Diagnostic Performance Ultrasonographic features and malignancy risk of medullary thyroid carcinoma: compare by papillary thyroid carcinoma

doi:10.21203/rs.3.rs-4819192/v1

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Diagnostic Performance Ultrasonographic features and malignancy risk of medullary thyroid carcinoma: compare by papillary thyroid carcinoma

https://doi.org/10.21203/rs.3.rs-4819192/v1

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Conclusion: MTCs exhibited malignant sonographic features similar to PTCs, but also had their own unique characteristics. C-TIRADS was more suitable for distinguishing MTCs from PTCs than the Kwak-TIRADS and ACR-TIRADS, but their diagnostic performance values were not ideal.

Objective: To compare ultrasonographic characteristics and diagnostic performance of medullary thyroid carcinomas (MTCs)and papillary thyroid carcinomas (PTCs) with three Thyroid Imaging Reporting and Data Systems (TIRADS), TIRADS proposed by Kwak (Kwak-TIRADS), the Chinese-TIRADS (C-TIRADS) and the 2017 American College of Radiology management guidelines (ACR-TIRADS).

Methods: This retrospective study was approved by the Ruijin hospital institutional review board.118 MTC nodules in 96 patients and 511 PTC nodules in 381 patients were included and that all were surgically and pathologically confirmed. Age, size and multiplicity were analyzed by independent sample t test. Sex and sonographic features, including position, composition, echogenicity, shape, border, margin, microcalcification, vascularization distribution and degree were evaluated byχ²orFisher exact test. Each thyroid nodule was categorized by Kwak-TIRADS, C-TIRADS and ACR-TIRADS, and the diagnostic performances was evaluated by receiver operating characteristic (ROC) curves.

Results: MTCs had a large size, and most of them were larger than 1 cm (P=0.000). Female patients were more common in this study(P=0.035). There was no statistical difference between MTCs and PTCs in age and multiplicity (P > 0.05). The significant statistical differences appeared in various ultrasound features between PTCs and MTCs (P < 0.05).C-TIRADS had the highest diagnostic efficacy (AUC=0.721), followed by Kwak-TIRADS (AUC=0.695) and the lowest ACR-TIRADS (AUC=0.523) (P<0.0001). Best cut-off point for Kwak-TIRADS, C-TIRADS and ACR-TIRADS were 4c, 4c and TR5. Among the three types of TIRADS, C-TIRADS had the highest sensitivity (66.73%) and negative predictive value (NPV) (32.00%), while KWAK-TIRADS had the highest specificity (72.03%) and positive predictive value (PPV) (90.52%).

medullary thyroid carcinoma

papillary thyroid carcinoma

ultrasound

TIRADS

Medullary thyroid carcinoma (MTC) was an uncommon and aggressive thyroid carcinoma with poor prognosis [1, 2] which was prone to lymph node metastasis and organs invasion. The average survival time was 8.6 years, and the 10-years survival rates ranged from 69 to 89% [3]. All of these characteristics gave us an important hint that early detection and treatment was the effective measure to ameliorate the survival and quality of life for MTCs patients.

Ultrasound (US) was still the preferred examination method for thyroid nodules. With the deepening of research on benign and malignant thyroid nodules, more and more Thyroid Imaging Reporting and Data System (TIRADS) or guidelines based on ultrasound features had been proposed to category the malignancy risk of thyroid nodules and guided the application of fine needle aspiration (FNA), such as TIRADS proposed by Kwak (Kwak-TIRADS)[4], the Chinese-TIRADS (C-TIRADS)[5] and the 2017 American College of Radiology TIRADS (ACR-TIRADS) [6].TIRADS is useful to standardize ultrasound diagnosis and improve diagnostic accuracy, further providing effective intervention guidelines for clinical doctors[7, 8]. A meta-analysis about TI-RADS of 10, 437 cases showed that the diagnostic sensitivity and specificity of TI-RADS was 0.79 and 0.71, respectively [9]. However, the vast majority of TIRADSs were based on research on benign thyroid nodules and papillary thyroid cancer (PTC), and there were few ultrasound risk scores or diagnostic guidelines for MTCs. To the best of our knowledge, there were only two studies on the diagnostic efficacy of TIRADS involved MTCs [10, 11].

