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Assessment of Malignancy Risk in Thyroid Nodules Using a Practical Ultrasound Predictor Model: “Alpha Score”

Open Journal of Radiology 2018年第4期8卷 191-202页

作者： mena glenn Benavides Raul Villagomez Rocio Muñ oz Marco mena Bucheli Santiago Mosquera Mariela Guerrero Rosa ALPHA Image Radiology and Interventionism Institute Quito Ecuador Axxis Pathology Laboratory Quito Ecuador

Objective: The aim of this study was to develop a simple predictor model to diagnose malignancy by using ultrasound features of thyroid nodules and the association with cytopathological diagnosis obtained by fine needle aspiration. Materials and Methods: The likelihood of malignancy from ultrasound features was assessed in thyroid nodules obtained by fine-needle aspiration biopsy (FNAB) according to cytopathological findings reported using Bethesda System. A score was developed depending on the presence of each ultrasound feature evaluated. Results: 429 nodules were assessed, 103 (24%) were malignant. The following ultrasound features were associated with malignancy, according to the logistic regression analysis and were assigned a score of 0, +1, +2 depending on the presence or absence of each one: hypoechogenicity, solid appearance, irregular margins, microcalcifications, absence of a halo, diameter of ≥10 mm and intranodular vascular flow. The area under the curve of the proposed model was 0.900, demonstrating its predictive capacity. 4 risk categories were stablished based on the score obtained. Malignant nodules scored higher than the benign nodules (7.24 ±1.87 vs. 3.74 ±1.83). Conclusions: The proposed predictive model demonstrated to be useful and easy to apply when stratifying thyroid nodule risk of malignancy using presented US features and applying the proposed risk categories to increase the accuracy at selecting nodules that need to be studied with FNA.

关键词： Thyroid Nodules Thyroid Cancer Ultrasound Fine-Needle Biopsy

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Thyroid Nodule: Alpha Score 2.0 Classification for FNAB Selection, Multicentric Study in Latin America

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Open Journal of Radiology 2021年第4期11卷 160-174页

作者： glenn mena Maria Cristina Chammas Carlos Mario Gonzalez Vasquez Lylian Rocío Villagómez Marco Alfredo Muñoz Pico Patricio Alejandro Montalvo Santiago mena-Bucheli Julio Olmedo Elizabeth Quintero Pedro Henrique de Marqui Moraes Osmar Cassio Saito Hubertino Diaz Denise Romero Gabriela Velalcazar Angel Ramón Sosa Fleitas Yamil Oliver Quevedo Ontaneda Victor Ricardo Chara Alpha Imagen Radiología e Intervencionismo Quito Ecuador Hospital das Clínicas Faculdade de Medicina da Universidade de Sã o Paulo S&#227 o Paulo Brasil Hospital Pablo Tobón Uribe Medellin Colombia Hospital del Instituto Ecuatoriano de Seguridad Social Quito Sur Quito Ecuador Hospital San Francisco de Quito Quito Ecuador Hospital Edgardo Rebagliati Martins Lima Perú Hospital Carlos Andrade Marín Quito Ecuador Hospital de Clínicas San José de San Martín Buenos Aires Argentina Hospital Universitario de Los Andes Mérida Venezuela Hospital de la Policía Quito Ecuador Hospital Sisol Tacna Perú

Introduction: To perform a Latin-American multicentric study for the prediction of benign and malignant thyroid nodules using Alpha Score, and to compare it with ACR TIRADS® and Bethesda®. Materials and Methods: A prospective multicentric study in 10 radiological hospitals and institutions of Latin America was performed and 818 thyroid nodules were analyzed by ultrasound and classified by using both ACR TIRADS® and Alpha Score;fine-needle aspiration biopsy was performed when needed and classified with Bethesda. The relationships between predictors were analyzed by using binary logistic regression, statistical significance was defined by a p-value of 0.05, with an error margin of 4% and 95% confidence intervals. Results: Alpha Score 2.0 establishes five types of malignant predictors: microcalcifications, irregular borders, taller-than-wide shape, predominant solid texture and hypoechogenicity;a diameter equal to or greater than 1.5 cm adds an extra point to the final score. Resulting classification divides TNs into 4 categories: benign (1.9%), low suspicion (8.7%), mild suspicion (13.6%) and high suspicion (75.7%) of malignancy probability;sensitivity of 82%, specificity of 74%, the positive predictive value of 94%, the negative predictive value of 51%, the statistical accuracy of 81%, odds ratio of 108.89 and correlation with ACR TIRADS of 0.77 and Bethesda of 0.91. Conclusions: Alpha Score 2.0 has superior diagnostic accuracy and performance compared to the previously published Alpha Score and is able to classify a benign TN in a precise, safe and accurate way, avoiding unnecessary FNABs or determining the necessity of FNAB in cases of moderate to high suspicion of malignancy.

关键词： Thyroid Cancer-Clinical Radiology-Imaging Thyroid Nodule Alpha Score TIRADS® Thyroid Ultrasonography

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