Zhang YF, et al. Korean J Radiol. 2019 Jan;20(1):166-170. https://doi.org/10.3348/kjr.2017.0772

Background: Ultrasound is widely used for detecting thyroid nodules in clinical practice. This retrospective study aimed to assess the diagnostic efficacy of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS), S-Detect, and elastography of the carotid artery for suspicious thyroid nodules and to determine the complementary value of artificial intelligence and elastography. Methods: Between January 2021 and November 2021, 101 consecutive patients with 138 thyroid nodules were enrolled in The First Hospital of China Medical University. All nodules were evaluated using ACR-TIRADS categories (TR), S-Detect, and elastography, and then the diagnostic performance of the different methods and the combined assessment were compared. The inclusion criteria were the following: (I) TR3, TR4, and TR5 nodules, which were defined as “suspicious nodules”; (II) patients who had surgical or cytopathological results after ultrasound examination; and (III) voluntary enrollment in this study. Meanwhile, the exclusion criteria were the following: (I) TR1 and TR2 nodules, (II) patients who had undergone fine-needle aspiration before ultrasound examination, and (III) inconclusive cytologic findings. Results: A total of 71 patients (12 men and 59 women) with 94 suspicious thyroid nodules (42 benign nodules and 52 malignant nodules) were finally included in this study. S-Detect had a significantly better sensitivity than did ACR-TIRADS [S-Detect: 98.1%, 95% confidence interval (CI): 89.7–100.0%; ACR-TIRADS: 84.6%, 95% CI: 71.9–93.1%; P=0.036], but its specificity was much lower (S-Detect: 19.0%; 95% CI: 8.6–34.1%; ACR-TIRADS: 40.5%, 95% CI: 25.6–56.7%; P=0.032). The accuracy was not significantly different between S-Detect (62.8%; 95% CI: 52.2–72.5%) and ACR-TIRADS (64.9%; 95% CI: 54.4–74.5%) (P=0.761). The elasticity contrast index (ECI) was not definitively useful in identifying suspicious thyroid nodules (P=0.592). Compared with the use of ACR-TIRADS and S-Detect alone, the specificity (45.2%; 95% CI: 29.8–61.3%), positive predictive value (65.2%; 95% CI: 52.4–76.5%), accuracy (66.0%; 95% CI: 55.5–75.4%), and the area under the receiver operating characteristic curve (0.640; 95% CI: 0.534–0.736) of their combination were higher but not significantly so. Conclusions: At present, S-Detect cannot replace manual diagnosis, and the value of elastography of the carotid artery in diagnosing suspected thyroid nodules remains unclear.

Background: The current diagnostic paradigm for thyroid nodule characterization predominantly depends on fine needle aspiration (FNA) cytology. Nevertheless, in cases of indeterminate cytology classified as Bethesda III and IV, the clinical community continues to face significant challenges in establishing reliable non-invasive diagnostic modalities for accurate pathological differentiation. This meta-analysis evaluates the diagnostic value of ultrasound elastography in Bethesda III-IV thyroid nodules, and compares the diagnostic efficacy when combined with conventional ultrasound. Methods: We searched English medical databases, including PubMed, Embase, Web of Science, Cochrane Library, and Ovid, for relevant literature. These studies were reviewed by 2 members who also extracted pertinent data. We calculated pooled values via random effects meta-analysis to determine diagnostic performance. Results: A total of 2,356 nodules were included in 27 studies. The overall sensitivity of ultrasound elastography was 0.81, the overall specificity was 0.83, the diagnostic odds ratio (DOR) was 16.40, and the area under the curve (AUC) was 0.87. A total of 8 articles incorporated the combined application of ultrasound elastography and conventional ultrasonography. The overall sensitivity was 0.87, the overall specificity was 0.73, the DOR was 21.33, and the AUC was 0.90. Conclusions: Ultrasound elastography has good diagnostic value for Bethesda III–IV thyroid nodules, and the semiquantitative method outperforms the qualitative and quantitative methods. Ultrasound elastography in combination with conventional ultrasonography has better sensitivity and a lower specificity, and there is no significant difference between the 2 methods overall (P>0.05).