In this study, to investigate the diagnostic performance of the currently used TIRADS for MTCs, we used the Kwak-TIRADS, C-TIRADS and ACR-TIRADS to compare the sonographic features and risk stratifications of MTCs and PTCs nodules, and then evaluated the diagnostic accuracy of the three TIRADSs for MTC.

This retrospective study was approved by the Ruijin Hospital Institutional Review Board, with waiver of informed consent. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013).

Patients

A total of 112 MTCs nodules in 96 patients from January 2008 to December 2016 and 511 PTCs nodules in 381 patients from June to December 2016 were included in this study. All patients were surgically and pathologically diagnosed in our hospital. Patients was excluded from the study if they met the following criteria: (I) incomplete clinical information; (II) the ultrasound images of thyroid nodules did not meet the requirements; (III) merge other types of thyroid cancer. General clinical features including age, sex, nodules size and multiplicity were compared between MTCs and PTCs.

Sonographic examinations and imaging analysis

US examinations of thyroid and the cervical regions including grayscale and Doppler sonography were conducted by MyLab 90 (Italy), Philips IU22 (New York) and GE LOGIQ E9 (New York) with a 5-12MHz linear array probe. All preoperative images were analyzed by the same sonographer who had more than 15 years experiences.

The ultrasound characteristic classification of nodules was made by position (upper and lower pole), composition (solid and mixed), echogenicity (markedly hypoechoic, hypoechoic, isoechoic and hyperechoic), shape (tall than wide and wide than tall), border (clear and obscure), margin (regular and irregular), microcalcification (microcalcifications were defined as hyperechoic spots less than 2mm). Vascularization distribution of nodules was classified as external or internal. Vascularization degree was classified as high, medium, low and none [12].

Three TIRADS

Each thyroid nodule was classified according to the three TIRADSs: Kwak-TIRADS, C-TIRADS and ACR-TIRADS. The higher the classification, the higher the risk of malignant tumors in nodules.

Kwak-TIRADS and C-TIRADS categorized thyroid nodules by counting the number of suspicious malignant US features. Category TR 4 in both Kwak-TIRADS and C-TIRADS were further divided into TR 4a, 4b, and 4c. Five suspicious US features were included in Kwak-TIRADS [4], the solid composition, hypoechoic intensity, a taller-than-wide shape, irregular margins and microcalcifications. Based on the number of features to classify as TR 3 (probably benign, no suspicious US features), TR 4a (low suspicion, 1 suspicious feature), TR 4b (intermediate suspicious, 2 suspicious features), TR 4c (moderate concern but not classic, 3 or 4 suspicious features), and TR 5 (highly suspicious, 5 suspicious features).

Similarly, C-TIRADS [5] also defined five US characteristics, including vertical orientation, solid composition, markedly hypoechoic, microcalcifications, ill-defined/irregular margins or extrathyroidal extension. But, it was worth noting that C-TIRADS treated the comet tail artifacts as a negative feature. This meant that if there was a comet tail in the nodule, one point should be subtracted from total.

ACR-TIRADS incorporated 5 key ultrasound features: structure, echogenicity, shape, margin, and echogenic foci. It reclassified each feature and assigned different scores through weights. Then, the total score for each thyroid nodule was calculated, and the risk stratification was classified into the following 5 levels: TIRADS (TR) 1 (benign), TR 2 (not suspicious), TR 3 (mild suspicious), TR4 (moderate suspicious), and TR5 (highly suspicious) [6].

Data and Statistical Analyses

Statistical analysis was performed with SPSS version 17.0 software. Variables were recorded as numbers (percentages) or mean ± standard deviation (SD). Categorical variables were analyzed by using chi-square test or Fisher’s exact test, and the continuous variables were analyzed by using independent t-test. Receiver operating characteristic (ROC) curves were established by MedCalc version 19.0 Software according to the grading of MTCs and PTCs. Then, Z-test was used to compare the diagnosis efficiency according to the area under each curve (AUC). Subsequently, sensitivity, specificity, positive predictive value (NPV), negative predictive (PPV) and Youden index of the best cut-off were used to evaluate the diagnostic performance for MTCs and PTCs. Statistical significance was defined for P < 0.05.

