Validation of Three Scoring Risk Stratification Models for Thyroid Nodules.

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Validation of Three Scoring Risk Stratification Models for Thyroid Nodules.

Thyroid. 2017 Nov 06;:

Authors: Ha SM, Ahn HS, Baek JH, Ahn HY, Chung YJ, Cho BY, Park SB

Abstract
BACKGROUND: To minimize potential harm from overuse of fine-needle aspiration, Thyroid Imaging Reporting and Data Systems (TIRADSs) were developed for thyroid nodule risk stratification. The purpose of this study was to perform validation of three scoring risk stratification models for thyroid nodules using ultrasonography features, a web-based malignancy risk stratification system at website (http://ift.tt/2hf04Lu) and those developed by the Korean Society of Thyroid Radiology (KSThR) and the American College of Radiology (ACR).
METHODS: Using ultrasonography images, radiologists assessed thyroid nodules according to the following criteria: internal content, echogenicity of the solid portion, shape, margin, and calcifications. 954 patients (mean age, 50.8 years; range, 13-86 years) with 1112 nodules were evaluated in our institute from January 2013 to December 2014. The discrimination ability of the three models was assessed by estimating the area under the receiver operating characteristic (ROC) curve. Additionally, Hosmer-Lemeshow goodness-of-fit statistics (calibration ability) were used to evaluate the agreement between the observed and expected number of nodules that were benign or malignant.
RESULTS: Thyroid malignancy was present in 37.2% of nodules (414/1112). According to the 14-point web-based scoring risk stratification system, malignancy risk ranged from 4.5% to 100.0% and was positively associated with an increase in risk scores. The areas under the ROC curve of the validation set were 0.884 in the web-based, 0.891 in the KSThR, and 0.875 in the ACR scoring risk stratification models. The Hosmer-Lemeshow goodness-of-fit test indicated that the web-based scoring system showed the best-calibrated result with a p value of 0.078.
CONCLUSION: The three scoring risk stratification models using the ultrasonography features of thyroid nodules to stratify malignancy risk showed acceptable predictive accuracy and similar areas under the curve. The web-based scoring system demonstrated the strongest agreement in calibration ability analysis. The easily accessible automated web-based scoring risk stratification system may overcome the complexity of the various TIRADS guidelines and provide simplified guidance on personalized and optimal management in real practice.

PMID: 29108488 [PubMed - as supplied by publisher]

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