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European Radiology
Published in: European Radiology 3/2019

01-03-2019 | Ultrasound

Development and validation of an ultrasound-based nomogram to improve the diagnostic accuracy for malignant thyroid nodules

Authors: Bao-liang Guo, Fu-sheng Ouyang, Li-zhu Ouyang, Zi-wei Liu, Shao-jia Lin, Wei Meng, Xi-yi Huang, Hai-xiong Chen, Shao-ming Yang, Qiu-gen Hu

Published in: European Radiology | Issue 3/2019

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Abstract

Objectives

The aim of this study was to develop an ultrasound-based nomogram to improve the diagnostic accuracy of the identification of malignant thyroid nodules.

Methods

A total of 1675 histologically proven thyroid nodules (1169 benign, 506 malignant) were included in this study. The nodules were grouped into the training dataset (n = 700), internal validation dataset (n = 479), or external validation dataset (n = 496). The grayscale ultrasound features included the nodule size, shape, aspect ratio, echogenicity, margins, and calcification pattern. We applied least absolute shrinkage and selection operator (lasso) regression to select the strongest features for the nomogram. Nomogram discrimination (area under the receiver operating characteristic curve, AUC) and calibration were assessed. The nomogram was subjected to bootstrapping validation (1000 bootstrap resamples) to calculate a mean AUC and 95% confidence interval (CI).

Results

The nomogram showed good discrimination in the training dataset, with an AUC of 0.936 (95% CI: 0.918–0.953) and good calibration. Application of the nomogram to the internal validation dataset also resulted in good discrimination (AUC: 0.935; 95% CI, 0.915–0.954) and good calibration. The model tested in an external validation dataset demonstrated a lower AUC of 0.782 (95% CI: 0.776–0.789).

Conclusions

This ultrasound-based nomogram can be used to quantify the probability of malignant thyroid nodules.

Key Points

• Ultrasound examination is helpful in the differential diagnosis of malignant and benign thyroid nodules.
• However, ultrasound accuracy relies heavily on examiner experience.
• A less subjective diagnostic model is desired, and the developed nomogram for thyroid nodules showed good discrimination and good calibration.
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Metadata
Title
Development and validation of an ultrasound-based nomogram to improve the diagnostic accuracy for malignant thyroid nodules
Authors
Bao-liang Guo
Fu-sheng Ouyang
Li-zhu Ouyang
Zi-wei Liu
Shao-jia Lin
Wei Meng
Xi-yi Huang
Hai-xiong Chen
Shao-ming Yang
Qiu-gen Hu
Publication date
01-03-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 3/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5715-5

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