Comparison of a model combining conventional ultrasonography and strain elastography with ACR TI-RADS for reducing unnecessary fine-needle aspiration in solid-predominant partially cystic thyroid nodules: a multicenter study.
6 affiliations
- 1Medical College, Yangzhou University, Yangzhou, China.
- 2Department of Ultrasound, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China.
- 3Department of Ultrasound, Nanjing Lishui District Hospital of Traditional Chinese Medicine, Nanjing, China.
- 4Department of Ultrasound, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China.
- 5Department of Ultrasound, Northern Jiangsu People's Hospital, Yangzhou, China.
- 6Jianhu Clinical Medical College of Yangzhou University, Yancheng, China.
Abstract
Solid-predominant partially cystic thyroid nodules (PCTNs) present challenges for malignancy risk stratification and fine-needle aspiration (FNA) decision-making. This study aimed to compare a multiparametric ultrasound model integrating conventional ultrasound and strain elastography with the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) management strategy for reducing unnecessary FNA in solid-predominant PCTNs. This multicenter retrospective study included solid-predominant PCTNs evaluated at three tertiary referral hospitals between October 2018 and May 2024. A total of 375 nodules were included, with 264 assigned to the training cohort and 111 to the validation cohort. Two predictive models were constructed: Model 1 incorporated maximum nodule diameter and conventional ultrasound features, and Model 2 additionally included elastography. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis. Among the 375 included nodules, 198 (52.8%) were malignant. In the validation cohort, the AUCs were 0.63 [95% confidence interval (CI): 0.54-0.73] for the ACR TI-RADS management strategy, 0.80 (95% CI: 0.72-0.88) for Model 1, and 0.86 (95% CI: 0.78-0.93) for Model 2. Using the continuous ACR TI-RADS score, Model 2 achieved a higher AUC (0.86 vs. 0.74; paired DeLong P=0.02). Elastographic stiffness was the strongest predictor of malignancy in Model 2 [odds ratio (OR), 10.53; 95% CI: 3.65-30.38; P<0.001]. At a threshold probability of 0.62 and relative to the hypothetical strategy of performing FNA for all nodules, Model 2 could potentially avoid 56% of FNAs while missing 27% of malignant nodules, compared with 41% and 27%, respectively, under the ACR TI-RADS management strategy. The combination of conventional ultrasound features and strain elastography outperformed the ACR TI-RADS system for FNA triage in solid-predominant PCTNs and may help reduce unnecessary FNA procedures.
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BibTeX
@article{wang2026comparison,
title = {{Comparison of a model combining conventional ultrasonography and strain elastography with ACR TI-RADS for reducing unnecessary fine-needle aspiration in solid-predominant partially cystic thyroid nodules: a multicenter study.}},
author = {Yuguo Wang and Wangxing Huang and Hanzhong Qi and Huajiao Zhao and Cuirong Li and Xusheng Song and Xiaoqin Qian},
journal = {Gland surgery},
year = {2026},
month = oct,
doi = {10.21037/gs-2026-0332},
url = {https://europepmc.org/article/MED/42996834},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Comparison of a model combining conventional ultrasonography and strain elastography with ACR TI-RADS for reducing unnecessary fine-needle aspiration in solid-predominant partially cystic thyroid nodules: a multicenter study.
AU - Yuguo Wang
AU - Wangxing Huang
AU - Hanzhong Qi
AU - Huajiao Zhao
AU - Cuirong Li
AU - Xusheng Song
AU - Xiaoqin Qian
PY - 2026
DA - 2026/10/19
JO - Gland surgery
DO - 10.21037/gs-2026-0332
UR - https://europepmc.org/article/MED/42996834
AB - Solid-predominant partially cystic thyroid nodules (PCTNs) present challenges for malignancy risk stratification and fine-needle aspiration (FNA) decision-making. This study aimed to compare a multiparametric ultrasound model integrating conventional ultrasound and strain elastography with the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) management strategy for reducing unnecessary FNA in solid-predominant PCTNs. This multicenter retrospective study included solid-predominant PCTNs evaluated at three tertiary referral hospitals between October 2018 and May 2024. A total of 375 nodules were included, with 264 assigned to the training cohort and 111 to the validation cohort. Two predictive models were constructed: Model 1 incorporated maximum nodule diameter and conventional ultrasound features, and Model 2 additionally included elastography. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis. Among the 375 included nodules, 198 (52.8%) were malignant. In the validation cohort, the AUCs were 0.63 [95% confidence interval (CI): 0.54-0.73] for the ACR TI-RADS management strategy, 0.80 (95% CI: 0.72-0.88) for Model 1, and 0.86 (95% CI: 0.78-0.93) for Model 2. Using the continuous ACR TI-RADS score, Model 2 achieved a higher AUC (0.86 vs. 0.74; paired DeLong P=0.02). Elastographic stiffness was the strongest predictor of malignancy in Model 2 [odds ratio (OR), 10.53; 95% CI: 3.65-30.38; P<0.001]. At a threshold probability of 0.62 and relative to the hypothetical strategy of performing FNA for all nodules, Model 2 could potentially avoid 56% of FNAs while missing 27% of malignant nodules, compared with 41% and 27%, respectively, under the ACR TI-RADS management strategy. The combination of conventional ultrasound features and strain elastography outperformed the ACR TI-RADS system for FNA triage in solid-predominant PCTNs and may help reduce unnecessary FNA procedures.
SN - 2227-684X
SN - 2227-8575
ER -