Clinic data and results

This study included 96 patients with 118 MTCs and 381 patients with 511 PTCs. The general clinical features of patients were presented in Table 1. The two types of thyroid carcinomas were more common in female, and female with PTCs were much more than MTCs (72.44% vs 61.46, P = 0.035).The size of MTCs nodules was significantly bigger than PTCs nodules (10.40 mm ± 8.17[size range, 2.0-46.8 mm]vs 8.7 mm ± 6.4[size range, 1.5–45.0 mm], respectively; P = 0.000). Furthermore, the proportion of MTCs nodules with the max diameters ≥ 10mm was much higher than that of PTCs (63.55% vs 24.9%, P = 0.000).MTCs had a higher multiplicity rate than PTCs (35.7% vs 25.2%), but there was not significance (P = 0.375). Also, there was no statistical significance in age between MTCs and PTCs(P = 0.112).

Table 1

Clinical features of the MTC and PTC patients.
Parameter	No. of MTC	No. of PTC	P Value
No. of nodules	118	511
No. of patients	96	381
Age (y)			0.112
Mean	41.30 ± 14.07	44.7 ± 12.3
Range	13–82	16–84
Sex			0.035
M	37(38.54)	105(27.56)
F	59(61.46)	276(72.44)
Size (mm)			0.000
Mean	10.40 ± 8.17	8.7 ± 6.4
Range	2.0-46.8	1.5–45.0
≤ 1.0cm (%)	43(36.44)	384(75.1)	0.000
>1.0cm (%)	75 (63.55)	127(24.9)	0.000
Multiplicity (%)	42(35.59)	129(25.2)	0.375

Ultrasound features of MTCs and PTCs

As shown in Table 2, 61.06% PTCs were located in the upper pole of thyroid glands, while the MTCs located in the upper and lower poles account for 50% respectively (P = 0.030).Most MTCs and PTCs nodules had solid internal composition, but the mixed composition was more commonly detected in MTCs than in PTCs (15.25% vs 2.35%, P = 0.000).Thyroid nodules with marked hypoechoic and hypoechoic accounted for the vast majority of MTCs and PTCs, whereas there were more MTCs with hyperechoic and isoechoic than PTCs (4.24% vs 0.39%, P = 0.002).Tall than wide was more common in PTCs, while wide than tall was more commonly detected in MTCs (54.79% vs 83.90%, P = 0.000).50% MTCs showed obscure border, and it was 72.02% in PTCs (P = 0.000). MTCs were mostly irregular margin, while most PTCs had regular margin (75.42% vs 82.97%, P = 0.000). There were more PTCs that presented microcalcifications than MTCs (38.94% vs 23.73%, P = 0.002). MTCs were mostly of external vascularization distribution, while PTCs were internal (90.68% vs 50.68%, P = 0.000). Furthermore, MTCs were mostly characterized by medium and high vascularization degree, while PTCs had no or low blood supply (59.32% vs 73.78%, P = 0.000).

Table 2

US features of the MTC and PTC.
Feature		MTC	PTC	P Value
Position				0.030
	Upper pole (%)	59 (50.0)	312 (61.06)
	Lower pole (%)	59(50.0)	199 (38.94)
Composition				0.000
	Solid (%)	100 (84.75)	499 (97.65)
	Mixed (%)	18(15.25)	12 (2.35)
Echogenicity				0.002
	Hyperechoic and isoechoic (%)	5 (4.24)	2 (0.39)
	Marked hypoechoic and hypoechoic (%)	113(95.76)	509 (99.61)
Shape				0.000
	Wide than tall (%)	99(83.90)	231 (45.21)
	Tall than wide (%)	19(16.10)	280 (54.79)
Border				0.000
	Clear (%)	59(50.00)	143 (27.98)
	Obscure (%)	59(50.00)	368 (72.02)
Margin				0.000
	Regular (%)	29 (24.58)	424 (82.97)
	Irregular (%)	89 (75.42)	87 (17.03)
Micalcification				0.002
	None (%)	90 (76.27)	312 (61.06)
	Present (%)	28(23.73)	199 (38.94)
Vascularization distribution
	External (%)	107 (90.68)	252 (49.32)	0.000
	Internal (%)	11 (9.32)	259 (50.68)
Vascularization degree
	None and low (%)	48(40.68)	377 (73.78)	0.000
	Medium and high (%)	70(59.32)	134 (26.22)

