Reducing Overtreatment of Indeterminate Thyroid Nodules Using a Multimodal Deep Learning Model

Shreeram Athreya; Andrew Melehy; Sujit Silas Armstrong Suthahar; Vedrana Ivezić; Ashwath Radhachandran; Vivek Sant; Chace Moleta; Henry Zheng; Maitraya Patel; Rinat Masamed; Corey W. Arnold; William Speier

arXiv · 2409.19171

Reducing Overtreatment of Indeterminate Thyroid Nodules Using a Multimodal Deep Learning Model

Shreeram Athreya·Andrew Melehy·Sujit Silas Armstrong Suthahar·Vedrana Ivezić·Ashwath Radhachandran·Vivek Sant·Chace Moleta·Henry Zheng·Maitraya Patel·Rinat Masamed·Corey W. Arnold·William Speier

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Abstract

Objective: Molecular testing (MT) classifies cytologically indeterminate thyroid nodules as benign or malignant with high sensitivity but low positive predictive value (PPV), only using molecular profiles, ignoring ultrasound (US) imaging and biopsy. We address this limitation by applying attention multiple instance learning (AMIL) to US images. Methods: We retrospectively reviewed 333 patients with indeterminate thyroid nodules at UCLA medical center (259 benign, 74 malignant). A multi-modal deep learning AMIL model was developed, combining US images and MT to classify the nodules as benign or malignant and enhance the malignancy risk stratification of MT. Results: The final AMIL model matched MT sensitivity (0.946) while significantly improving PPV (0.477 vs 0.448 for MT alone), indicating fewer false positives while maintaining high sensitivity. Conclusion: Our approach reduces false positives compared to MT while maintaining the same ability to identify positive cases, potentially reducing unnecessary benign thyroid resections in patients with indeterminate nodules.

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Shreeram Athreya, Andrew Melehy, Sujit Silas Armstrong Suthahar, Vedrana Ivezić, Ashwath Radhachandran, Vivek Sant, Chace Moleta, Henry Zheng, Maitraya Patel, Rinat Masamed, Corey W. Arnold, William Speier. 2024-09-27. Reducing Overtreatment of Indeterminate Thyroid Nodules Using a Multimodal Deep Learning Model. https://arxiv.org/abs/2409.19171

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