroid lesions, namely, Thyroid Imaging Reporting And Data System (TIRADS). The introduction of TIRADSs into the clinical practice has significantly increased the diagnostic power of US to a level approaching that of fine-needle aspiration cytology (FNAC). At the present time, we are probably running toward a new era in which US could be the primary tool to diagnose thyroid cancer. However, before using US in this new dominant role we need further proof.

This Special Issue, including reviews and original articles, would like to pave the way for the future in the field of thyroid US. Highly experienced thyroidologists focused on US are asked to contribute to this honorable aim.

Prof. Dr. Pierpaolo Trimboli
Guest Editor

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • thyroid
  • cancer
  • nodule
  • ultrasound
  • Thyroid Imaging Reporting And Data Systems (TIRADS)
  • Risk of Malignancy (ROM)

Published Papers (15 papers)

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Editorial

Jump to: Research, Review, Other

2 pages, 176 KiB  
Editorial
Advancements in Ultrasound and Ultrasound-Based Risk Stratification Systems for the Assessment of Thyroid Nodule
by Pierpaolo Trimboli
Cancers 2022, 14(7), 1668; https://doi.org/10.3390/cancers14071668 - 25 Mar 2022
Viewed by 1380
Abstract
Ultrasound (US) is an essential in-office imaging procedure used for evaluating thyroid nodules [...] Full article
(This article belongs to the Special Issue Risk Stratification of Thyroid Nodule: From Ultrasound Features to TIRADS)
2 pages, 175 KiB  
Editorial
Ultrasound: The Extension of Our Hands to Improve the Management of Thyroid Patients
by Pierpaolo Trimboli
Cancers 2021, 13(3), 567; https://doi.org/10.3390/cancers13030567 - 2 Feb 2021
Cited by 5 | Viewed by 1461
Abstract
Ultrasonography (US) was introduced in the thyroid field in the 1980s to guide the biopsy of palpable, scintigraphically cold nodules [...] Full article
(This article belongs to the Special Issue Risk Stratification of Thyroid Nodule: From Ultrasound Features to TIRADS)

Research

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15 pages, 2044 KiB  
Article
Impact of the Hypoechogenicity Criteria on Thyroid Nodule Malignancy Risk Stratification Performance by Different TIRADS Systems
by Nina Malika Popova, Maija Radzina, Peteris Prieditis, Mara Liepa, Madara Rauda and Kaspars Stepanovs
Cancers 2021, 13(21), 5581; https://doi.org/10.3390/cancers13215581 - 8 Nov 2021
Cited by 4 | Viewed by 3700
Abstract
Background: Various Thyroid Imaging and Reporting data systems (TIRADS) are used worldwide for risk stratification of thyroid nodules. Their sensitivity is high, while the specificity is suboptimal. The aim of the study was to compare several TIRADS systems and evaluate the effect of [...] Read more.
