A predictive model to distinguish malignant and benign thyroid nodules based on age, gender and ultrasonographic features

Girardi, Fábio Muradás; Silva, Laura Mezzomo da; Flores, Cecilia Dias

doi:10.1016/j.bjorl.2017.10.001

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Brazilian Journal of Otorhinolaryngology

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Original articles • Braz. j. otorhinolaryngol. 85 (1) • Jan-Feb 2019 • https://doi.org/10.1016/j.bjorl.2017.10.001 copy

A predictive model to distinguish malignant and benign thyroid nodules based on age, gender and ultrasonographic features^☆ ☆ Please cite this article as: Girardi FM, Silva LM, Flores CD. A predictive model to distinguish malignant and benign thyroid nodules based on age, gender and ultrasonographic features. Braz J Otorhinolaryngol. 2019;85:24-31.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

A discussion in literature about a standardized decision support tool for the management of thyroid nodules remains.

Objective:

The purpose of this study was to create a statistical prediction model for thyroid nodules management.

Methods:

Two hundred and four benign and 57 malignant thyroid nodules were selected for a retrospective study. The variables age, gender and ultrasonographic features were examined using univariate and multivariate models. A statistical formula was used to calculate the risk of cancer of each case.

Results:

In multivariate analysis, irregular shape, absence of halo, lower mean age, homogeneous echotexture, microcalcifications and solid content were associated with cancer. After applying the formula, 20 cases (7.6%) with a calculated risk for malignancy ≤3.0% were found, all of them benign. Setting the calculated risk in ≥80%, 21 (8.0%) cases were selected, and in 85.7% of them cancer was confirmed in histopathology. Internal accuracy of the prediction formula was 92.5%.

Conclusions:

The prediction formula reached high accuracy and may be an alternative to other decision support tools for thyroid nodule management.

KEYWORDS
Thyroid nodule; Thyroid neoplasms; Ultrasonography; Cytology; Biopsy needle

	Benign		Malignant		Total		p-value
	Mean (SD)		Mean (SD)		Mean (SD)
Age	51.04 (13.41)		46.54 (15.00)		50.06 (13.87)		0.031
Diameter	2.31 (1.25)		1.68 (1.14)		2.17 (1.25)		0.004
	n = 204	% = 78.1	n = 57	% = 21.8	n = 261	% = 100
Gender (M/F)	23/181	11.2/88.7	7/50	12.2/87.7	30/231	11.4/88.5	0.867
Position							0.125
Left lobe	94	46.0	21	36.8	115	44.0
Right lobe	79	38.7	21	36.8	100	38.3
Isthmus	31	15.1	14	24.5	45	17.2
NI	0	0	1	1.7	1	0.3
Content							<0.001
Solid	108	52.9	47	82.4	155	59.3
Mixed pred. cystic	2	0.9	0	0	2	0.7
Mixed pred. solid	73	35.7	7	12.2	80	30.6
Cystic	21	10.2	3	5.2	24	9.1
Echotexture							0.403
Heterogeneous	36	17.6	7	12.2	43	16.4
Homogeneous	168	82.3	50	87.7	218	83.5
Echogenicity							<0.001
Pred. anechoic	22	10.7	2	3.5	24	9.1
Pred. hypoechoic	47	23.0	7	12.2	54	20.6
Pred. hyperecoic	11	5.3	0	0	11	4.2
Pred. isoechoic	85	41.6	11	19.2	96	36.7
Markedly hypoechoic	36	17.6	36	63.1	72	27.5
NI	3	1.4	1	1.7	4	1.5
Halo							<0.001
Absent	55	26.9	35	61.4	90	34.4
Regular	106	51.9	18	31.5	124	47.5
Irregular	43	21.0	4	7.0	47	18.0
Margins							0.001
Well defined	197	96.5	51	89.4	248	95.0
Ill defined	7	3.4	6	10.5	13	4.9
Shape							<0.001
Regular	178	87.2	29	50.8	207	79.3
Irregular	12	5.8	17	29.8	29	11.1
Lobulated	14	6.8	11	19.2	25	9.5
Calcifications							<0.001
Absent	160	78.4	22	38.5	182	69.7
Macrocalcifications	11	5.3	5	8.7	16	6.1
Peripheral ("eggshell")	9	4.4	1	1.7	10	3.8
Microcalcifications	24	11.7	29	50.8	53	20.3
Vascular flow							0.959
Absent	10	4.9	3	5.2	13	4.9
Intranodular	102	50.0	25	43.8	127	48.6
Perinodular	59	28.9	17	29.8	76	29.1
Peri-intranodular	23	11.2	6	10.5	29	11.1
NI	10	4.9	6	10.5	16	6.1

	β	SE	p-value	OR	95% CI
					Lower	Upper
Irregular shape	0.762	0.629	0.016	6.884	1.434	33.044
Microcalcification	2.066	1.222	0.014	7.895	0.719	86.660
Absent halo	1.929	0.800	0.016	5.522	1.370	22.249
Homogeneous echotexture	1.601	0.682	0.019	4.956	1.302	18.858
Lower mean age	0.034	0.015	0.020	0.967	0.940	0.995
Solid content	1.475	0.551	0.007	4.373	1.302	18.588

Variable	Features
X1	Gender: female = 0; Male = 1
X2	Age: in years
X3	Isthmus location = 1; if left or right lobe = 0
X4	Right lobe location = 1; if isthmus or left lobe = 0
X5	Predominantly or purely cystic content = 1; if predominantly solid or mixed solid-cystic = 0
X6	Predominantly solid content = 1; if predominantly or purely cystic or mixed solid-cystic = 0
X7	Homogeneous echotexture = 1; heterogeneous = 0
X8	Halo: if absent = 1; if present and complete or partially present = 0
X9	Halo: if present and complete = 1; if partially present or absent = 0
X10	Undefined margins = 1; defined = 0
X11	Irregular shape = 1; if regular or lobulated = 0
X12	Lobulated shape = 1; if irregular or regular = 0
X13	Calcification: if absent = 1; if micro or macrocalcifications or peripheral rim calcifications = 0
X14	Calcification: if macrocalcifications = 1; if absent or microcalcifications or peripheral rim calcifications = 0
X15	Calcification: if microcalcifications = 1; if absent or macrocalcifications or peripheral rim calcifications = 0
X16	Absent vascular flow = 1; if predominantly central, peripheral or mixed = 0
X17	Mixed vascular flow = 1; if absent, predominantly central or peripheral = 0
X18	Peripheral vascular flow = 1; if absent, predominantly central or mixed = 0

Histopathology	Calculated cancer risk
	0-10%		10.1-30%		30.1-50%		50.1-70%		70.1-90%		90.1-100%
	n	%	n	%	n	%	n	%	n	%	n	%
Malignant	6	7.4	15	14.5	6	20.6	8	42.1	11	64.7	11	91.6
Total	81		103		29		19		17		12

Cases (%)	7.2	49.8	31.8	3.0	8.0
Calculated cancer risk (%)	0-3	3.1-20	20.1-69.9	70-79.9	80-100
Cancer cases (%)	0	8.4	28.9	50.0	85.7
Clinical management	Observation	Observation/FNAB	FNAB	Surgery/FNAB	Surgery

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] * Corresponding author. E-mail:fabiomgirardi@gmail.com (F.M. Girardi).