Skip to content
2000
Volume 21, Issue 1
  • ISSN: 1573-4056
  • E-ISSN: 1875-6603
side by side viewer icon HTML

Abstract

Background

The malignant risk of cystic-solid thyroid nodules may be underestimated in the ultrasound assessment.

Objective

This systematic review and meta-analysis aimed to evaluate the value of multimodal ultrasound characteristics in the malignant risk assessment of cystic-solid thyroid nodules.

Methods

We conducted a comprehensive search of PubMed, Web of Science, and Cochrane Library databases for studies depicting the ultrasound characteristics of cystic-solid thyroid nodules published prior to October 2023. The Review Manager 5.4 software was utilized to evaluate the ultrasound features suggestive of malignancy and to determine their sensitivity and specificity. Additionally, the Sata 12.0 software was utilized to construct summary receiver operating characteristic curves (SROC), estimate the area under the curve (AUC), and evaluate any potential publication bias.

Results

This review included 16 studies comprising 5,655 cystic-solid thyroid nodules. Nine ultrasound features were identified as risk factors for tumor malignancy. Among the ultrasound features, microcalcification in the solid portion, heterogeneous hypoenhancement on Contrast-Enhanced Ultrasound (CEUS), and sharp angles in the solid portion exhibited higher malignant predictive value in cystic-solid thyroid nodules, with AUC values of 0.91, 0.84, and 0.81, respectively.

Conclusion

Our findings indicate that microcalcification and sharp angles in the solid part of the nodule, along with heterogeneous hypoenhancement on contrast-enhanced ultrasound (CEUS), can better predict malignant cystic-solid thyroid nodules.

The systematic review and meta-analysis was registered prospectively in the International Prospective Register of Systematic Reviews (No. CRD42024602893).

This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Loading

Article metrics loading...

/content/journals/cmir/10.2174/0115734056360924250106091630
2025-01-01
2025-11-01
Loading full text...

Full text loading...

/deliver/fulltext/cmir/21/1/CMIR-21-E15734056360924.html?itemId=/content/journals/cmir/10.2174/0115734056360924250106091630&mimeType=html&fmt=ahah

