Size-Specific Predictors for Malignancy Risk in Follicular Thyroid Neoplasms: Machine Learning Analysis

TL;DR

This study uses machine learning to identify predictors of malignancy in follicular thyroid tumors based on their size, helping surgeons make preoperative decisions.

Contribution

The study introduces size-specific predictors for malignancy risk in follicular thyroid neoplasms using machine learning.

Findings

Macrocalcification and peripheral calcification are significant predictors for malignancy in small-sized follicular thyroid neoplasms.

Lower thyroid-stimulating hormone levels and larger tumor size are associated with malignancy risk in both small- and large-sized tumors.

Nodule-in-nodule appearance is a key predictor for malignancy in large-sized follicular thyroid neoplasms.

Abstract

Surgeons often face challenges in distinguishing between benign and malignant follicular thyroid neoplasms (FTNs), particularly small tumors, until diagnostic surgery is performed.

This study aimed to identify the size-specific predictors for the malignancy risk of FTNs preoperatively.

A retrospective cohort study was conducted at Peking University Third Hospital in Beijing, China, from 2012 to 2023. Patients with a postoperative pathological diagnosis of follicular thyroid adenoma (FTA) or follicular thyroid carcinoma (FTC) were included. FTNs were classified into small- and large-sized categories based on the cutoff value of the tumor diameter derived from spline regression, which indicated the turning point of malignancy risk. We identified the 5 most important predictors from 22 variables including demography, sonography, and hormones, using machine learning methods. We also calculated the odds ratios (OR) with 95% CI for these predictors in both small- and large-sized FTNs.

Altogether, we included 1494 FTNs, comprising 1266 FTAs and 228 FTCs. FTNs with a maximum diameter less than 3.0 cm were grouped as small-sized tumors (n=715), while those with larger diameters were categorized as large-sized tumors (n=779). In the small-sized group, tumors with macrocalcification (OR 2.90, 95% CI 1.50-5.60), those with peripheral calcification (OR 4.50, 95% CI 1.50-13.00), and those in younger patients (OR 1.33, 95% CI 1.05-1.69) showed a higher malignancy risk. In the large-sized group, tumors presenting with a nodule-in-nodule appearance (OR 3.30, 95% CI 1.30-7.90) exhibited a higher malignancy risk. In both groups, lower thyroid-stimulating hormone levels (OR 1.49, 95% CI 1.20-1.85 for small-sized FTNs; OR 1.61, 95% CI 1.37-1.96 for large-sized FTNs) and a larger mean diameter (OR 1.40, 95% CI 1.10-1.70 for small-sized FTNs; OR 1.50 95% CI 1.20-1.70 for large-sized FTNs) were associated with the malignancy risk of FTNs.

This study identified size-specific predictors for malignancy risk in FTNs, highlighting the importance of stratified prediction based on tumor size.

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