Learning to Measure and Diagnose: A Clinical-Dictionary Radiomic Bottleneck Model for Thyroid Nodule Classification

Thyroid nodule malignancy assessment relies on ultrasound imaging, yet current risk stratification systems suffer from substantial interobserver variability, contributing to a high rate of unnecessary biopsies. We propose a radiomics-based framework combining quantitative feature extraction via PyRadiomics with a Generalized Additive Model (GAM) classifier, selected among six candidates for its favorable trade-off between discriminative performance and interpretability. To complement point predictions with uncertainty estimates, Cross-Conformal Prediction with label-conditional guarantees is applied, flagging ambiguous cases for clinical review rather than forcing a binary decision. Experiments are conducted on TN5000, a publicly available ultrasound dataset of thyroid nodules. After Spearman correlation filtering, 36 features are retained and the GAM achieves an AUC of $0.89$, a sensitivity of $0.83$, and a specificity of $0.82$ on the validation set. At a significance level $ε=0.09$, selected to ensure empirical coverage guarantees on both classes, 63% of nodules on the test set receive a certain (i.e., single-label) prediction, with conditional precision of $0.94$ for certain malignant and conditional Negative Predictive Value (NPV) of $0.73$ for certain benign cases, while the remaining 37% are referred to the clinician.

Ultrasound is the primary imaging modality for assessing thyroid nodules, and the ACR TI-RADS framework standardizes diagnosis through five ultrasound feature categories that are aggregated into five risk levels (TR1-TR5). Although widely adopted in clinical practice, most deep learning approaches focus on binary malignancy classification, while multi-class prediction and explicit utilization of feature-level supervision remain underexplored, largely due to limited annotated data. In this study, we introduce the STN dataset of 600 thyroid nodules with paired transverse and longitudinal ultrasound images, bounding box annotations, and complete labels for all five TI-RADS feature categories. Following the clinical decision process, we investigate how structured feature information can guide representation learning during training while requiring only images at inference. We demonstrate that text embeddings derived from standardized feature descriptions form a stable surrogate representation for TI-RADS risk levels. Based on this observation, we propose CMCNet, which aligns image embeddings to fixed textual embeddings via a Center-Margin Contrastive Loss that simultaneously promotes intra-class compactness and inter-class separation. Experimental results show that this embedding alignment strategy is more data-efficient and robust than direct multitask learning, and consistently outperforms InfoNCE, center loss, a strong multitask baseline, and a VQA-style multimodal model, particularly in imbalanced settings. The dataset is freely available at doi: 10.5281/zenodo.19125693 and the source code is available at: https://www.healthinformaticslab.org/supp/.

Thyroid ultrasound is the first-line exam for assessing thyroid nodules and determining whether biopsy is warranted. In routine reporting, radiologists produce two coupled outputs: a nodule contour for measurement and a TI-RADS risk category based on sonographic criteria. Yet both contouring style and risk grading vary across readers, creating inconsistent supervision that can degrade standard learning pipelines. In this paper, we address this workflow with a clinically guided multitask framework that jointly predicts the nodule mask and TI-RADS category within a single model. To ground risk prediction in clinically meaningful evidence, we guide the classification embedding using a compact TI-RADS aligned radiomics target during training, while preserving complementary deep features for discriminative performance. However, under annotator variability, naive multitask optimization often fails not because the tasks are unrelated, but because their gradients compete within the shared representation. To make this competition explicit and controllable, we introduce RLAR, a representation-level adversarial gradient regularizer. Rather than performing parameter-level gradient surgery, RLAR uses each task's normalized adversarial direction in latent space as a geometric probe of task sensitivity and penalizes excessive angular alignment between task-specific adversarial directions. On a public TI-RADS dataset, our clinically guided multitask model with RLAR consistently improves risk stratification while maintaining segmentation quality compared to single-task training and conventional multitask baselines. Code and pretrained models will be released.