Risk category of MTCs and PTCs according to three TIRADS

Table 3 showed the distribution of MTCs and PTCs nodules malignancy risk rates. MTCs nodules categoried3, 4A, 4B, 4C and 5 were 0%, 6.78%, 16.10%, 76.27% and 0.85% by Kwak-TIRADS, while PTCs accounted for 0.20%, 0.59%, 8.22%, 76.71% and 14.29%. In C-TIRADS, MTCs rated as 3, 4A, 4B, 4C, 5 accounted for 2.54%,19.49%, 46.61%, 0, whereas PTCs accounted for 0.78%, 4.89%, 27.20%, 64.77%, and 2.35% respectively. According to ACR-TIRADS, 1.69%, 1.69%, 27.97%, 68.64% of MTCs were graded 2, 3, 4, and 5, respectively, while 0.78%, 0%, 27.40%, 71.82% of PTCs had the corresponding grade. There were statistically significant differences in MTCs and PTCs between categories with Kwak-TIRADS, 2017 ACR and C-TIRADS (P = 0.000, P = 0.022 and P = 0.000).

Table 3

ThreeTI-RADS risk category of MTCs and PTCs.
	TIRADS Category	MTC	PTC	P Value
Kwak-TIRADS				0.000
	3	0	1(0.20%)	0.812
	4A	8 (6.78%)	3(0.59%)	0.000
	4B	19 (16.10%)	42(8.22%)	0.010
	4C	90 (76.27%)	392(76.71%)	0.502
	5	1 (0.85%)	73(14.29%)	0.000
C-TIRADS				0.000
	3	3(2.54%)	4(0.78%)	0.126
	4A	22(19.49%)	25(4.89%)	0.000
	4B	52(46.61%)	139(27.20%)	0.000
	4C	35(31.36%)	331(64.77%)	0.000
	5	0(0%)	12(2.35%)	0.081
ACR-TIRADS				0.022
	2	2(1.69%)	4(0.78%)	0.314
	3	2(1.69%)	0	0.035
	4	33(27.97%)	140(27.40%)	0.492
	5	81(68.64%)	367(71.82%)	0.281

Diagnostic performance of three TIRADS for PTCs and MTCs

Three ROC curves were presented in Fig. 1. The AUC of Kwak-TIRADS, C-TIRADS and ACR-TIRADS were 0.695 (95% CI: 0.667–0.740), 0.721 (95% CI: 0.505–0.584) and 0.523(95% CI: 0.666–0.739). Differences were found between Kwak-TIRADS and ACR-TIRADS (P < 0.0001), C-TIRADS and ACR-TIRADS (P < 0.0001), whereas there was not significant difference between Kwak-TIRADS and C-TIRADS (P = 0.952). Best cut-off point of Kwak-TIRADS, C-TIRADS and ACR-TIRADS were 4C, 4C and5. From the comprehensive view of the best cut-off point, diagnostic performance of Kwak-TIRADS and C-TIRADS were better than ACR-TIRADS (Table 4).

Table 4

Three TIRADS diagnostic performance of MTCs and PTCs
TIRADS	Best cut-off point	Sensitivity, %	Specificity, %	PPV, %	NPV, %	Youden index
Kwak	4C	61.64	72.03	90.52	30.35	0.337
C-TIRADS	4C	66.73	67.80	89.97	32.00	0.345
ACR	TR5	63.60	50.00	84.64	24.08	0.136

MTC was a rare type of thyroid malignant tumor which accounts for 3–10% of all thyroid gland cancers [13]. In our study, there was no difference in the age of patients with MTCs and PTCs, both of which were more common in female, which was consistent with previous studies [14, 15]. Same conclusion had been reported [16] that the average size of MTCs nodules were bigger than that of PTCs, furthermore, in this study the proportion of MTCs which larger than 10 mm was much more than that of PTCs. Compared with PTCs, MTCs had more multiple nodules, which might be due to its high invasiveness, but there was no statistical significance.

MTCs and PTCs had overlapping sonographic features, but they still presented their own characteristics [11, 14].Most MTCs nodules showed the shape of wide than tall, irregular margin, medium and high vascular degree and external distribution, whereas PTCs nodules showed tall than wide shape, obscure border, regular margin, microcalcification, none or low vascular degree and internal distribution (P < 0.05).According to previously reported studies [2, 13, 15], MTCs was mostly located in the upper middle pole. However, in this study, the proportion of MTCs located in the upper and lower poles was equal. The reason might be that the location of nodules was classified into two categories(the upper pole and the lower pole) in this study ,. For the volume of the nodule was large and located in the middle, if the part of the lower pole exceeds 50%, it was considered a lower pole nodule. Although most MTCs and PTCs nodules were solid, mixed structures were more common in MTCs (15.25% vs 2.35%). This might be related to the size and the growth characteristics of the MTCs nodules.