References

  1. MulitaF. AnjumF. Thyroid adenoma.StatPearlsStatPearls PublishingTreasure Island (FL)2024
    [Google Scholar]
  2. BurmanK.D. WartofskyL. Thyroid nodules.N. Engl. J. Med.2015373242347235610.1056/NEJMcp141578626650154
    [Google Scholar]
  3. HaugenB.R. AlexanderE.K. BibleK.C. DohertyG.M. MandelS.J. NikiforovY.E. PaciniF. RandolphG.W. SawkaA.M. SchlumbergerM. SchuffK.G. ShermanS.I. SosaJ.A. StewardD.L. TuttleR.M. WartofskyL. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer.Thyroid2016261113310.1089/thy.2015.002026462967
    [Google Scholar]
  4. LiW. ZhuQ. JiangY. ZhangQ. MengZ. SunJ. LiJ. DaiQ. Partially cystic thyroid nodules in ultrasound-guided fine needle aspiration.Medicine20179646e868910.1097/MD.000000000000868929145304
    [Google Scholar]
  5. ZhouJ. SongY. ZhanW. WeiX. ZhangS. ZhangR. GuY. ChenX. ShiL. LuoX. YangL. LiQ. BaiB. YeX. ZhaiH. ZhangH. JiaX. DongY. ZhangJ. YangZ. ZhangH. ZhengY. XuW. LaiL. YinL. Superficial Organ and Vascular Ultrasound Group of the Society of Ultrasound in Medicine of Chinese Medical Association Chinese Artificial Intelligence Alliance for Thyroid and Breast Ultrasound Thyroid imaging reporting and data system (TIRADS) for ultrasound features of nodules: Multicentric retrospective study in China.Endocrine202172115717010.1007/s12020‑020‑02442‑x32852733
    [Google Scholar]
  6. HaE.J. ChungS.R. NaD.G. AhnH.S. ChungJ. LeeJ.Y. ParkJ.S. YooR.E. BaekJ.H. BaekS.M. ChoS.W. ChoiY.J. HahnS.Y. JungS.L. KimJ. KimS.K. KimS.J. LeeC.Y. LeeH.K. LeeJ.H. LeeY.H. LimH.K. ShinJ.H. SimJ.S. SungJ.Y. YoonJ.H. ChoiM. 2021 Korean thyroid imaging reporting and data system and imaging-based management of thyroid nodules: Korean society of thyroid radiology consensus statement and recommendations.Korean J. Radiol.202122122094212310.3348/kjr.2021.071334719893
    [Google Scholar]
  7. TesslerF.N. MiddletonW.D. GrantE.G. Thyroid imaging reporting and data system (TI-RADS): A user’s guide.Radiology20182871293610.1148/radiol.201717124029558300
    [Google Scholar]
  8. RussG. BonnemaS.J. ErdoganM.F. DuranteC. NguR. LeenhardtL. European thyroid association guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: The EU-TIRADS.Eur. Thyroid J.20176522523710.1159/00047892729167761
    [Google Scholar]
  9. GharibH. PapiniE. GarberJ.R. DuickD.S. HarrellR.M. HegedüsL. PaschkeR. ValcaviR. VittiP. AACE/ACE/AME Task Force on Thyroid Nodules American association of clinical endocrinologists, american college of endocrinology, and associazione medici endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules--2016 update.Endocr. Pract.201622516010.4158/EP161208.GL27167915
    [Google Scholar]
  10. ShiX. LiuR. GaoL. XiaY. JiangY. Diagnostic value of sonographic features in distinguishing malignant partially cystic thyroid nodules: A systematic review and meta-analysis.Front. Endocrinol.20211262440910.3389/fendo.2021.62440933815282
    [Google Scholar]
  11. MoherD. LiberatiA. TetzlaffJ. AltmanD.G. PRISMA Group Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.BMJ2009339jul21 1b253510.1136/bmj.b253519622551
    [Google Scholar]
  12. ZhouT. HuangH. DongH. NiZ. SunH. HeT. MaC. Ultrasound-based risk stratification system for the assessment of partially cystic thyroid nodules.Endocr. Pract.202329642843510.1016/j.eprac.2023.03.27537004871
    [Google Scholar]
  13. WangC.Y. LiY. ZhangM.M. YuZ.L. WuZ.Z. LiC. ZhangD.C. YeY.J. WangS. JiangK.W. Analysis of differential diagnosis of benign and malignant partially cystic thyroid nodules based on ultrasound characterization with a TIRADS grade-4a or higher nodules.Front. Endocrinol.20221386107010.3389/fendo.2022.86107035651976
    [Google Scholar]
  14. LeeY.J. KimJ.Y. NaD.G. KimJ. OhM. KimD.B. YoonR.G. KimS.K. BakS. Malignancy risk of thyroid nodules with minimal cystic changes: A multicenter retrospective study.Ultrasonography202241467067710.14366/usg.2205936039031
    [Google Scholar]
  15. XinY. LiuF. ShiY. YanX. LiuL. ZhuJ. A scoring system for assessing the risk of malignant partially cystic thyroid nodules based on ultrasound features.Front. Oncol.20211173177910.3389/fonc.2021.73177934692506
    [Google Scholar]
  16. SongQ. TianX. JiaoZ. YanL. LanY. ZhuY. LuoY. Value of conventional ultrasonography with contrast-enhanced ultrasonography in the differential diagnosis of partial cystic thyroid nodules.Ultrasound Med. Biol.20214792494250110.1016/j.ultrasmedbio.2021.03.00934119357
    [Google Scholar]
  17. LiuY. ZhaoY. FuJ. LiuS. Ultrasonographic differentiation and Ultrasound-based management of partially cystic thyroid nodules.Arch. Endocrinol. Metab.202165333634110.20945/2359‑399700000036733939910
