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A nomogram for predicting malignancy in thyroid nodules diagnosed as atypia of undetermined significance/follicular lesions of undetermined significance on fine needle aspiration

 Jung Hyun Yoon  ;  Hye Sun Lee  ;  Eun-Kyung Kim  ;  Hee Jung Moon  ;  Jin Young Kwak 
 SURGERY, Vol.155(6) : 1006-1013, 2014 
Journal Title
Issue Date
Adenocarcinoma, Follicular/diagnostic imaging ; Adenocarcinoma, Follicular/pathology* ; Adenoma, Oxyphilic ; Adult ; Biopsy, Fine-Needle ; Carcinoma/diagnostic imaging ; Carcinoma/pathology ; Carcinoma, Neuroendocrine ; Carcinoma, Papillary ; Decision Support Techniques* ; Female ; Follow-Up Studies ; Humans ; Image-Guided Biopsy ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Nomograms* ; ROC Curve ; Retrospective Studies ; Thyroid Gland/diagnostic imaging ; Thyroid Gland/pathology* ; Thyroid Neoplasms/diagnostic imaging ; Thyroid Neoplasms/pathology* ; Thyroid Nodule/diagnostic imaging ; Thyroid Nodule/pathology* ; Ultrasonography, Interventional
We hypothesized that a nomogram constructed of clinical and imaging variables could be applied to predicting the risk of malignancy in thyroid nodules diagnosed as atypia of undetermined significance/follicular lesions of undetermined significance (AUS/FLUS) on ultrasonographic fine-needle aspiration (US-FNA).
This retrospectively designed study included 393 thyroid nodules in 392 patients (mean age, 49 ± 12 years), which were diagnosed as AUS/FLUS with US-FNA during the study period. Medical records, US images, and cytopathology results were reviewed and analyzed. The 393 thyroid nodules were divided into training and validation sets. Logistic regression analysis was performed to predict the probability of malignancy, and nomograms were constructed using the training set and subsequently applied to the validation set.
Three sets of nomograms were constructed separately using clinical factors and (1) individual US features; (2) final assessment of US; and (3) the number of suspicious US features. All 3 sets of nomograms built were proven accurate and discriminative, these nomograms had an area under the receiver operating characteristic curve (AUC) of 0.817 (95% confidence interval [CI], 0.757-0.877) when using clinical factors and individual US features, an AUC of 0.769 (95% CI, 0.705-0.833) wen using final assessment, and an AUC of 0.779 (95% CI, 0.718-0.840) when using the number of suspicious US features. The AUC of each validation set was 0.754 (95% CI, 0.659-0.850), 0.757 (95% CI, 0.661-0.853), and 0.721 (95% CI, 0.621-0.820), respectively.
Nomograms constructed in our study using US can be utilized in predicting the probability of malignancy in thyroid nodules diagnosed as AUS/FLUS on US-FNA, and may help in selecting patients who are at high risk for malignancy.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kwak, Jin Young(곽진영) ORCID logo https://orcid.org/0000-0002-6212-1495
Kim, Eun-Kyung(김은경) ORCID logo https://orcid.org/0000-0002-3368-5013
Moon, Hee Jung(문희정) ORCID logo https://orcid.org/0000-0002-5643-5885
Yoon, Jung Hyun(윤정현) ORCID logo https://orcid.org/0000-0002-2100-3513
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
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