Risk stratification in GIST: shape quantification with CT is a predictive factor

Abstract Background Tumor shape is strongly associated with some tumor’s genomic subtypes and patient outcomes. Our purpose is to find the relationship between risk stratification and the shape of GISTs. Methods A total of 101 patients with primary GISTs were confirmed by pathology and immunohistochemistry and underwent enhanced CT examination. All lesions’ pathologic sizes were 1 to 10 cm. Points A and B were the extremities of the longest diameter (LD) of the tumor and points C and D the extremities of the small axis, which was the longest diameter perpendicular to AB. The four angles of the quadrangle ABCD were measured and each angle named by its summit (A, B, C, D). For regular lesions, we took angles A and B as big angle (BiA) and small angle (SmA). For irregular lesions, we compared A/B ratio and D/C ratio and selected the larger ratio for analysis. The chi-square test, t test, ROC analysis, and hierarchical or binary logistic regression analysis were used to analyze the data. Results The BiA/SmA ratio was an independent predictor for risk level of GISTs (p = 0.019). With threshold of BiA at 90.5°, BiA/SmA ratio at 1.35 and LD at 6.15 cm, the sensitivities for high-risk GISTs were 82.4%, 85.3%, and 83.8%, respectively; the specificities were 87.1%, 71%, and 77.4%, respectively; and the AUCs were 0.852, 0.818, and 0.844, respectively. LD could not effectively distinguish between intermediate-risk and high-risk GISTs, but BiA could (p < 0.05). Shape and Ki-67 were independent predictors of the mitotic value (p = 0.036 and p < 0.001, respectively), and the accuracy was 87.8%. Conclusions Quantifying tumor shape has better predictive efficacy than LD in predicting the risk level and mitotic value of GISTs, especially for high-risk grading and mitotic value > 5/50HPF. Key Points • The BiA/SmA ratio was an independent predictor affecting the risk level of GISTs. LD could not effectively distinguish between intermediate-risk and high-risk GISTs, but BiA could. • Shape and Ki-67 were independent predictors of the mitotic value. • The method for quantifying the tumor shape has better predictive efficacy than LD in predicting the risk level and mitotic value of GISTs.

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Racial differences in abnormalities by FISH in minorities with multiple myeloma: A single-center experience.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.8044 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 8044-8044

Author(s):

Miguel Gonzalez Velez ◽

Valentina Jaramillo Restrepo ◽

Narjust Duma ◽

Matthew Palascak ◽

Marshall McKenna ◽

...

Keyword(s):

Multiple Myeloma ◽

Statistical Analysis ◽

High Risk ◽

Risk Stratification ◽

Racial Disparities ◽

Racial Differences ◽

Intermediate Risk ◽

Single Center ◽

Chi Square ◽

Single Center Experience

8044 Background: Racial disparities of FISH abnormalities in multiple myeloma (MM) have been well described in whites (W) but partially described in minorities (M) (Paulus et al, ASH 2016, 4432). We aimed to explore racial-based differences of FISH abnormalities using the largest cohort of m to date. Methods: CD-138 selected FISH was done on 799 consecutive patients (pts). Pts without symptomatic MM, and biopsy >6 months after diagnosis were excluded. The abnormalities evaluated included standard and intermediate risk: IGH rearrangements (IGH r), t(4;14), t(11;14), and high risk: t(14;20), t(14;16), del13q, del 17p, 1q21. Chi-square was used for statistical analysis. Due to smaller numbers, all m (Hispanic (H), Black (B), Asian (A) and Other (O)) were included into the same group for statistical analysis. Results: 482 pts were eligible, 343 (71%) were W, 52 (10%) H, 50 (10%) B, 19 (3%) A, and 18 (3%) O. Median age was 65 years, 54% were male, and 26% ISS stage 3. There were no were no statistically significant differences in FISH abnormalities between the m (Table1). Overall W had more abnormalities in IGH r, t(4;14), t(11;14), t(14:20), 1q21 gain compared to M. Most notably W had more IGH r (39% vs 28%; p=0.019) and t(11;14) (20% vs 12%; p=0.024). There were no statistically significant differences between W and m in the high risk FISH abnormalities. Conclusions: We had significant differences in FISH compared to M. W had more IGH r and t(11;14) than M, and there was no difference in high risk FISH abnormalities between W and M. This study confirms the biological racial disparities that exist in minorities with MM. Further studies with more inclusion of minorities are needed to elucidate these disparities and its effects on risk stratification and outcomes. [Table: see text]

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Solitary Fibrous Tumor: Integration of Clinical, Morphologic, Immunohistochemical and Molecular Findings in Risk Stratification and Classification May Better Predict Patient Outcome

International Journal of Molecular Sciences ◽

10.3390/ijms22179423 ◽

2021 ◽

Vol 22 (17) ◽

pp. 9423

Author(s):

Isidro Machado ◽

María Gema Nieto Morales ◽

Julia Cruz ◽

Javier Lavernia ◽

Francisco Giner ◽

...

