Thyroid nodules are a common endocrine disorder, and their early detection and accurate diagnosis are crucial for the prevention of thyroid cancer. However, the highly heterogeneous morphology and boundaries of thyroid nodules pose significant challenges to their precise identification and classification. Traditional diagnostic approaches rely heavily on physicians' experience, which increases the risk of misdiagnosis and missed diagnoses. With the rapid advancement of computer-aided diagnosis (CAD) technologies, applying deep learning algorithms to the analysis of thyroid nodule ultrasound images has shown great potential. This paper reviews the latest research progress on deep learning-based CAD methods for thyroid nodules, with a focus on their applications in image preprocessing, segmentation and classification. The advantages and limitations of current techniques are analyzed, and potential future directions are discussed. This review aims to highlight the potential of deep learning in thyroid nodule diagnosis and to provide a foundation for selecting feasible pathways for future clinical applications.
Humans ; Thyroid Nodule/diagnostic imaging* ; Deep Learning ; Ultrasonography/methods* ; Diagnosis, Computer-Assisted/methods* ; Algorithms ; Thyroid Neoplasms/diagnostic imaging* ; Image Processing, Computer-Assisted/methods*

Objective To investigate the influencing factors of Bethesda Ⅲ results in fine-needle aspiration biopsy of thyroid nodules.Methods A total of 300 thyroid nodules with cytological diagnosis results were analyzed retrospectively,including 100 Bethesda Ⅲ nodules and 50 nodules of Bethesda Ⅱ,Ⅳ,Ⅴ,and Ⅵ categories,respectively.Univariate analysis and Logistic regression analysis were performed on the clinical data of patients and the ultrasound signs of thyroid nodules to clarify the factors influencing the diagnosis of Bethesda Ⅲ nodules.Results Univariate analysis showed that Bethesda Ⅲ nodules were mostly adjacent to the capsule(P<0.001),with no blood flow in the color Doppler assessment(P=0.011)and lack of blood supply(P=0.033)and maximum diameter ≤0.9 cm(P=0.038)as revealed by the contrast-enhanced ultrasound.Logistic regression showed that the position close to the capsule(OR=5.110,95%CI=2.153-12.130,P<0.001)and color Doppler without blood flow signal(OR=3.015,95%CI=1.094-8.311,P=0.033)were independent risk factors for the diagnosis of Bethesda Ⅲ nodules.Conclusions The puncture difficulty caused by the dangerous position of thyroid nodules close to the capsule and the aspiration difficulty caused by the absence of blood flow signal in color Doppler are the main factors influencing the diagnosis of Bethesda Ⅲ nodules.Therefore,corresponding avoidance measures should be taken during the aspiration process to reduce the diagnosis results of Bethesda Ⅲ nodules.
Humans ; Thyroid Nodule/diagnostic imaging* ; Thyroid Neoplasms/diagnosis* ; Biopsy, Fine-Needle/methods* ; Retrospective Studies ; Ultrasonography/methods*

Objective To evaluate extrathyroidal extension (ETE) in papillary thyroid microcarcinoma (PTMC) with three-dimensional tomographic ultrasound imaging (3D-TUI). Methods A total of 97 thyroid nodules of 79 patients with PTMC treated in PUMC Hospital from February 2016 to January 2018 were included in this study.Two ultrasound experts performed independent blinded assessment of the relationship between thyroid nodules and thyroid capsule by two-dimensional ultrasound (2D-US) and 3D-TUI.The results of 2D-US and 3D-TUI in evaluating ETE were compared with intraoperative findings and postoperative histological and pathological results. Results Among the 97 nodules,54 (55.7%) nodules had ETE.The diagnostic sensitivity (68.5% vs.37.0%;χ²=10.737,P=0.002),accuracy (74.5% vs.56.7%;χ²=6.686,P=0.015),and area under the receiver operating characteristic curve[0.761 (95%CI=0.677-0.845) vs.0.592 (95%CI=0.504-0.680);Z=3.500,P<0.001] of 3D-TUI were higher than those of 2D-US.However,3D-TUI and 2D-US showed no significant difference in the specificity (84.1% vs.81.4%;χ²=0.081,P=0.776),negative predictive value (67.9% vs.50.7%;χ²=3.645,P=0.066),or positive predictive value (84.1% vs.71.4%;χ²=1.663,P=0.240). Conclusion Compared with 2D-US,3D-TUI demonstrates increased diagnostic efficiency for ETE of PTMC.
Humans ; Thyroid Nodule ; Thyroid Neoplasms/diagnosis* ; Carcinoma, Papillary/pathology* ; Ultrasonography/methods* ; Retrospective Studies

