AI-Assisted Ultrasound Review Before Thyroid Surgery

August 5, 2026 updated by: Bo Wang,MD, Fujian Medical University

Clinical Application of AI-assisted Ultrasound Technology in the Preoperative Evaluation of Thyroid Cancer

This prospective, single-center, single-arm study evaluates a locked artificial intelligence (AI) system as a surgeon-led second-read tool before thyroid surgery. Eligible participants scheduled for thyroid surgery undergo standard ultrasonography followed by a standardized AI-assisted repeat examination. The AI system evaluates thyroid nodules only; cervical lymph nodes are assessed by clinicians. The study assesses participant-level supplementary pathological examinations and treatment-decision changes and evaluates nodule-level diagnostic performance against final surgical histopathology.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

This prospective, single-center, single-arm study evaluates a locked AI-assisted ultrasound system used during surgeon-led preoperative review in participants scheduled for thyroid surgery. Each participant undergoes standard preoperative ultrasonography followed by a standardized AI-assisted repeat examination. The locked system provides thyroid-nodule malignancy scores and classifications; it was not retrained or recalibrated during the study and did not assess cervical lymph nodes. Clinicians integrate standard ultrasound, cytology, clinical findings, and other information and retain responsibility for all supplementary examinations and final management decisions. The two primary outcomes are participant-level: (1) whether a participant undergoes an additional cytologic or pathologic examination and (2) whether a participant has at least one change in planned surgical management. Participants are counted once within each outcome, while event counts may be summarized separately. The embedded diagnostic analysis is nodule-level and uses unambiguously pathology-matched surgical histopathology as the reference standard. Only nodules with a definitive benign or malignant surgical histopathological diagnosis are included in binary diagnostic-performance calculations. Low-risk or borderline thyroid neoplasms, including follicular tumors of uncertain malignant potential (FT-UMP), well-differentiated tumors of uncertain malignant potential (WDT-UMP), and non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP), and nodules without unambiguous lesion-level linkage are excluded from binary reference-standard analyses. These post-enrollment analysis exclusions do not alter the 515-participant actual enrollment or the participant-level workflow cohort. A participant may contribute another eligible nodule if that lesion has an unambiguous definitive diagnosis. Cervical lymph-node pathology is described only for nodes actually removed or sampled; no reference diagnosis is assigned to unsampled nodes.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
515

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Study Locations

  • China
    • Fujian
      • Fuzhou, Fujian, China, 350001
        • Fujian Medical University Union Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Patients with preoperative pathological confirmation of thyroid malignant tumors undergoing surgical treatment.
  • Patients with benign thyroid tumors, such as thyroid adenomas causing compressive symptoms, undergoing surgical treatment.
  • Patients with complete and high-quality traditional two-dimensional color ultrasound images.
  • Complete postoperative pathology reports.
  • Willingness to participate in this clinical trial and signing of informed consent.

Exclusion Criteria:

  • Patients with a history of neck surgery or radiotherapy.
  • Patients with a history of malignant tumors in other parts of the body.
  • Patients with thyroid dysfunction.
  • Incomplete or poor-quality traditional two-dimensional color ultrasound images.
  • Incomplete postoperative pathology reports.
  • Refusal to participate in this clinical trial.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Diagnostic
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: AI-Assisted Preoperative Review
Participants undergo standard preoperative thyroid ultrasonography followed by a standardized AI-assisted repeat examination and surgeon-led review incorporating the locked AI system's thyroid-nodule output. The AI system does not assess cervical lymph nodes. All supplementary examinations and final diagnostic and surgical decisions are made by clinicians.
Diagnostic test: Locked AI-Assisted Thyroid Ultrasound Repeat Examination and Review
After standard preoperative ultrasonography, the same participant underwent a standardized AI-assisted repeat examination. The locked system identified and classified thyroid nodules and provided malignancy-score information for surgeon-led review. It did not assess cervical lymph nodes and was not retrained or recalibrated during the study. Additional fine-needle aspiration, intraoperative pathologic examination, and surgical management were determined by clinicians using the complete clinical assessment.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Proportion of Participants Undergoing Supplementary Cytologic or Pathologic Examination
Time Frame: From completion of the AI-assisted repeat examination through completion of surgery
Number and proportion of enrolled participants who underwent at least one additional cytologic or pathologic examination, such as fine-needle aspiration or intraoperative frozen-section examination, after completion of conventional ultrasonography and AI-assisted review and before completion of surgery. Each participant is counted once regardless of the number of examinations. The decision remained clinician led; cervical lymph-node examinations were outside the AI system's task.
From completion of the AI-assisted repeat examination through completion of surgery
Proportion of Participants With a Change in Planned Surgical Management
Time Frame: From completion of the AI-assisted review through surgery
Number and proportion of enrolled participants with at least one documented change in the surgeon-led planned surgical approach or extent after conventional ultrasonography, AI-assisted review, and any supplementary pathological examination, when performed. Changes may involve thyroid resection or cervical lymph-node management. Each participant is counted once regardless of the number of changes. The AI system provided thyroid-nodule information only and did not assess cervical lymph nodes.
From completion of the AI-assisted review through surgery