Background: Various Thyroid Imaging and Reporting data systems (TIRADS) are used worldwide for risk stratification of thyroid nodules. Their sensitivity is high, while the specificity is suboptimal. The aim of the study was to compare several TIRADS systems and evaluate the effect of hypoechogenicity as a sign of risk of malignancy on the overall assessment of diagnostic accuracy. Methods: The prospective study includes 274 patients with 289 thyroid nodules to whom US and risk of malignancy were assessed according to four TIRADS systems—European (EU-TIRADS), Korean (K-TIRADS), TIRADS by American College of Radiology (ACR TIRADS), and modified Kwak et al. TIRADS (L-TIRADS) systems, in which mild hypoechogenicity is not included in malignancy risk suggestive signs. For all thyroid nodules, a fine needle aspiration (FNA) biopsy was performed and evaluated according to the Bethesda system. For all systems, diagnostic accuracy was calculated. Results: Assessing the echogenicity of the thyroid nodules: from 81 of isoechogenic nodules, 2 were malignant (2.1%), from 151 mild hypoechogenic, 18 (12%) were malignant, and from 48 marked hypoechogenic nodules, 16 (33%) were malignant. In 80 thyroid nodules, mild hypoechogenicity was the only sign of malignancy and none appeared malignant. Assessing various TIRADS systems on the same cohort, sensitivity, specificity, PPV, NPV, and accuracy, firstly for EU-TIRADS, they were 97.2%; 39.9%; 18.7%; 99.0%, and 73.3%, respectively; for K-TIRADS they were 97.2%; 46.6%; 20.6%; 99.2%, and 53.9%; for ACR-TIRADS they were 97.2%; 41.1%, 19.0%; 99.0%, and 48.0%, respectively; finally, for L-TIRADS they were 80.6%; 72.7%; 29.6%; 96.3%, and 73.3%. Conclusions: This comparative research has highlighted that applying different TIRADS systems can alter the number of necessary biopsies by re-categorization of the thyroid nodules. The main pattern that affected differences was inconsistent hypoechogenicity interpretation, giving the accuracy superiority to the systems that raise the malignancy risk with marked hypoechogenicity, at the same time with minor compensation for sensitivity. Full article
(This article belongs to the Special Issue Risk Stratification of Thyroid Nodule: From Ultrasound Features to TIRADS)
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13 pages, 591 KiB  
Article
Exploring the Performance of Ultrasound Risk Stratification Systems in Thyroid Nodules of Pediatric Patients
by Lorenzo Scappaticcio, Maria Ida Maiorino, Sergio Iorio, Giovanni Docimo, Miriam Longo, Anna Grandone, Caterina Luongo, Immacolata Cozzolino, Arnoldo Piccardo, Pierpaolo Trimboli, Emanuele Miraglia Del Giudice, Katherine Esposito and Giuseppe Bellastella
Cancers 2021, 13(21), 5304; https://doi.org/10.3390/cancers13215304 - 22 Oct 2021
Cited by 23 | Viewed by 1997
Abstract
Neck ultrasound (nUS) is the cornerstone of clinical management of thyroid nodules in pediatric patients, as well as adults. The current study was carried out to explore and compare the diagnostic performance of the main US-based risk stratification systems (RSSs) (i.e., the American [...] Read more.
Neck ultrasound (nUS) is the cornerstone of clinical management of thyroid nodules in pediatric patients, as well as adults. The current study was carried out to explore and compare the diagnostic performance of the main US-based risk stratification systems (RSSs) (i.e., the American College of Radiology (ACR), European (EU), Korean (K) TI-RADSs and ATA US RSS criteria) for detecting malignant thyroid lesions in pediatric patients. We conducted a retrospective analysis of consecutive children and adolescents who received a diagnosis of thyroid nodule. We included subjects with age <19 years having thyroid nodules with benign cytology/histology or final histological diagnosis. We excluded subjects with (a) a previous malignancy, (b) a history of radiation exposure, (c) cancer genetic susceptibility syndromes, (d) lymph nodes suspicious for metastases of thyroid cancer at nUS, (e) a family history of thyroid cancer, or (f) cytologically indeterminate nodules without histology