Objective To evaluate the performance of micro-flow imaging(MFI)in the differential diagnosis of benign and malignant thyroid nodules. Methods Totally 50 patients with thyroid nodules examined by conventional ultrasound,MFI,and contrast-enhanced ultrasound and confirmed by histological or cytological pathology in the First Medical Center of Chinese PLA General Hospital from May to December in 2020 were enrolled in the study.The clinical data and ultrasound images were retrospectively analyzed.A binary logistic regression model was established to evaluate the performance of the model in predicting benign and malignant thyroid nodules. Results Logistic regression showed that composition and "S-W-C" sign were independent risk factors for predicting malignant thyroid nodule.The sensitivity,specificity,and Youden index of the logistic regression model were 73.33%,80.00%,and 0.53,respectively,and the area under receiver operating characteristic curve was 0.799(95%CI=0.662-0.899). Conclusion MFI facilitates the differential diagnosis of benign and malignant thyroid nodules and has the potential to be applied in the future.
Diagnosis, Differential ; Humans ; ROC Curve ; Retrospective Studies ; Thyroid Nodule/diagnostic imaging* ; Ultrasonography/methods*

Objective To explore the roles of conventional ultrasound and contrast-enhanced ultrasound in distinguishing between benign and malignant thyroid nodules with calcification. Methods A total of 102 solid thyroid nodules with calcification in 76 patients were evaluated by conventional ultrasound alone and conventional ultrasound combined with contrast-enhanced ultrasound.The features obtained through conventional ultrasound alone and that combined with contrast-enhanced ultrasound were scored,and the diagnostic performance of the two methods was analyzed based on the final pathological results. Results The distribution of microcalcification(
Calcinosis/diagnostic imaging* ; Contrast Media ; Diagnosis, Differential ; Humans ; Sensitivity and Specificity ; Thyroid Neoplasms ; Thyroid Nodule/diagnostic imaging* ; Ultrasonography

OBJECTIVE: To determine whether a computer-aided diagnosis (CAD) system for the evaluation of thyroid nodules is non-inferior to radiologists with different levels of experience.MATERIALS AND METHODS: Patients with thyroid nodules with a decisive diagnosis of benign or malignant nodule were consecutively enrolled from November 2017 to September 2018. Three radiologists with different levels of experience (1 month, 4 years, and 7 years) in thyroid ultrasound (US) reviewed the thyroid US with and without using the CAD system. Statistical analyses included non-inferiority testing of the diagnostic accuracy for malignant thyroid nodules between the CAD system and the three radiologists with a non-inferiority margin of 10%, comparison of the diagnostic performance, and the added value of the CAD system to the radiologists.RESULTS: Altogether, 197 patients were included in the study cohort. The diagnostic accuracy of the CAD system (88.48%, 95% confidence interval [CI] = 82.65–92.53) was non-inferior to that of the radiologists with less experience (1 month and 4 year) of thyroid US (83.03%, 95% CI = 76.52–88.02; p < 0.001), whereas it was inferior to that of the experienced radiologist (7 years) (95.76%, 95% CI = 91.37–97.96; p = 0.138). The sensitivity and negative predictive value of the CAD system were significantly higher than those of the less-experienced radiologists were, whereas no significant difference was found with those of the experienced radiologist. A combination of US and the CAD system significantly improved sensitivity and negative predictive value, although the specificity and positive predictive value deteriorated for the less-experienced radiologists.CONCLUSION: The CAD system may offer support for decision-making in the diagnosis of malignant thyroid nodules for operators who have less experience with thyroid US.
Cohort Studies ; Diagnosis ; Humans ; Prospective Studies ; Sensitivity and Specificity ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Ultrasonography

OBJECTIVE: Recent studies demonstrated that core needle biopsy (CNB) can effectively reduce the possibility of inconclusive results and prevent unnecessary diagnostic surgery. However, the effectiveness of CNB in patients with suspicious thyroid nodules has not been fully evaluated. This prospective study aimed to determine the potential of CNB to assess thyroid nodules with suspicious ultrasound (US) features. MATERIALS AND METHODS: Patients undergoing CNB for thyroid nodules with suspicious features on US were enrolled between May and August 2016. Diagnostic performance and the incidence of non-diagnostic results, inconclusive results, conclusive results, malignancy, unnecessary surgery, and complications were analyzed. Subgroup analysis according to nodule size was performed. The risk factors associated with inconclusive results were evaluated using multivariate logistic regression analysis. RESULTS: A total of 93 patients (102 thyroid nodules) were evaluated. All samples obtained from CNB were adequate for diagnosis. Inconclusive results were seen in 12.7% of cases. The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for diagnosis of malignancy were 93.8%, 100%, 100%, 78.9%, and 95%, respectively. None of the patients underwent unnecessary surgery. The diagnostic performance was not significantly different according to nodule size. On multivariate logistic regression analysis, larger nodule size and shorter needle length were independent risk factors associated with inconclusive results. CONCLUSION: Samples obtained by CNB were sufficient for diagnosis in all cases and resulted in high diagnostic values and conclusive results in the evaluation of suspicious thyroid nodules. These findings indicated that CNB is a promising diagnostic tool for suspicious thyroid nodules.
Biopsy, Fine-Needle ; Biopsy, Large-Core Needle* ; Diagnosis ; Humans ; Incidence ; Logistic Models ; Needles ; Prospective Studies ; Risk Factors ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography* ; Unnecessary Procedures

