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Markedly hypoechoic: a new definition improves the diagnostic performance of thyroid ultrasound

  • Ultrasound
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To determine the contribution of a modified definition of markedly hypoechoic in the differential diagnosis of thyroid nodules.

Methods

A total of 1031 thyroid nodules were included in this retrospective multicenter study. All of the nodules were examined with US before surgery. The US features of the nodules were evaluated, in particular, the classical markedly hypoechoic and modified markedly hypoechoic (decreased or similar echogenicity relative to the adjacent strap muscles). The sensitivity, specificity, and AUC of classical/modified markedly hypoechoic and the corresponding ACR-TIRADS, EU-TIRADS, and C-TIRADS categories were calculated and compared. The inter- and intraobserver variability in the evaluation of the main US features of the nodules was assessed.

Results

There were 264 malignant nodules and 767 benign nodules. Compared with classical markedly hypoechoic as a diagnostic criterion for malignancy, using modified markedly hypoechoic as the criterion resulted in a significant increase in sensitivity (28.03% vs. 63.26%) and AUC (0.598 vs. 0.741), despite a significant decrease in specificity (91.53% vs. 84.88%) (p < 0.001 for all). Compared to the AUC of the C-TIRADS with the classical markedly hypoechoic, the AUC of the C-TIRADS with the modified markedly hypoechoic increased from 0.878 to 0.888 (p = 0.01); however, the AUCs of the ACR-TIRADS and EU-TIRADS did not change significantly (p > 0.05 for both). There was substantial interobserver agreement (κ = 0.624) and perfect intraobserver agreement (κ = 0.828) for the modified markedly hypoechoic.

Conclusion

The modified definition of markedly hypoechoic resulted in a significantly improved diagnostic efficacy in determining malignant thyroid nodules and may improve the diagnostic performance of the C-TIRADS.

Clinical relevance statement

Our study found that, compared with the original definition, modified markedly hypoechoic significantly improved the diagnostic performance in differentiating malignant from benign thyroid nodules and the predictive efficacy of the risk stratification systems.

Key Points

• Compared with the classical markedly hypoechoic as a diagnostic criterion for malignancy, the modified markedly hypoechoic resulted in a significant increase in sensitivity and AUC.

• The C-TIRADS with the modified markedly hypoechoic achieved higher AUC and specificity than that with the classical markedly hypoechoic (p = 0.01 and  < 0.001, respectively).

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Abbreviations

AUC:

Area under the ROC curve

FNA:

Fine needle aspiration

ROC:

Receiver operating characteristic

TIRADS:

Thyroid Imaging Reporting and Data System

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Acknowledgements

The authors would like to thank all the staff working in ultrasound department of eight hospitals in the research.

Funding

This research did not receive any specific grant from any funding agency.

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Author notes

  1. Juan Liu and Ting Luo contributed equally and share first authorship.

Authors and Affiliations

  1. Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Rd, Shanghai, 200025, China

    Juan Liu, Ting Luo, XiaoHong Jia, YiJie Dong, JingWen Zhang, WenWen Xu & JianQiao Zhou

  2. Department of Ultrasound, The Anyang Tumor Hospital, 1 Huanbinbei Road, Anyang, 455001, China

    Hua Zhang

  3. Department of Ultrasound, The Affiliated Hospital of Southwest Medical University, 25 TaiPing Street, Luzhou, 646000, China

    Hui Liu

  4. Department of Ultrasound, The Affiliated Hospital of Guizhou Medical University, 28 Guiyijie Street, Guiyang, 550001, China

    Ying Gu, Xia Chen & LiYing Shi

  5. Department of Ultrasound, Gansu Provincial Cancer Hospital, 2 Xiaoxihu East Road, Qilihe District, Lanzhou, 730050, China

    Ling Guan

  6. Department of Medical Ultrasound, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, 226001, China

    XueJun Ni

  7. Department of Ultrasound, Dalian Central Hospital Affiliated to Dalian Medical University, 42 Xuegong Street, Shahekou District, Dalian, 116033, China

    XinDan Zhang

  8. Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, 1 Eastern Jianshe Road, Zhengzhou, 450052, China

    RuiFang Zhang

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  1. Juan Liu
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Corresponding author

Correspondence to JianQiao Zhou.

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Guarantor

The scientific guarantor of this publication is JianQiao Zhou, MD.

Conflict of interest

The authors declare no competing interests.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

There was no overlap with any themes from previously published works.

Methodology

• retrospective

• diagnostic or prognostic study

• multicenter study

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Liu, J., Luo, T., Zhang, H. et al. Markedly hypoechoic: a new definition improves the diagnostic performance of thyroid ultrasound. Eur Radiol 33, 7857–7865 (2023). https://doi.org/10.1007/s00330-023-09828-1

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  • DOI: https://doi.org/10.1007/s00330-023-09828-1

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