The individual US characteristics were not unreliable to predict malignant nodules [17]. Therefore, the risk stratification system based on multiple suspicious malignant ultrasound features was currently a popular method for diagnosing thyroid nodules [7, 8]. The characteristics including solid, hypoechoic, tall than wide, microcalcifications, and irregular margin were suspicious malignant signs of nodules, which were widely used in several guidelines or TIRADSs [4–6]. However, the statistical sources of these suspicious malignant signs were mostly based on differentiated thyroid cancer, papillary carcinoma and follicular carcinoma. To the best of our knowledge, there was no specialized risk assessment system for MTCs. MTC had some of the same ultrasound features as differentiated thyroid carcinoma, such as solid, hypoechoic or marked hypoechoic. These characteristics happen to be indicators of risk assessment, so existing TIRADS could be applied to the risk assessment of MTCs. Thus, this study selected widely used system Kwak-TIRADS, C-TIRADS and ACR-TIRADS to evaluate the risk of MTCs and PTCs.

In this study, MTCs and PTCs had the highest proportion of 4C in Kwak-TIRADS and TR5 in ACR-TIRADS, but there was no statistical significance (P > 0.01). This indicated that the three TIRADSs had a higher grading for most of MTCs and PTCs, which was conducive to the development of diagnosis and treatment plans or appropriate interventions in the future. Although the main malignant signs included in the different TIRADSs were similar, there were still differences, such as echogenicity. The evaluation criteria for C-TIRADS were marked hypoechoic and Kwak-TIRADS was hypoechoic, while ACR-TIRADS assigned high scores to very hypoechoic and hypoechoic. This study combined marked hypoechoic and hypoechoic in ultrasound sign analysis, but MTCs with low hypoechoic were much more numerous than those with marked hypoechoic in the calculation process, resulting in a lower score in C-TIRADS compared to Kwak and ACR-TIRADS. In addition, the different values assigned to malignant signs were also the reason why most MTCs were graded high in Kwak and ACR-TIRADS. Kwak and C-TIRADS counted the number of malignant features, while ACR accumulated the total score of malignant features for rating. This led to high scores and grading of suspected malignant nodules.

In C-TIRADS, the highest MTCs was 4B followed by 4C, and the highest PTCs was graded as 4C followed by 4B (P < 0.01). The reason was that in this study PTCs exhibited more malignant features than MTCs, such as tall than wide, microcalcifications and solid structures, resulting in a higher score and grading. The AUC of C-TIRADS was the largest (AUC = 0.721), higher than that of Kwak-TIRADS (AUC = 0.695) and ACR-TIRADS (AUC = 0.523). It indicated that C-TIRADS had the highest diagnostic efficiency for MTC and PTC among the three TIRADSs. This was consistent with previous research findings in this study that C-TIRADS had differences in grading, while Kwak-TIRADS and ACR-TIRADS had similar risk grading.

The current popular TIRADS or guidelines had not yet incorporated features of thyroid nodules Doppler ultrasound. Although studies had represented that most PTCs nodules were hypovascular, vascularization information showed the unique advantage in diagnosing the nature of nodules for other types of thyroid cancer nodules, such as MTCs and FTCs (Follicular Thyroid Carcinomas). Previous researches had shown that hypervascular was one of the sonographic features of MTCs [10, 11]. Similarly, in this study, MTC showed statistical differences in vascularization distribution and degree compared to PTCs (P = 0.000). External distribution and medium or high vascularization were displayed in majority MTCs. This feature played an important role in the diagnosis of MTCs and could be used as one of the evaluation indicators for risk grading. This study did not separately analyze macrocalcifications when analyzing the calcification characteristics of MTCs and PTCs. However, reviewing previous literature had found that macrocalcifications could be a characteristic manifestation of MTCs [11]. It was also an inspiration for us that macrocalcifications could be considered when developing a risk grading system for MTCs in the future.