and nodules with inadequate cytology. We included 41 nodules in 36 patients with median age 15 years (11–17 years). Of the 41 thyroid nodules, 29 (70.7%) were benign and 12 (29.3%) were malignant. For both ACR TI-RADS and EU-TIRADS, we found a sensitivity of 41.7%. Instead, for both K-TIRADS and ATA US RSS, we found a sensitivity of 50%. The missed malignancy rate for ACR-TIRADS and EU-TIRADS was 58.3%, while that for K-TIRADS and ATA US RSS was 50%. The unnecessary FNA prevalence for ACR TI-RADS and EU-TIRADS was 58.3%, while that for K-TIRADS and ATA US RSS was 76%. Our findings suggest that the four US-based RSSs (i.e., ACR-TIRADS, EU-TIRADS, K-TIRADS, and ATA US RSS) have suboptimal performance in managing pediatric patients with thyroid nodules, with one-half of cancers without indication for FNA according to their recommendations. Full article
(This article belongs to the Special Issue Risk Stratification of Thyroid Nodule: From Ultrasound Features to TIRADS)
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16 pages, 308 KiB  
Article
Validation of Four Thyroid Ultrasound Risk Stratification Systems in Patients with Hashimoto’s Thyroiditis; Impact of Changes in the Threshold for Nodule’s Shape Criterion
by Dorota Słowińska-Klencka, Mariusz Klencki, Martyna Wojtaszek-Nowicka, Kamila Wysocka-Konieczna, Ewa Woźniak-Oseła and Bożena Popowicz
Cancers 2021, 13(19), 4900; https://doi.org/10.3390/cancers13194900 - 29 Sep 2021
Cited by 5 | Viewed by 1618
Abstract
The aim of the study was to validate thyroid US malignancy features, especially the nodule’s shape, and selected Thyroid Imaging Reporting and Data Systems (EU-TIRADS; K-TIRADS; ACR-TIRADS, ATA guidelines) in patients with or without Hashimoto’s thyroiditis (HT and non-HT groups). The study included [...] Read more.
The aim of the study was to validate thyroid US malignancy features, especially the nodule’s shape, and selected Thyroid Imaging Reporting and Data Systems (EU-TIRADS; K-TIRADS; ACR-TIRADS, ATA guidelines) in patients with or without Hashimoto’s thyroiditis (HT and non-HT groups). The study included 1188 nodules (HT: 358, non-HT: 830) with known final diagnoses. We found that the strongest indications of nodule’s malignancy were microcalcifications (OR: 22.7) in HT group and irregular margins (OR:13.8) in non-HT group. Solid echostructure and macrocalcifications were ineffective in patients with HT. The highest accuracy of nodule’s shape criterion was noted on transverse section, with the cut-off value of anteroposterior to transverse dimension ratio (AP/T) close to 1.15 in both groups. When round nodules were regarded as suspicious in patients with HT (the cut-off value of AP/T set to ≥1), it led to a three-fold increase in sensitivity of this feature, with a disproportionally lower decrease in specificity and similar accuracy. Such a modification was effective also for cancers other than PTC. The diagnostic effectiveness of analyzed TIRADS in patients with HT and without HT was similar. Changes in the threshold for AP/T ratio influenced the number of nodules classified into the category of the highest risk, especially in the case of EU-TIRADS. Full article
(This article belongs to the Special Issue Risk Stratification of Thyroid Nodule: From Ultrasound Features to TIRADS)
10 pages, 754 KiB  
Article
Facing Thyroid Nodules in Paediatric Patients Previously Treated with Radiotherapy for Non-Thyroidal Cancers: Are Adult Ultrasound Risk Stratification Systems Reliable?
by Arnoldo Piccardo, Francesco Fiz, Gianluca Bottoni, Camilla De Luca, Michela Massollo, Ugo Catrambone, Luca Foppiani, Monica Muraca, Alberto Garaventa and Pierpaolo Trimboli
Cancers 2021, 13(18), 4692; https://doi.org/10.3390/cancers13184692 - 18 Sep 2021
Cited by 10 | Viewed by 1969
Abstract
Thyroid nodule ultrasound-based risk stratification systems (US-RSSs) have been successfully used in adults to predict the likelihood of malignancies. However, their applicability to the paediatric population is unclear, especially in children with a history of radiation exposure, who are at a higher cancer [...] Read more.