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Distribution of C-TIRADS Categories Among Evaluated Thyroid Nodules
Time Frame: During standard preoperative ultrasonography, before the AI-assisted repeat examination
Number and percentage of evaluated thyroid nodules in each clinician-assigned C-TIRADS category during conventional ultrasonography. Nodule size, composition, echogenicity, margins, calcifications, and clinician-assessed cervical lymph-node findings were recorded as descriptive covariates and were not treated as separate outcome measures.
During standard preoperative ultrasonography, before the AI-assisted repeat examination
Proportion of Evaluated Thyroid Nodules Classified as AI-Positive
Time Frame: During the preoperative AI-assisted repeat examination, before surgery
Number and percentage of evaluated thyroid nodules with a locked AI malignancy score >0.5. The AI system evaluated thyroid nodules only and did not assess cervical lymph nodes.
During the preoperative AI-assisted repeat examination, before surgery
Results of Supplementary Cytologic or Pathologic Examinations
Time Frame: From supplementary sampling to availability of the corresponding result, before or during surgery
Among participants who underwent at least one additional cytologic or pathologic examination, record the cytologic or histopathologic result for each sampled thyroid nodule or cervical lymph node. Results are summarized at the examination level as nonmalignant, indeterminate, malignant, or metastatic, as applicable.
From supplementary sampling to availability of the corresponding result, before or during surgery
Final Histopathological Diagnosis of Resected Thyroid Nodules
Time Frame: From surgery until the final postoperative histopathology report became available; assessed through October 15, 2025, over the approximately 14-month study period.
For each resected thyroid nodule linked unambiguously to the evaluated lesion, record the final diagnosis as benign, malignant, follicular tumor of uncertain malignant potential (FT-UMP), well-differentiated tumor of uncertain malignant potential (WDT-UMP), non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), or another borderline diagnosis.
From surgery until the final postoperative histopathology report became available; assessed through October 15, 2025, over the approximately 14-month study period.
Nodule-Level Sensitivity of AI and C-TIRADS
Time Frame: From the preoperative examinations until the final postoperative histopathology report became available; assessed through October 15, 2025, over the approximately 14-month study period.
Using definitive postoperative histopathology as the reference standard, sensitivity is TP/(TP + FN), expressed as a percentage, for the locked AI classification (positive if score >0.5) and conventional C-TIRADS (positive if category 4a or higher). Include only pathology-matched nodules with an unambiguous lesion-level link and a definitive benign or malignant diagnosis. Exclude FT-UMP, WDT-UMP, NIFTP, other borderline diagnoses, and nodules without unambiguous lesion-level linkage. These lesion-level exclusions do not alter the 515-participant workflow cohort.
From the preoperative examinations until the final postoperative histopathology report became available; assessed through October 15, 2025, over the approximately 14-month study period.
Nodule-Level False-Negative Rate of AI and C-TIRADS
Time Frame: From the preoperative examinations until the final postoperative histopathology report became available; assessed through October 15, 2025, over the approximately 14-month study period.
For each method, the false-negative rate is FN/(TP + FN), expressed as a percentage, among definitively malignant thyroid nodules. AI positivity is defined as score >0.5; conventional ultrasound positivity is C-TIRADS category 4a or higher. Include only pathology-matched nodules with an unambiguous lesion-level link and a definitive benign or malignant diagnosis. Exclude FT-UMP, WDT-UMP, NIFTP, other borderline diagnoses, and nodules without unambiguous lesion-level linkage.
From the preoperative examinations until the final postoperative histopathology report became available; assessed through October 15, 2025, over the approximately 14-month study period.
Nodule-Level Positive Predictive Value of AI and C-TIRADS
Time Frame: From the preoperative examinations until the final postoperative histopathology report became available; assessed through October 15, 2025, over the approximately 14-month study period.
For each method, positive predictive value is TP/(TP + FP), expressed as a percentage, among thyroid nodules classified as positive. AI positivity is defined as score >0.5; conventional ultrasound positivity is C-TIRADS category 4a or higher. Include only pathology-matched nodules with an unambiguous lesion-level link and a definitive benign or malignant diagnosis. Exclude FT-UMP, WDT-UMP, NIFTP, other borderline diagnoses, and nodules without unambiguous lesion-level linkage.
From the preoperative examinations until the final postoperative histopathology report became available; assessed through October 15, 2025, over the approximately 14-month study period.
Nodule-Level Youden Index of AI and C-TIRADS
Time Frame: From the preoperative examinations until the final postoperative histopathology report became available; assessed through October 15, 2025, over the approximately 14-month study period.
For each method, the Youden index is sensitivity + specificity - 1 using fixed binary thresholds. AI positivity is defined as score >0.5; conventional ultrasound positivity is C-TIRADS category 4a or higher. Include only pathology-matched nodules with an unambiguous lesion-level link and a definitive benign or malignant diagnosis. Exclude FT-UMP, WDT-UMP, NIFTP, other borderline diagnoses, and nodules without unambiguous lesion-level linkage.