Radioiodine has been known as an important and safe armamentarium in the diagnosis and treatment of differentiated thyroid cancer (DTC) for more than 70 years. The 2015 guidelines from the American Thyroid Association (ATA) for adults with thyroid nodules and DTC seem to be the most comprehensive guidelines in the thyroid cancer field. The 2015 ATA guidelines provided an advance in evidence-based management of DTC, and resulted in a significant change in the patterns of practice regarding the application of the radioiodine. However, the 2015 ATA guidelines also provoked much controversy because a substantial portion of the recommendations announced were not based on sufficiently strong evidence. While the number of radioiodine administrations in Korea in the year of 2018 has decreased to a level less than 50% of that in 2013, in this review, we address some of the current issues and controversies regarding the application of radioiodine for the diagnosis, ablation and treatment of DTC, especially related to the 2015 ATA guidelines. Possible strategies for the achievement of better quality in radioiodine imaging and improvement in treatment efficiency that can be used in the near future are also discussed here.
Adult ; Diagnosis ; Humans ; Iodine ; Korea ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule

BACKGROUND AND OBJECTIVES: Thyroid scan is a good tool for diagnosis of hyperfunctioning thyroid nodules (HNs), however it has been limited in use in a primary clinical practice, because of its inconvenience and low accessibility. This study aimed to analyze ultrasonographic (US) characteristics of HNs and to predict HNs by US. MATERIALS AND METHODS: We included 114 patients who exhibited results of ‘hot’ nodule in the thyroid scan from 2008 to 2017. Analysis for US characteristics included 73 patients without unclear US images and other inevitable reasons. We compared US characteristics of HNs with cold nodules that showed “cold” in the thyroid scan. Additionally, we compared US characteristics of HNs between suppressed thyroid-stimulating hormone (TSH) (<0.25 uIU/mL) or normal TSH, and analysis receiver operating characteristics (ROC) curve for prediction of suppressed TSH among HNs. RESULTS: The HNs showed more partially cystic nodule, isoechoic echogenicity, hypervascularity and presence of halo in the US finding than the cold nodule. In subgroup analysis of nodules with TSH suppression among HNs, the TSH suppression nodules was lager in max size and volume than the normal TSH nodules. In ROC analyses for prediction of the TSH suppression among HNs, area under receiver operating characteristics curves was 0.736 in max size, 0.761 in volume. CONCLUSION: HNs showed more frequently partially cystic contents, isoechoic echogenicity, hypervascularity, and peripheral halo sign in US finding. Thyroid nodule size and volume were associated with suppressed TSH level of HNs, and optimal cutoff levels for prediction of TSH suppression among HNs were 2.6 cm and 1.13 cm3, respectively.
Diagnosis ; Humans ; ROC Curve ; Thyroid Gland ; Thyroid Nodule ; Thyrotropin ; Ultrasonography

Thyroid nodules are the most common endocrine tumor. Ultrasonography and fine-needle aspiration (FNA) are currently accurate diagnostic tools for evaluating thyroid nodules. However, 10–30% of FNA specimens are cytologically indeterminate. Making an accurate diagnosis between benign and malignant nodules is important so that patients with malignant nodule receive proper treatment and patients with benign nodule can avoid unnecessary treatment. Several genetic changes such as point mutations of the BRAF or RAS and rearrangements of the RET/PTC1, RET/PTC3, PAX8/PPARY are used to adjust to indeterminate FNA. Such a mutational analysis has an excellent positive predictive value (PPV), but there is a weakness in the low negative predictive value (NPV). Gene-expression classifier (GEC) has been found helpful in identify nodules that are benign rather than malignant. GEC has an excellent NPV, but there is a weakness of low PPV. Multiplatform mutational and miRNA test (MPT) and next-generation sequencing assay (NGS) are being studied to compensate for these weaknesses. Molecular tests appear to be a good solution for improving the accuracy of indeterminate FNA cytology specimens and support the clinical management decisions in patients with indeterminate cytologic nodules, but further prospective multicenter trials are required for validation of reported findings and need evaluation of cost-effectiveness. This paper will review recently available molecular diagnostic tools of thyroid nodule.
Biopsy, Fine-Needle ; Diagnosis ; Humans ; MicroRNAs ; Multicenter Studies as Topic ; Pathology, Molecular ; Point Mutation ; Prospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Ultrasonography