Thyroid nodule ultrasound-based risk stratification systems (US-RSSs) have been successfully used in adults to predict the likelihood of malignancies. However, their applicability to the paediatric population is unclear, especially in children with a history of radiation exposure, who are at a higher cancer risk. We tested the efficacy of three US-RSSs in this setting by retrospectively applying three classification systems (ACR-TIRADS, ATA and EU-TIRADS) to all paediatric patients referred for thyroid nodules and with a radiation exposure history. We compared the results with a reference standard (pathology or 36-month follow-up); sensitivity, specificity, positive and negative predictive values (PPV and NPV) and accuracy were calculated. A total of 52 patients were included; fourteen of them (27%) had papillary thyroid cancer (PTC) at the final histology. No significant differences across the US-RSSs were detected; specificity (range 95–97%) and NPV (range 88–93%) were particularly elevated. However, ACR-TIRADS, ATA and EU-TIRADS did not indicate the need for a biopsy in six (42.8%), seven (50%) and eight (57%) cases of PTC; in five cases, this lack of indication was due to a small (<1 cm) nodule size. In conclusion, US-RSSs show a high NPV and specificity in paediatric patients, whereas the cytology indication could be improved by reconsidering the dimensional criterion. Full article
(This article belongs to the Special Issue Risk Stratification of Thyroid Nodule: From Ultrasound Features to TIRADS)
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14 pages, 1372 KiB  
Article
Diagnostic Performance of Kwak, EU, ACR, and Korean TIRADS as Well as ATA Guidelines for the Ultrasound Risk Stratification of Non-Autonomously Functioning Thyroid Nodules in a Region with Long History of Iodine Deficiency: A German Multicenter Trial
by Philipp Seifert, Simone Schenke, Michael Zimny, Alexander Stahl, Michael Grunert, Burkhard Klemenz, Martin Freesmeyer, Michael C. Kreissl, Ken Herrmann and Rainer Görges
Cancers 2021, 13(17), 4467; https://doi.org/10.3390/cancers13174467 - 4 Sep 2021
Cited by 25 | Viewed by 3672
Abstract
Germany has a long history of insufficient iodine supply and thyroid nodules occur in over 30% of the adult population, the vast majority of which are benign. Non-invasive diagnostics remain challenging, and ultrasound-based risk stratification systems are essential for selecting lesions requiring further [...] Read more.
Germany has a long history of insufficient iodine supply and thyroid nodules occur in over 30% of the adult population, the vast majority of which are benign. Non-invasive diagnostics remain challenging, and ultrasound-based risk stratification systems are essential for selecting lesions requiring further clarification. However, no recommendation can yet be made about which system performs the best for iodine deficiency areas. In a German multicenter approach, 1211 thyroid nodules from 849 consecutive patients with cytological or histopathological results were enrolled. Scintigraphically hyperfunctioning lesions were excluded. Ultrasound features were prospectively recorded, and the resulting classifications according to five risk stratification systems were retrospectively determined. Observations determined 1022 benign and 189 malignant lesions. The diagnostic accuracies were 0.79, 0.78, 0.70, 0.82, and 0.79 for Kwak Thyroid Imaging Reporting and Data System (Kwak-TIRADS), American College of Radiology (ACR) TI-RADS, European Thyroid Association (EU)-TIRADS, Korean-TIRADS, and American Thyroid Association (ATA) Guidelines, respectively. Receiver Operating Curves revealed Areas under the Curve of 0.803, 0.795, 0.800, 0.805, and 0.801, respectively. According to the ATA Guidelines, 135 thyroid nodules (11.1%) could not be classified. Kwak-TIRADS, ACR TI-RADS, and Korean-TIRADS outperformed EU-TIRADS and ATA Guidelines and therefore can be primarily recommended for non-autonomously functioning lesions in areas with a history of iodine deficiency. Full article
(This article belongs to the Special Issue Risk Stratification of Thyroid Nodule: From Ultrasound Features to TIRADS)
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11 pages, 977 KiB  
Article
Diagnostic Algorithm for Metastatic Lymph Nodes of Differentiated Thyroid Carcinoma
by Sae Rom Chung, Jung Hwan Baek, Young Jun Choi, Tae-Yon Sung, Dong Eun Song, Tae Yong Kim and Jeong Hyun Lee
Cancers 2021, 13(6), 1338; https://doi.org/10.3390/cancers13061338 - 16 Mar 2021
Cited by 17 | Viewed by 2005
Abstract
We aimed to evaluate appropriate strategies for interpreting fine-needle aspiration cytology (FNAC) and thyroglobulin concentrations obtained through aspiration (FNA-Tg) results based on the sonographic features of lymph nodes (LNs). Consecutive patients who underwent ultrasound-guided FNAC and FNA-Tg for metastatic LNs from differentiated thyroid [...] Read more.