From the preoperative examinations until the final postoperative histopathology report became available; assessed through October 15, 2025, over the approximately 14-month study period.
Distribution of Cervical Lymph-Node Metastasis Status Among Pathologically Examined Nodes
Time Frame: From surgery or supplementary sampling until the corresponding pathology result became available; assessed through October 15, 2025, over the approximately 14-month study period.
Among cervical lymph nodes actually removed or sampled and pathologically examined, record the number and percentage with and without metastasis. No pathologic reference diagnosis is assigned to unsampled lymph nodes.
From surgery or supplementary sampling until the corresponding pathology result became available; assessed through October 15, 2025, over the approximately 14-month study period.
Nodule-Level Specificity of AI and C-TIRADS
Time Frame: From the preoperative examinations until the final postoperative histopathology report became available; assessed through October 15, 2025, over the approximately 14-month study period.
Using definitive postoperative histopathology as the reference standard, specificity is TN/(TN + FP), expressed as a percentage, for the locked AI classification (positive if score >0.5) and conventional C-TIRADS (positive if category 4a or higher). Include only pathology-matched nodules with an unambiguous lesion-level link and a definitive benign or malignant diagnosis. Exclude FT-UMP, WDT-UMP, NIFTP, other borderline diagnoses, and nodules without unambiguous lesion-level linkage.
From the preoperative examinations until the final postoperative histopathology report became available; assessed through October 15, 2025, over the approximately 14-month study period.
Nodule-Level Negative Predictive Value of AI and C-TIRADS
Time Frame: From the preoperative examinations until the final postoperative histopathology report became available; assessed through October 15, 2025, over the approximately 14-month study period.
Using definitive postoperative histopathology as the reference standard, negative predictive value is TN/(TN + FN), expressed as a percentage, for the locked AI classification (positive if score >0.5) and conventional C-TIRADS (positive if category 4a or higher). Include only pathology-matched nodules with an unambiguous lesion-level link and a definitive benign or malignant diagnosis. Exclude FT-UMP, WDT-UMP, NIFTP, other borderline diagnoses, and nodules without unambiguous lesion-level linkage.
From the preoperative examinations until the final postoperative histopathology report became available; assessed through October 15, 2025, over the approximately 14-month study period.
Nodule-Level Accuracy of AI and C-TIRADS
Time Frame: From the preoperative examinations until the final postoperative histopathology report became available; assessed through October 15, 2025, over the approximately 14-month study period.
Using definitive postoperative histopathology as the reference standard, accuracy is (TP + TN)/(TP + TN + FP + FN), expressed as a percentage, for the locked AI classification (positive if score >0.5) and conventional C-TIRADS (positive if category 4a or higher). Include only pathology-matched nodules with an unambiguous lesion-level link and a definitive benign or malignant diagnosis. Exclude FT-UMP, WDT-UMP, NIFTP, other borderline diagnoses, and nodules without unambiguous lesion-level linkage.
From the preoperative examinations until the final postoperative histopathology report became available; assessed through October 15, 2025, over the approximately 14-month study period.
Area Under the ROC Curve for the Continuous AI Malignancy Score
Time Frame: From the preoperative examinations until the final postoperative histopathology report became available; assessed through October 15, 2025, over the approximately 14-month study period.
Using definitive postoperative histopathology as the reference standard, calculate the area under the receiver operating characteristic curve for the continuous locked AI malignancy score. Include only pathology-matched nodules with an unambiguous lesion-level link and a definitive benign or malignant diagnosis. Exclude FT-UMP, WDT-UMP, NIFTP, other borderline diagnoses, and nodules without unambiguous lesion-level linkage. No AUC is calculated for the single-threshold C-TIRADS classification.
From the preoperative examinations until the final postoperative histopathology report became available; assessed through October 15, 2025, over the approximately 14-month study period.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Fujian Medical University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
September 1, 2024

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
September 28, 2025

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
October 15, 2025

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
June 9, 2024

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
July 11, 2024

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
July 12, 2024

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
August 7, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
August 5, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
August 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • AI-base PCD

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Individual participant data are not planned for external sharing because the dataset contains detailed clinical records and ultrasound images that may remain re-identifiable, and the available study records do not document participant consent specifically permitting external IPD sharing or institutional authorization for such sharing. Aggregate, non-identifiable results will be reported in publications.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

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