Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Clinicoradiological Characteristics in the Differential Diagnosis of Follicular-Patterned Lesions of the Thyroid: A Multicenter Cohort Study

  • Jeong Hoon Lee (Department of Radiology, Ajou University School of Medicine) ;
  • Eun Ju Ha (Department of Radiology, Ajou University School of Medicine) ;
  • Da Hyun Lee (Department of Radiology, Ajou University School of Medicine) ;
  • Miran Han (Department of Radiology, Ajou University School of Medicine) ;
  • Jung Hyun Park (Department of Radiology, Ajou University School of Medicine) ;
  • Ji-hoon Kim (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine)
  • Received : 2022.02.10
  • Accepted : 2022.04.26
  • Published : 2022.07.01
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Abstract

Objective: Preoperative differential diagnosis of follicular-patterned lesions is challenging. This multicenter cohort study investigated the clinicoradiological characteristics relevant to the differential diagnosis of such lesions. Materials and Methods: From June to September 2015, 4787 thyroid nodules (≥ 1.0 cm) with a final diagnosis of benign follicular nodule (BN, n = 4461), follicular adenoma (FA, n = 136), follicular carcinoma (FC, n = 62), or follicular variant of papillary thyroid carcinoma (FVPTC, n = 128) collected from 26 institutions were analyzed. The clinicoradiological characteristics of the lesions were compared among the different histological types using multivariable logistic regression analyses. The relative importance of the characteristics that distinguished histological types was determined using a random forest algorithm. Results: Compared to BN (as the control group), the distinguishing features of follicular-patterned neoplasms (FA, FC, and FVPTC) were patient's age (odds ratio [OR], 0.969 per 1-year increase), lesion diameter (OR, 1.054 per 1-mm increase), presence of solid composition (OR, 2.255), presence of hypoechogenicity (OR, 2.181), and presence of halo (OR, 1.761) (all p < 0.05). Compared to FA (as the control), FC differed with respect to lesion diameter (OR, 1.040 per 1-mm increase) and rim calcifications (OR, 17.054), while FVPTC differed with respect to patient age (OR, 0.966 per 1-year increase), lesion diameter (OR, 0.975 per 1-mm increase), macrocalcifications (OR, 3.647), and non-smooth margins (OR, 2.538) (all p < 0.05). The five important features for the differential diagnosis of follicular-patterned neoplasms (FA, FC, and FVPTC) from BN are maximal lesion diameter, composition, echogenicity, orientation, and patient's age. The most important features distinguishing FC and FVPTC from FA are rim calcifications and macrocalcifications, respectively. Conclusion: Although follicular-patterned lesions have overlapping clinical and radiological features, the distinguishing features identified in our large clinical cohort may provide valuable information for preoperative distinction between them and decision-making regarding their management.

Keywords

Acknowledgement

This work was supported by the Korean Thyroid Association Clinical Research Award 2019.

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