We aimed to evaluate appropriate strategies for interpreting fine-needle aspiration cytology (FNAC) and thyroglobulin concentrations obtained through aspiration (FNA-Tg) results based on the sonographic features of lymph nodes (LNs). Consecutive patients who underwent ultrasound-guided FNAC and FNA-Tg for metastatic LNs from differentiated thyroid carcinomas (DTCs) from January 2014 to December 2018 were reviewed retrospectively. LNs were categorized sonographically as suspicious, indeterminate, or benign. The optimal FNA-Tg cutoff for metastatic LNs was evaluated preoperatively, after lobectomy, and after total thyroidectomy. The diagnostic performances of FNA-Tg, FNAC, and their combination were analyzed based on the sonographic features of LNs. The malignancy rates of LNs were analyzed based on the sonographic features, FNAC, and FNA-Tg results. Of the 1543 LNs analyzed, 528 were benign, whereas 1015 were malignant. FNA-Tg increased the sensitivity and accuracy of FNAC for LNs. The malignancy rate of LNs found to be malignant by FNAC or elevated FNA-Tg ranged from 82% to 100%, regardless of the sonographic features. The malignancy rate of LNs with indeterminate or benign FNAC findings and low FNA-Tg were stratified according to their sonographic features. We propose a diagnostic algorithm, based on combined FNAC, FNA-Tg, and ultrasound features of LNs, for diagnosing metastatic LNs of DTCs. Full article
(This article belongs to the Special Issue Risk Stratification of Thyroid Nodule: From Ultrasound Features to TIRADS)
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16 pages, 1182 KiB  
Article
Sonographic Features Differentiating Follicular Thyroid Cancer from Follicular Adenoma–A Meta-Analysis
by Martyna Borowczyk, Kosma Woliński, Barbara Więckowska, Elżbieta Jodłowska-Siewert, Ewelina Szczepanek-Parulska, Frederik A. Verburg and Marek Ruchała
Cancers 2021, 13(5), 938; https://doi.org/10.3390/cancers13050938 - 24 Feb 2021
Cited by 15 | Viewed by 2950
Abstract
Certain ultrasound features are associated with an increased risk of thyroid malignancy. However, they were studied mainly in papillary thyroid cancers (PTCs); these results cannot be simply extrapolated for the differentiation of follicular thyroid adenomas and cancers (FTAs and FTCs). The aim of [...] Read more.