Keyword(s):

Patient Outcome ◽

High Risk ◽

Risk Stratification ◽

Gene Fusion ◽

Tp53 Mutation ◽

Low Risk ◽

Intermediate Risk ◽

Ki 67 ◽

Common Location

Although solitary fibrous tumors (SFTs) have an unpredictable evolution, some specific clinicopathologic factors have been associated with the final outcome. We retrieved clinical, pathological and molecular data of 97 patients with a histological diagnosis of SFT and Signal transducer and activator of transcription 6 (STAT6) positivity. We retrospectively studied the pathological factors predictive of recurrence/metastasis and compared them with the clinical outcome. A wide immunohistochemical study and molecular analysis to detect NAB2/STAT6 gene fusion, tumor protein-53 (TP53) and/or (telomerase reverse transcriptase) TERT promotor mutation were performed. The risk of metastasis was calculated using the Demicco risk stratification system (RSS). The results were combined and examined to assess the accuracy of risk stratification and classification. The most common location was in non-extremities; 66% were located in soft tissue or subcutaneous areas and 92.8% in deep locations. On microscopic analysis, 38.1% of tumors revealed hypercellularity with a predominant patternless and/or hemangiopericytic growth pattern; 13.4% had ³4 mitoses/10HPF; 16.5% showed necrosis, and almost half the tumors showed at least focal myxoid areas. Dedifferentiation was observed in three tumors. Immunomarker expression in SFTs was as follows: CD34 92.9%, CD99 57.1%, Bcl2 67.9%, neuroendocrine markers (at least 1) 25.7%, Desmin 14.3%, CK(AE1/AE3) 3%, Apoptotic Protease Activating Factor (APAF-1) 87% and finally Ki-67 ≥ 10% in 14.4%. The NAB2/STAT6 gene fusion was detected in 50 tumors. After a median follow-up of 90 months, 9.3% recurred, 11.3% metastasized, 10.3% died of disease and 76.2% were free of disease. TERT mutations were detected in 40.6% of the SFTs; the TP53 mutation was detected in 17%, and only 9.3% showed both mutations. According to the Demicco RSS, 6.1%, 11.3% and 82.4% of the tumors were classified as high, intermediate or low-risk of metastasis, respectively. All high-risk tumors had ³4 mitoses/10HPF, necrosis, Ki-67 ≥ 10, HTER and/or TP53 mutation and poor evolution. The intermediate risk SFTs with worse evolution displayed the HTER mutation. Almost all low-risk tumors had a favorable evolution, although four showed at least one adverse factor (Ki-67 ≥ 10, ³4 mitoses/10HPF or high tumor size) and had a worse evolution. An integration of clinical, morphologic, immunohistochemical and molecular findings may improve risk stratification and classification and better predict patient outcome. The unfavorable course seems to be more frequent in high-risk SFTs, although it is not exceptional in low-risk SFTs either; hence, a long-term follow-up is required independently of the assigned risk stratification score. The inclusion of molecular findings in risk stratification systems could improve the precision in the classification of SFTs, especially those of intermediate risk. Future studies will be required to determine the most effective way to incorporate molecular analyses into RSS on SFTs. The coexistence of several adverse factors such as ≥4 mitoses/10HPF, necrosis, Ki-67 ≥ 10%, mutations in HTER and/or p53 may suggest a closer clinical follow-up regardless of the histological appearance of the tumor.

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Prevalence of facemask use among general public when visiting wet market during Covid-19 pandemic: An observational study. (Preprint)

10.2196/preprints.20555 ◽

2020 ◽

Author(s):

Gobi Hariyanayagam ◽

Sera Selvanthan Sundram Gunasekaran ◽

Shargunan Selvanthan Gunasekaran ◽

Nur Syafina Insyirah Zaimi ◽

Nor Amirah Abdul Halim

Keyword(s):