Limitations also existed in this study. This study was a retrospective study, and the awareness of the pathological diagnosis might affect the results of the evaluation images. Another limitation was that there was only one doctor who had 10-years thyroid ultrasound diagnosis to evaluate the images, which might cause the results to be subjectively affected. Considering the extremely low incidence of MTCs, the sample size of this study was small, which might also have a statistical bias.

MTCs had malignant ultrasound characteristics similar to PTCs, which lead to higher risk ratings among the three TI-RADS and guidelines, but the diagnostic efficiency was average. This indicated that MTCs, as a special pathological type different from differentiated thyroid cancer, might require its own risk assessment system or guideline.

MTC: medullary thyroid carcinoma

PTC: papillary thyroid carcinoma

TIRADS: Thyroid Imaging Reporting and Data Systems

ROC: receiver operating characteristic

NPV: negative predictive value

PPV: positive predictive value

US: ultrasound

FNA: fine needle aspiration

SD: standard deviation

AUC: area under each curve

Ethics approval and consent to participate

Consent for publication

Not applicable.

Availability of data and materials

All data used in this study are available from the corresponding author upon reasonable request.

Competing Interests

The authors declare no competing interests.

Funding

No funding was received for this work.

Authors' contributions

Weiwei Zhan and Wei Zhou participated in the design of the study. Xiaoyu Li collected clinical data and wrote the main manuscript text. Jiejie Yao supplemented data and reviewed statistical results. All authors reviewed the manuscript and approved the final manuscript.

Acknowledgements

None.

