Predictors and a prediction model for positive fine needle aspiration biopsy in C-TIRADS 4 thyroid nodules

作者全名："Yang, Zhijie; Gao, Xin; Yang, Lu"

作者地址："[Yang, Zhijie; Gao, Xin; Yang, Lu] Chongqing Med Univ, Affiliated Hosp 2, Dept Breast & Thyroid Surg, Chongqing, Peoples R China"

通信作者："Yang, L (通讯作者)，Chongqing Med Univ, Affiliated Hosp 2, Dept Breast & Thyroid Surg, Chongqing, Peoples R China."

来源：FRONTIERS IN ENDOCRINOLOGY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001043380400001

JCR分区：Q2

影响因子：3.9

年份：2023

卷号：14

期号：　

开始页：　

结束页：　

文献类型：Article

关键词：thyroid nodules; C-TIRADS; fine needle aspiration biopsy; predictor; prediction model 444; 95% Cl=0.296 similar to 0.666; low echo (OR=3.549)

摘要："Objectives: To screen out the predictors and establish a prediction model of positive fine needle aspiration biopsy (FNAB) in the Chinese Guidelines for Malignant Risk Stratification of Thyroid Nodule Ultrasound (C-TIRADS) 4 thyroid nodules, and this nomogram can help clinicians evaluate the risk of positive FNAB and determine if FNAB is necessary. Methods: We retrospectively analyzed data from 547 patients who had C-TIRADS 4 thyroid nodules and underwent fine-needle aspiration biopsy (FNAB) at the Second Affiliated Hospital of Chongqing Medical University between November 30, 2021 and September 5, 2022. Patients who met our inclusion criteria were divided into two groups based on positive or negative FNAB results. We compared their ultrasound (US) features, BRAF V600E status, thyroid function, and other general characteristics using univariate and multivariate logistic regression analyses to identify independent predictors. These predictors were then used to construct a nomogram. The calibration plot, area under the curve (AUC), and decision curve analysis were employed to evaluate the calibration, discrimination, and clinical utility of the prediction model. Results: Out of 547 patients, 39.3% (215/547) had a positive result on fine-needle aspiration biopsy (FNAB), while 60.7% (332/547) had a negative result. Univariate logistic regression analysis revealed no significant differences in TPOAb, TgAb, TSH, Tg, nodule location, sex, or solid status between the two groups (P>0.05). However, age, nodule size, internal or surrounding blood flow signal, microcalcifications, aspect ratio, morphology, and low echo showed significant differences (P<0.05). Multivariate logistic regression analysis was conducted to explore the correlation between potential independent predictors. The results showed that only age (OR=0.444, 95% Cl=0.296 similar to 0.666, P<0.001), low echo (OR=3.549, 95% Cl=2.319 similar to 5.432, P<0.001), microcalcifications (OR=2.531, 95% Cl=1.661 similar to 3.856, P<0.001), aspect ratio (OR=3.032, 95% Cl=1.819 similar to 5.052, P<0.001), and morphology (OR=2.437, 95% Cl=1.586 similar to 3.745, P<0.001) were independent predictors for a positive FNAB. These variables were used to construct a prediction nomogram. An ROC curve analysis was performed to assess the accuracy of the nomogram, and AUC=0.793, which indicated good discrimination and decision curve analysis demonstrated clinical significance within a threshold range of 14% to 91%. Conclusion: In conclusion, 5 independent predictors of positive FNAB, including age (<= 45 years old), low echo (yes), microcalcifications (yes), aspect ratio (>1) and morphology (irregular), were identified. A nomogram was established based on the above 5 predictors, and the nomogram can be used as a complementary basis to help clinicians make decisions on FNAB of C-TI-RADS 4 thyroid nodules."

基金机构："Chongqing Natural Science Foundation [cstc2020jcyj-msxmX2011]; Science and Technology Bureau of Yuzhong District, Chongqing [20200145]; Kuanren Talents Program of the second affiliated hospital of Chongqing Medical University; Senior Medical Talents Program of Chongqing for Young and Middle-aged; [2022 [15]]"

基金资助正文："This study was supported by Chongqing Natural Science Foundation (grant no. cstc2020jcyj-msxmX2011), Science and Technology Bureau of Yuzhong District, Chongqing (grant no. 20200145), Kuanren Talents Program of the second affiliated hospital of Chongqing Medical University, and Senior Medical Talents Program of Chongqing for Young and Middle-aged (2022 [15])."