    [Google Scholar]
  18. FangF. GongY. LiaoL. YeF. ZuoZ. QiZ. LiX. NiuC. Value of contrast-enhanced ultrasound in partially cystic papillary thyroid carcinomas.Front. Endocrinol.20211278367010.3389/fendo.2021.78367034956094
    [Google Scholar]
  19. ZhaoH.N. LiuJ.Y. LinQ.Z. HeY.S. LuoH.H. PengY.L. MaB.Y. Partially cystic thyroid cancer on conventional and elastographic ultrasound: A retrospective study and a machine learning—assisted system.Ann. Transl. Med.20208749510.21037/atm.2020.03.21132395539
    [Google Scholar]
  20. ShiY.Z. JinY. ZhengL. Partially cystic thyroid nodules on ultrasound: The associated factors for malignancy.Clin. Hemorheol. Microcirc.202074437338110.3233/CH‑19058231658050
    [Google Scholar]
  21. NaD.G. KimJ. KimD.S. KimS.J. Thyroid nodules with minimal cystic changes have a low risk of malignancy.Ultrasonography201635215315810.14366/usg.1507026760848
    [Google Scholar]
  22. HaE.J. MoonW.J. NaD.G. LeeY.H. ChoiN. KimS.J. KimJ.K. A multicenter prospective validation study for the korean thyroid imaging reporting and data system in patients with thyroid nodules.Korean J. Radiol.201617581182110.3348/kjr.2016.17.5.81127587972
    [Google Scholar]
  23. WangX. WeiX. XuY. XinX. ZhangS. Ultrasound characteristics of partially cystic thyroid nodules and their relationship with differential diagnosis of the lesions.Zhonghua Zhong Liu Za Zhi201436861762025430030
    [Google Scholar]
  24. ParkJ.M. ChoiY. KwagH.J. Partially cystic thyroid nodules: Ultrasound findings of malignancy.Korean J. Radiol.201213553053510.3348/kjr.2012.13.5.53022977318
    [Google Scholar]
  25. KimD.W. LeeE.J. InH.S. KimS.J. Sonographic differentiation of partially cystic thyroid nodules: A prospective study.AJNR Am. J. Neuroradiol.201031101961196610.3174/ajnr.A220420634308
    [Google Scholar]
  26. LeeM.J. KimE.K. KwakJ.Y. KimM.J. Partially cystic thyroid nodules on ultrasound: Probability of malignancy and sonographic differentiation.Thyroid200919434134610.1089/thy.2008.025019355824
    [Google Scholar]
  27. WuY. ZhouC. ShiB. ZengZ. WuX. LiuJ. Systematic review and meta-analysis: Diagnostic value of different ultrasound for benign and malignant thyroid nodules.Gland Surg.20221161067107710.21037/gs‑22‑25435800749
    [Google Scholar]
  28. RadzinaM. RatnieceM. PutrinsD.S. SauleL. CantisaniV. Performance of contrast-enhanced ultrasound in thyroid nodules: Review of current state and future perspectives.Cancers20211321546910.3390/cancers1321546934771632
    [Google Scholar]
  29. CantisaniV. ConsortiF. GuerrisiA. GuerrisiI. RicciP. Di SegniM. MancusoE. ScardellaL. MilazzoF. D’AmbrosioF. AntonaciA. Prospective comparative evaluation of quantitative-elastosonography (Q-elastography) and contrast-enhanced ultrasound for the evaluation of thyroid nodules: Preliminary experience.Eur. J. Radiol.201382111892189810.1016/j.ejrad.2013.07.00523928231
    [Google Scholar]
  30. DuranteC. HegedüsL. NaD.G. PapiniE. SiposJ.A. BaekJ.H. FrasoldatiA. GraniG. GrantE. HorvathE. HoangJ.K. MandelS.J. MiddletonW.D. NguR. OrloffL.A. ShinJ.H. TrimboliP. YoonJ.H. TesslerF.N. International expert consensus on US lexicon for thyroid nodules.Radiology20233091e23148110.1148/radiol.23148137906014
    [Google Scholar]
  31. MulitaF. PlachouriM.K. LiolisE. VailasM. PanagopoulosK. MaroulisI. Patient outcomes following surgical management of thyroid nodules classified as Bethesda category III (AUS/FLUS).Endokrynol. Pol.202172214314410.5603/EP.a2021.001833749812
    [Google Scholar]
  32. MulitaF. IliopoulosF. TsilivigkosC. TchabashviliL. LiolisE. KaplanisC. PerdikarisI. MaroulisI. Cancer rate of Bethesda category II thyroid nodules.Medicinski Glasnik20221910.17392/1413‑21
    [Google Scholar]
  33. MulitaF. VerrasG.I. DafnomiliV.D. TchabashviliL. PerdikarisI. BousisD. LiolisE. SamarasA. VafeiadisV. DelisA. Thyroidectomy for the management of differentiated thyroid carcinoma and their outcome on early postoperative complications: A 6-year single-centre retrospective study.Chirurgia202211755656210.21614/chirurgia.2736
    [Google Scholar]
/content/journals/cmir/10.2174/0115734056360924250106091630
Loading
/content/journals/cmir/10.2174/0115734056360924250106091630
Loading

Data & Media loading...

Supplements

PRISMA checklist is available as supplementary material on the publisher’s website along with the published article.

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error
Please enter a valid_number test