Certain ultrasound features are associated with an increased risk of thyroid malignancy. However, they were studied mainly in papillary thyroid cancers (PTCs); these results cannot be simply extrapolated for the differentiation of follicular thyroid adenomas and cancers (FTAs and FTCs). The aim of our study was to perform a meta-analysis to identify sonographic features suggesting malignancy in the case of follicular lesions, potentially differentiating FTA and FTC. We searched thirteen databases from January 2006 to December 2020 to find all relevant, full-text journal articles written in English. Analyses assessed the accuracy of malignancy detection in case of follicular lesions, potentially differentiating FTA and FTC included the odds ratio (OR), sensitivity, specificity, positive and negative predictive values. A random-effects model was used to summarize collected data. Twenty studies describing sonographic features of 10,215 nodules met the inclusion criteria. The highest overall ORs to increase the risk of malignancy were calculated for tumor protrusion (OR = 10.19; 95% confidence interval: 2.62–39.71), microcalcifications or mixed type of calcifications (coexisting micro and macrocalcifications): 6.09 (3.22–11.50), irregular margins: 5.11 (2.90–8.99), marked hypoechogenicity: 4.59 (3.23–6.54), and irregular shape: 3.6 (1.19–10.92). The most crucial feature associated with an increased risk of FTC is capsule protrusion, followed by the presence of calcifications, irrespectively of their type. Full article
(This article belongs to the Special Issue Risk Stratification of Thyroid Nodule: From Ultrasound Features to TIRADS)
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Review

Jump to: Editorial, Research, Other

12 pages, 291 KiB  
Review
Risk Stratification of Thyroid Nodules: From Ultrasound Features to TIRADS
by Teresa Rago and Paolo Vitti
Cancers 2022, 14(3), 717; https://doi.org/10.3390/cancers14030717 - 30 Jan 2022
Cited by 16 | Viewed by 4458
Abstract
Thyroid nodules are common in iodine deficient areas, in females, and in patients undergoing neck irradiation. High-resolution ultrasonography (US) is important for detecting and evaluating thyroid nodules. US is used to determine the size and features of thyroid nodules, as well as the [...] Read more.
Thyroid nodules are common in iodine deficient areas, in females, and in patients undergoing neck irradiation. High-resolution ultrasonography (US) is important for detecting and evaluating thyroid nodules. US is used to determine the size and features of thyroid nodules, as well as the presence of neck lymph node metastasis. It also facilitates guided fine-needle aspiration (US-FNA). The most consistent US malignancy features of thyroid nodules are spiculated margins, microcalcifications, a taller-than-wide shape, and marked hypoechogenicity. Increased nodular vascularization is not identified as a predictor of malignancy. Thyroid elastosonography (USE) is also used to characterize thyroid nodules. In fact, a low elasticity of nodules at USE has been related to a higher risk of malignancy. According to their US features, thyroid nodules can be stratified into three categories: low-, intermediate-, and high-risk nodules. US-FNA is suggested for intermediate and high-risk nodules. Full article
(This article belongs to the Special Issue Risk Stratification of Thyroid Nodule: From Ultrasound Features to TIRADS)
19 pages, 30658 KiB  
Review
Performance of Contrast-Enhanced Ultrasound in Thyroid Nodules: Review of Current State and Future Perspectives
by Maija Radzina, Madara Ratniece, Davis Simanis Putrins, Laura Saule and Vito Cantisani
Cancers 2021, 13(21), 5469; https://doi.org/10.3390/cancers13215469 - 30 Oct 2021
Cited by 43 | Viewed by 6918
Abstract
Ultrasound has been established as a baseline imaging technique for thyroid nodules. The main advantage of adding CEUS is the ability to assess the sequence and intensity of vascular perfusion and hemodynamics in the thyroid nodule, thus providing real-time characterization of nodule features, [...] Read more.
