Korean J Radiol.  2020 Mar;21(3):369-376. 10.3348/kjr.2019.0581.

Computer-Aided Diagnosis System for the Evaluation of Thyroid Nodules on Ultrasonography: Prospective Non-Inferiority Study according to the Experience Level of Radiologists

Affiliations
  • 1Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. radbaek@naver.com
  • 2Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
  • 3Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
  • 4Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Abstract


OBJECTIVE
To determine whether a computer-aided diagnosis (CAD) system for the evaluation of thyroid nodules is non-inferior to radiologists with different levels of experience.
MATERIALS AND METHODS
Patients with thyroid nodules with a decisive diagnosis of benign or malignant nodule were consecutively enrolled from November 2017 to September 2018. Three radiologists with different levels of experience (1 month, 4 years, and 7 years) in thyroid ultrasound (US) reviewed the thyroid US with and without using the CAD system. Statistical analyses included non-inferiority testing of the diagnostic accuracy for malignant thyroid nodules between the CAD system and the three radiologists with a non-inferiority margin of 10%, comparison of the diagnostic performance, and the added value of the CAD system to the radiologists.
RESULTS
Altogether, 197 patients were included in the study cohort. The diagnostic accuracy of the CAD system (88.48%, 95% confidence interval [CI] = 82.65-92.53) was non-inferior to that of the radiologists with less experience (1 month and 4 year) of thyroid US (83.03%, 95% CI = 76.52-88.02; p < 0.001), whereas it was inferior to that of the experienced radiologist (7 years) (95.76%, 95% CI = 91.37-97.96; p = 0.138). The sensitivity and negative predictive value of the CAD system were significantly higher than those of the less-experienced radiologists were, whereas no significant difference was found with those of the experienced radiologist. A combination of US and the CAD system significantly improved sensitivity and negative predictive value, although the specificity and positive predictive value deteriorated for the less-experienced radiologists.
CONCLUSION
The CAD system may offer support for decision-making in the diagnosis of malignant thyroid nodules for operators who have less experience with thyroid US.

Keyword

Computer-aided diagnosis; Thyroid nodule; Thyroid cancer; Ultrasonography

MeSH Terms

Cohort Studies
Diagnosis*
Humans
Prospective Studies*
Sensitivity and Specificity
Thyroid Gland*
Thyroid Neoplasms
Thyroid Nodule*
Ultrasonography*
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