Dadu R, Bagheri-Yarmand R, Ringel MD, Grubbs EG, Zafereo M, Cote G, Gagel RF, Robinson BG, Shaw KR, Hu MI. HEREDITARY ENDOCRINE TUMOURS: CURRENT STATE-OF-THE-ART AND RESEARCH OPPORTUNITIES: The state of science in medullary thyroid carcinoma: current challenges and unmet needs. Endocr Relat Cancer. 2020 Aug;27(8):T27-T39. doi: 10.1530/ERC-20-0110. PMID: 32580150.
Links TP, Verbeek HH, Hofstra RM, Plukker JT. Endocrine tumours: progressive metastatic medullary thyroid carcinoma: first- and second-line strategies. Eur J Endocrinol. 2015 Jun;172(6): R241-51. doi: 10.1530/EJE-14-0726. Epub 2015 Jan 27. PMID: 25627652.
Docimo G, Tolone S, Conzo G, Limongelli P, Del Genio G, Parmeggiani D, De Palma M, Lupone G, Avenia N, Lucchini R, Monacelli M, Gulotta G, Scerrino G, Pasquali D, Bellastella G, Esposito K, De Bellis A, Pezzolla A, Ruggiero R, Docimo L. A Gelatin-Thrombin Matrix Topical Hemostatic Agent (Floseal) in Combination With Harmonic Scalpel Is Effective in Patients Undergoing Total Thyroidectomy: A Prospective, Multicenter, Single-Blind, Randomized Controlled Trial. Surg Innov. 2016 Feb;23(1):23-9. doi: 10.1177/1553350615596638. Epub 2015 Aug 3. PMID: 26243629.
Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, Jung HK, Choi JS, Kim BM, Kim EK. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology. 2011 Sep;260(3):892-9. doi: 10.1148/radiol.11110206. Epub 2011 Jul 19. PMID: 21771959.
Zhou J, Song Y, Zhan W, Wei X, Zhang S, Zhang R, Gu Y, Chen X, Shi L, Luo X, Yang L, Li Q, Bai B, Ye X, Zhai H, Zhang H, Jia X, Dong Y, Zhang J, Yang Z, Zhang H, Zheng Y, Xu W, Lai L, Yin L; Superficial Organ and Vascular Ultrasound Group of the Society of Ultrasound in Medicine of Chinese Medical Association; Chinese Artificial Intelligence Alliance for Thyroid and Breast Ultrasound. Thyroid imaging reporting and data system (TIRADS) for ultrasound features of nodules: multicentric retrospective study in China. Endocrine. 2021 Apr;72(1):157-170. doi: 10.1007/s12020-020-02442-x. Epub 2020 Aug 27. PMID: 32852733.
Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, Teefey SA, Cronan JJ, Beland MD, Desser TS, Frates MC, Hammers LW, Hamper UM, Langer JE, Reading CC, Scoutt LM, Stavros AT. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. J Am Coll Radiol. 2017 May;14(5):587-595. doi: 10.1016/j.jacr.2017.01.046. Epub 2017 Apr 2. PMID: 28372962.
Kim DH, Kim SW, Basurrah MA, Lee J, Hwang SH. Diagnostic Performance of Six Ultrasound Risk Stratification Systems for Thyroid Nodules: A Systematic Review and Network Meta-Analysis. AJR Am J Roentgenol. 2023 Jun;220(6):791-803. doi: 10.2214/AJR.22.28556. Epub 2023 Feb 8. PMID: 36752367.
Kim JS, Kim BG, Stybayeva G, Hwang SH. Diagnostic Performance of Various Ultrasound Risk Stratification Systems for Benign and Malignant Thyroid Nodules: A Meta-Analysis. Cancers (Basel). 2023 Jan 9;15(2):424. doi: 10.3390/cancers15020424. PMID: 36672373; PMCID: PMC9857194.
Wei X, Li Y, Zhang S, Gao M. Meta-analysis of thyroid imaging reporting and data system in the ultrasonographic diagnosis of 10,437 thyroid nodules. Head Neck. 2016 Feb;38(2):309-15. doi: 10.1002/hed.23878. Epub 2015 Jun 16. PMID: 25244250.
Jiang L, Zhu HB, Liang ZW, Chen L, Sun XM, Shao YH, Chen LZ. Comparison of the diagnostic performance and clinical role of different ultrasound-based thyroid malignancy risk stratification systems for medullary thyroid carcinoma. Quant Imaging Med Surg. 2023 Jun 1;13(6):3776-3788. doi: 10.21037/qims-22-968. Epub 2023 May 4. PMID: 37284109; PMCID: PMC10240009.
Matrone A, Gambale C, Biagini M, Prete A, Vitti P, Elisei R. Ultrasound features and risk stratification systems to identify medullary thyroid carcinoma. Eur J Endocrinol. 2021 Jun 28;185(2):193-200. doi: 10.1530/EJE-21-0313. PMID: 34010144.
Koike E, Noguchi S, Yamashita H, Murakami T, Ohshima A, Kawamoto H, Yamashita H. Ultrasonographic characteristics of thyroid nodules: prediction of malignancy. Arch Surg. 2001 Mar;136(3):334-7. doi: 10.1001/archsurg.136.3.334. PMID: 11231857.
Kebebew E, Ituarte PH, Siperstein AE, Duh QY, Clark OH. Medullary thyroid carcinoma: clinical characteristics, treatment, prognostic factors, and a comparison of staging systems. Cancer.2000Mar 1;88(5):1139-48.doi: 10.1002/(sici)1097-0142(20000301)88:5<1139::aid-cncr26>3.0.co;2-z. PMID: 10699905.
Zhu J, Li X, Wei X, Yang X, Zhao J, Zhang S, Guo Z. The application value of modified thyroid imaging report and data system in diagnosing medullary thyroid carcinoma. Cancer Med. 2019 Jul;8(7):3389-3400. doi: 10.1002/cam4.2217. Epub 2019 May 9. PMID: 31070290; PMCID: PMC6601574.
Choi N, Moon WJ, Lee JH, Baek JH, Kim DW, Park SW. Ultrasonographic findings of medullary thyroid cancer: differences according to tumor size and correlation with fine needle aspiration results. Acta Radiol. 2011;52:312-6.
Lee S, Shin JH, Han BK, Ko EY. Medullary thyroid carcinoma: comparison with papillary thyroid carcinoma and application of current sonographic criteria. AJR Am J Roentgenol. 2010;194:1090-4.
Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association (ATA) guidelines taskforce on thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19:1167-1214.

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Diagnostic Performance Ultrasonographic features and malignancy risk of medullary thyroid carcinoma: compare by papillary thyroid carcinoma

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Abstract

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INTRODUCTION

MATERIALS AND METHODS

Patients

Sonographic examinations and imaging analysis

Three TIRADS

Data and Statistical Analyses

RESULTS

Clinic data and results

Ultrasound features of MTCs and PTCs

Risk category of MTCs and PTCs according to three TIRADS

Diagnostic performance of three TIRADS for PTCs and MTCs

DISCUSSION

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1