Ultrasound has been established as a baseline imaging technique for thyroid nodules. The main advantage of adding CEUS is the ability to assess the sequence and intensity of vascular perfusion and hemodynamics in the thyroid nodule, thus providing real-time characterization of nodule features, considered a valuable new approach in the determination of benign vs. malignant nodules. Original studies, reviews and six meta-analyses were included in this article. A total of 624 studies were retrieved, and 107 were included in the study. As recognized for thyroid nodule malignancy risk stratification by US, for acceptable accuracy in malignancy a combination of several CEUS parameters should be applied: hypo-enhancement, heterogeneous, peripheral irregular enhancement in combination with internal enhancement patterns, and slow wash-in and wash-out curve lower than in normal thyroid tissue. In contrast, homogeneous, intense enhancement with smooth rim enhancement and “fast-in and slow-out” are indicative of the benignity of the thyroid nodule. Even though overlapping features require standardization, with further research, CEUS may achieve reliable performance in detecting or excluding thyroid cancer. It can also play an operative role in guiding ablation procedures of benign and malignant thyroid nodules and metastatic lymph nodes, and providing accurate follow-up imaging to assess treatment efficacy. Full article
(This article belongs to the Special Issue Risk Stratification of Thyroid Nodule: From Ultrasound Features to TIRADS)
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18 pages, 2779 KiB  
Review
Artificial Intelligence in Thyroid Field—A Comprehensive Review
by Fabiano Bini, Andrada Pica, Laura Azzimonti, Alessandro Giusti, Lorenzo Ruinelli, Franco Marinozzi and Pierpaolo Trimboli
Cancers 2021, 13(19), 4740; https://doi.org/10.3390/cancers13194740 - 22 Sep 2021
Cited by 22 | Viewed by 3952
Abstract
Artificial intelligence (AI) uses mathematical algorithms to perform tasks that require human cognitive abilities. AI-based methodologies, e.g., machine learning and deep learning, as well as the recently developed research field of radiomics have noticeable potential to transform medical diagnostics. AI-based techniques applied to [...] Read more.
Artificial intelligence (AI) uses mathematical algorithms to perform tasks that require human cognitive abilities. AI-based methodologies, e.g., machine learning and deep learning, as well as the recently developed research field of radiomics have noticeable potential to transform medical diagnostics. AI-based techniques applied to medical imaging allow to detect biological abnormalities, to diagnostic neoplasms or to predict the response to treatment. Nonetheless, the diagnostic accuracy of these methods is still a matter of debate. In this article, we first illustrate the key concepts and workflow characteristics of machine learning, deep learning and radiomics. We outline considerations regarding data input requirements, differences among these methodologies and their limitations. Subsequently, a concise overview is presented regarding the application of AI methods to the evaluation of thyroid images. We developed a critical discussion concerning limits and open challenges that should be addressed before the translation of AI techniques to the broad clinical use. Clarification of the pitfalls of AI-based techniques results crucial in order to ensure the optimal application for each patient. Full article
(This article belongs to the Special Issue Risk Stratification of Thyroid Nodule: From Ultrasound Features to TIRADS)
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Graphical abstract

21 pages, 851 KiB  
Review
The New Era of TIRADSs to Stratify the Risk of Malignancy of Thyroid Nodules: Strengths, Weaknesses and Pitfalls
by Gilles Russ, Pierpaolo Trimboli and Camille Buffet
Cancers 2021, 13(17), 4316; https://doi.org/10.3390/cancers13174316 - 26 Aug 2021
Cited by 23 | Viewed by 10242
Abstract
Since 2009, thyroid imaging reporting and data systems (TI-RADS) have been playing an increasing role in the field of thyroid nodules (TN) imaging. Their common aims are to provide sonologists of varied medical specialties and clinicians with an ultrasound (US) based malignancy risk [...] Read more.
Since 2009, thyroid imaging reporting and data systems (TI-RADS) have been playing an increasing role in the field of thyroid nodules (TN) imaging. Their common aims are to provide sonologists of varied medical specialties and clinicians with an ultrasound (US) based malignancy risk stratification score and to guide decision making of fine-needle aspiration (FNA). Schematically, all TI-RADSs scores can be classified as either pattern-based or point-based approaches. The main strengths of these systems are their ability (i) to homogenize US TN descriptions among operators, (ii) to facilitate and shorten communication on the malignancy risk of TN between sonologists and clinicians, (iii) to provide quantitative ranges of malignancy risk assessment with high sensitivity and negative predictive values, and (iv) to reduce the number of unnecessary FNAs. Their weaknesses are (i) the remaining inter-observer discrepancies and (ii) their insufficient sensitivity for the diagnosis of follicular cancers and follicular variant of papillary cancers. Most common pitfalls are degenerating shrinking nodules and confusion between individual and coalescent nodules. The benefits of all TI-RADSs far outweigh their shortcomings, explaining their rising use, but the necessity to improve and merge the different existing systems remains. Full article
(This article belongs to the Special Issue Risk Stratification of Thyroid Nodule: From Ultrasound Features to TIRADS)
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12 pages, 1156 KiB  
Review
Overview of the Ultrasound Classification Systems in the Field of Thyroid Cytology
by Esther Diana Rossi, Liron Pantanowitz, Marco Raffaelli and Guido Fadda
Cancers 2021, 13(13), 3133; https://doi.org/10.3390/cancers13133133 - 23 Jun 2021
Cited by 8 | Viewed by 3103
Abstract
The increasing application of ultrasound (US) in recent years has led to a greater number of thyroid nodule diagnoses. Consequently, the number of fine needle aspirations performed to evaluate these lesions has increased. Although the majority of thyroid nodules are benign, identifying methods [...] Read more.