Background: Not all the breast lesions were mass-like, some were non-mass-like at ultrasonography. In these lesions, conventional ultrasonography had a high sensitivity but a low specificity. Sonoelastography can evaluate tissue stiffness to differentiate malignant masses from benign ones. Then what about the non-mass lesions? The aim of this study was to evaluate the current accuracy of sonoelastography in the breast non-mass lesions and compare the results with those of the American College of Radiology breast Imaging-Reporting and Data System (BI-RADS). Methods: An independent literature search of English medical databases, including PubMed, Web of Science, Embase & MEDLINE (Embase.com) and Cochrane Library, was performed by 2 researchers. The accuracy of sonoelastography was calculated and compared with those of BI-RADS. Results: Fourteen relevant studies including 1058 breast non-mass lesions were included. Sonoelastography showed a pooled sensitivity of 0.74 (95% CI: 0.70–0.78), specificity of 0.89 (95% CI: 0.85–0.91), diagnostic odds ratio (DOR) of 25.22 (95% CI: 17.71–35.92), and an area under the curve of 0.9042. Eight articles included both sonoelastography and BI-RADS. The pooled sensitivity, specificity, DOR and AUC were 0.69 versus 0.91 (P < .01), 0.90 versus 0.68 (P < .01), 19.65 versus 29.34 (P > .05), and 0.8685 versus 0.9327 (P > .05), respectively. Conclusions: Sonoelastography has a higher specificity and a lower sensitivity for differential diagnosis between malignant and benign breast non-mass lesions compared with BI-RADS, although there were no differences in AUC between them.

This case report details a case of intrathyroid thymic carcinoma (ITTC). ITTC is extremely rare with few reports. Diagnosis is difficult due to a lack of specific features and depends on pathology. A 36‐year‐old male was diagnosed. His condition and relevant tests are described. The tumor was removed, and he recovered well. This case report also discusses ITTC's characteristics, diagnosis, treatment, and prognosis, emphasizing its rarity and the need for a better understanding.

Objectives: Thyroid nodules classified as Bethesda category IV cannot be diagnosed with fine-needle aspiration. RAS mutations have been linked to thyroid cancer, although it is still unclear if they are useful as a pre-operative molecular screening for this particular subgroup. In order to assess the diagnostic accuracy (sensitivity, specificity, AUC, etc.) of RAS mutations in identifying malignancy among Bethesda IV nodules and to ascertain whether this can consistently direct clinical decision-making and minimize non-essential interventions, we carried out a systematic review and meta-analysis using postoperative histopathology as the reference standard. Methods: A literature search of the PubMed, Embase, Cochrane Library, Web of Science and OVID databases was conducted. In all of the included studies, the diagnostic accuracy of RAS was compared with that of postoperative pathology, which was used as a standard. Data were pooled, and the sensitivity, specificity, area under the curve (AUC), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were calculated to estimate the accuracy of RAS. Results: A total of 10 studies were included after screening, comprising 913 cases of Bethesda Category IV nodules. Among them, there were 246 malignant lesions and 667 benign lesions. The pooled sensitivity of RAS mutations was 0.35 (95% CI, 0.29-0.41), and the specificity was 0.93 (95% CI, 0.90-0.95). The positive likelihood ratio was 3.46 (95% CI, 1.94-6.18), the negative likelihood ratio was 0.73 (95% CI, 0.60-0.89), and the AUC was 0.7954. Heterogeneity testing showed p<0.05, I ² = 58.5%, indicating significant heterogeneity. Conclusion: RAS mutations have a moderate diagnostic value in the diagnosis of Bethesda Category IV thyroid nodules. Despite the presence of some heterogeneity, the detection of RAS mutations may be helpful in guiding clinical decision-making and management strategies. Systematic Review Registration: https://www.crd.york.ac.uk/prospero , identifier CRD42024608197.