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Public Library of Science, PLoS ONE, 1(16), p. e0245617, 2021

DOI: 10.1371/journal.pone.0245617

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Diagnostic performance evaluation of different TI-RADS using ultrasound computer-aided diagnosis of thyroid nodules: An experience with adjusted settings

Journal article published in 2021 by Nonhlanhla Chambara ORCID, Shirley Y. W. Liu, Xina Lo, Michael Ying ORCID
This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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Data provided by SHERPA/RoMEO

Abstract

Background Thyroid cancer diagnosis has evolved to include computer-aided diagnosis (CAD) approaches to overcome the limitations of human ultrasound feature assessment. This study aimed to evaluate the diagnostic performance of a CAD system in thyroid nodule differentiation using varied settings. Methods Ultrasound images of 205 thyroid nodules from 198 patients were analysed in this retrospective study. AmCAD-UT software was used at default settings and 3 adjusted settings to diagnose the nodules. Six risk-stratification systems in the software were used to classify the thyroid nodules: The American Thyroid Association (ATA), American College of Radiology Thyroid Imaging, Reporting, and Data System (ACR-TIRADS), British Thyroid Association (BTA), European Union (EU-TIRADS), Kwak (2011) and the Korean Society of Thyroid Radiology (KSThR). The diagnostic performance of CAD was determined relative to the histopathology and/or cytology diagnosis of each nodule. Results At the default setting, EU-TIRADS yielded the highest sensitivity, 82.6% and lowest specificity, 42.1% while the ATA-TIRADS yielded the highest specificity, 66.4%. Kwak had the highest AUROC (0.74) which was comparable to that of ACR, ATA, and KSThR TIRADS (0.72, 0.73, and 0.70 respectively). At a hyperechoic foci setting of 3.5 with other settings at median values; ATA had the best-balanced sensitivity, specificity and good AUROC (70.4%; 67.3% and 0.71 respectively). Conclusion The default setting achieved the best diagnostic performance with all TIRADS and was best for maximizing the sensitivity of EU-TIRADS. Adjusting the settings by only reducing the sensitivity to echogenic foci may be most helpful for improving specificity with minimal change in sensitivity.