The increasing application of ultrasound (US) in recent years has led to a greater number of thyroid nodule diagnoses. Consequently, the number of fine needle aspirations performed to evaluate these lesions has increased. Although the majority of thyroid nodules are benign, identifying methods to define specific lesions and tailor risk of malignancy has become vital. Some of the tools employed to stratify thyroid nodule risk include clinical factors, thyroid US findings, and reporting systems for thyroid cytopathology. Establishing high concordance between US features and cytologic diagnoses might help reduce healthcare costs by diminishing unnecessary thyroid procedures and treatment. This review aims to review radiology US classification systems that influence the practice of thyroid cytology. Full article
(This article belongs to the Special Issue Risk Stratification of Thyroid Nodule: From Ultrasound Features to TIRADS)
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Other

17 pages, 1093 KiB  
Systematic Review
Current Status and Challenges of US-Guided Radiofrequency Ablation of Thyroid Nodules in the Long Term: A Systematic Review
by Stella Bernardi, Andrea Palermo, Rosario Francesco Grasso, Bruno Fabris, Fulvio Stacul and Roberto Cesareo
Cancers 2021, 13(11), 2746; https://doi.org/10.3390/cancers13112746 - 1 Jun 2021
Cited by 19 | Viewed by 3599
Abstract
Background: US-guided minimally-invasive techniques, such as radiofrequency ablation (RFA) have emerged as an alternative treatment for benign and malignant thyroid nodules. This systematic review aims to provide an overview on the long-term outcomes of US-guided RFA in patients with benign and malignant thyroid [...] Read more.
Background: US-guided minimally-invasive techniques, such as radiofrequency ablation (RFA) have emerged as an alternative treatment for benign and malignant thyroid nodules. This systematic review aims to provide an overview on the long-term outcomes of US-guided RFA in patients with benign and malignant thyroid nodules. Methods: We systematically searched PubMed/MEDLINE, EMBASE, and Scopus to identify articles reporting the outcomes of thyroid RFA after a follow-up of at least 3 years. Results: A total of 20 studies met the inclusion criteria and were included in the review. In patients with benign thyroid nodules, RFA significantly reduced nodule volume and this was generally maintained for the following 5 years. However, a small but not negligible proportion of nodules regrew and some of them required further treatments over time. In patients with malignant nodules, RFA has been used not only to treat differentiated thyroid cancer (DTC) neck recurrences, but also to treat papillary thyroid microcarcinoma (PTMC). In most patients with PTMC, RFA led to complete disappearance of the tumor. When it was compared to surgery, RFA was not inferior in terms of oncologic efficacy but it had a lower complication rate. However, RFA did not allow for final pathology, disease staging and accurate risk stratification. Conclusions: US-guided RFA significantly reduces benign thyroid nodules and destroys most PTMC, and this is generally maintained for at least 5 years after the initial treatment. Further studies addressing the risk of regrowths in patients with benign thyroid nodules, as well as the risk of recurrence in patients with PTMC are needed. Full article
(This article belongs to the Special Issue Risk Stratification of Thyroid Nodule: From Ultrasound Features to TIRADS)
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