Work

Differentiation of benign from malignant thyroid nodules using diffuse reflectance spectroscopy

Year: 2025

Type: article

Abstract: Background Indeterminate thyroid nodules are a common diagnostic challenge, with cytological results returning as indeterminate in 39-52% of fine needle aspiration biopsies. Diagnostic surgery may be required; this may later be judged as under- or over- treatment, depending on histological results. Diffuse reflectance spectroscopy (DRS) is an optical technique utilising spectral data to assess tissue morphology, functionality and biochemical composition, with studies showing its capability in differentiating cancerous from non-cancerous tissue across multiple organs. This study aims to assess if DRS can differentiate benign from malignant thyroid nodules. Methods This is a prospective study whereby patients undergoing thyroid surgery were prospectively recruited. Freshly resected ex-vivo specimens were analysed with a handheld DRS probe; spectral data was validated against histopathology. Binary classification was performed with the XGB supervised machine learning classifier. Data were divided into training and testing sets with a stratified 5-fold cross-validation method, and the classifier evaluated. Results Of 54 patients, 37(69%) were female, with a median age of 51.5(25-80) years. Across 28 benign and 28 malignant nodules, 6964 spectra were collected. In nodules pre-operatively confirmed as benign or malignant, the classifier achieved a diagnostic accuracy of 88.3%. In pre-operatively indeterminate nodules, accuracy was preserved at 88.4%. Conclusion This study provides ex-vivo validation of the DRS system for differentiation of benign and malignant thyroid nodules, with an accuracy exceeding that of cytology (for which the PPV is 17-68%). This represents a significant step toward the development of a tool to improve the diagnosis and management of indeterminate thyroid nodules.

Source: British journal of surgery

DOI: 10.1093/bjs/znaf096.034