ArticleUltrasonography (Seoul, Korea)2025
Predicting multigenic co-mutations in differentiated thyroid cancer using contrast-enhanced ultrasonography: model development and internal validation.
Article in Ultrasonography (Seoul, Korea), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThis study aimed to analyze the ultrasonographic characteristics of differentiated thyroid cancer (DTC) with multigenic co-mutations and to establish a predictive model using contrast-enhanced ultrasonography (CEUS).
methodsThis retrospective study included consecutive patients with pathologically confirmed DTC who underwent preoperative CEUS and next-generation sequencing at the authors' institution between September 2021 and December 2023. Clinical and CEUS features were compared between patients with and without multigenic co-mutations. Bayesian logistic regression (non-informative normal priors) was applied for predictor selection and model development, with Markov-chain Monte Carlo (MCMC) convergence checks and posterior predictive validation. Internal validation was performed using bootstrap resampling (n=1,000 iterations) to evaluate model stability.
resultsA total of 116 patients (mean age, 39.84±11.02 years; 33 men) were included, of whom 12 had multigenic co-mutations and 104 did not. Patients with multigenic co-mutations demonstrated a higher incidence of aggressive histological subtypes (25.0% vs. 1.9%, P=0.008) and lymph node metastasis (83.3% vs. 51.9%, P=0.038). Tumor size, enhancement homogeneity, and contrast agent arrival time were identified as significant predictors, with robust posterior distributions (all inclusion probabilities >0.9) and satisfactory MCMC convergence (potential scale reduction factor <1.01). The model achieved an area under the curve (AUC) of 0.873, with posterior predictive checks confirming favorable predicted-observed agreement (coverage ≥0.85). Internal validation with 1,000 bootstrap replicates yielded a consistent AUC of 0.880 (95% confidence interval, 0.745 to 0.978).
conclusionThe CEUS-based predictive model demonstrated strong discrimination for detecting multigenic co-mutations in differentiated thyroid cancer; however, external validation is required to confirm its clinical applicability.
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