High Risk ◽

General Population ◽

Binary Logistic Regression ◽

Final Analysis ◽

High Risk Population ◽

Binary Logistic Regression Model ◽

Chi Square ◽

Hygiene Measures ◽

Wet Market ◽

Medical Grade

BACKGROUND In late December 2019, an outbreak of a novel coronavirus disease (COVID-19; previously known as 2019-nCoV) was epidemiologically linked to seafood and wet animal market in Wuhan, Hubei, China. This event has instigated negative stigma among the general population to view the wet market as a high-risk location for potential transmission of coronavirus. OBJECTIVE This study investigated the prevalence of facemask use among general population visiting the wet market as well as factors contributing to unacceptable facemask practice. Setting The visitors to a district wet market selling range of live or freshly slaughtered animals during COVID-19 pandemic outbreak was observed for facemask practice. METHODS All Individuals visiting the market were observed for the type, category and practice of wearing facemas. Subjects were categorized into two groups of acceptable and unacceptable facemask practice. The Pearson chi-square was used to test for differences in investigated variables in the univariate setting and Binary Logistic regression model was used in the multivariate setting. Main outcome measure Prevalence, acceptance practice and odds ratio of unacceptance of facemask use. RESULTS Among 1697 individuals included in the final analysis, 1687 (99.7%) was observed wearing facemask with 1338 (78.8%) using medical-grade facemask. Among them, 1615 (95.7%) individuals facemask practice was acceptable while the reaming 72 (4.3%) individuals were observed with unacceptable facemask practice. Individuals using medical-grade facemask and high-risk age group are 6.4 times (OR=6.40; 95% CI, 2.00-20.43; p=.002) and 2.06 times practice (OR=2.06; 95% CI, 1.08-3.94; p=.028) more likely to have unacceptable facemask practice respectively. CONCLUSIONS High saturation of facemask among the general population is an adequate indicator of public hygiene measures strategy which can help to mitigate the COVID-19 epidemic impact. Alarmingly, the unacceptable facemask practice among high-risk population raises the need for a targeted approach by healthcare authorities to ensure satisfactory facemask use.

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Establishment of an Ultrasound Malignancy Risk Stratification Model for Thyroid Nodules Larger Than 4 cm

Frontiers in Oncology ◽

10.3389/fonc.2021.592927 ◽

2021 ◽

Vol 11 ◽

Author(s):

Xuehua Xi ◽

Ying Wang ◽

Luying Gao ◽

Yuxin Jiang ◽

Zhiyong Liang ◽

...

Keyword(s):

High Risk ◽

Risk Stratification ◽

Diagnostic Performance ◽

Thyroid Nodules ◽

Low Risk ◽

Validation Dataset ◽

Intermediate Risk ◽

Solid Mass ◽

Incidence And Mortality ◽

Risk Stratification Model

BackgroundThe incidence and mortality of thyroid cancer, including thyroid nodules > 4 cm, have been increasing in recent years. The current evaluation methods are based mostly on studies of patients with thyroid nodules < 4 cm. The aim of the current study was to establish a risk stratification model to predict risk of malignancy in thyroid nodules > 4 cm.MethodsA total of 279 thyroid nodules > 4 cm in 267 patients were retrospectively analyzed. Nodules were randomly assigned to a training dataset (n = 140) and a validation dataset (n = 139). Multivariable logistic regression analysis was applied to establish a nomogram. The risk stratification of thyroid nodules > 4 cm was established according to the nomogram. The diagnostic performance of the model was evaluated and compared with the American College Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS), Kwak TI-RADS and 2015 ATA guidelines using the area under the receiver operating characteristic curve (AUC).ResultsThe analysis included 279 nodules (267 patients, 50.6 ± 13.2 years): 229 were benign and 50 were malignant. Multivariate regression revealed microcalcification, solid mass, ill-defined border and hypoechogenicity as independent risk factors. Based on the four factors, a risk stratified clinical model was developed for evaluating nodules > 4 cm, which includes three categories: high risk (risk value = 0.8-0.9, with more than 3 factors), intermediate risk (risk value = 0.3-0.7, with 2 factors or microcalcification) and low risk (risk value = 0.1-0.2, with 1 factor except microcalcification). In the validation dataset, the malignancy rate of thyroid nodules > 4 cm that were classified as high risk was 88.9%; as intermediate risk, 35.7%; and as low risk, 6.9%. The new model showed greater AUC than ACR TI-RADS (0.897 vs. 0.855, p = 0.040), but similar sensitivity (61.9% vs. 57.1%, p = 0.480) and specificity (91.5% vs. 93.2%, p = 0.680).ConclusionMicrocalcification, solid mass, ill-defined border and hypoechogenicity on ultrasound may be signs of malignancy in thyroid nodules > 4 cm. A risk stratification model for nodules > 4 cm may show better diagnostic performance than ACR TI-RADS, which may lead to better preoperative decision-making.

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Persisting new nodules in incidence rounds of the NELSON CT lung cancer screening study

Thorax ◽

10.1136/thoraxjnl-2018-212152 ◽

2018 ◽

Vol 74 (3) ◽

pp. 247-253 ◽

Cited By ~ 7

Author(s):

Joan E Walter ◽

Marjolein A Heuvelmans ◽

Kevin ten Haaf ◽

Rozemarijn Vliegenthart ◽

Carlijn M van der Aalst ◽

...

Keyword(s):

Lung Cancer ◽

Cancer Screening ◽

High Risk ◽

Risk Stratification ◽

Lung Cancer Screening ◽

Low Risk ◽

Intermediate Risk ◽

Solid Nodule ◽

Volume Limit ◽

Management Protocol

BackgroundThe US guidelines recommend low-dose CT (LDCT) lung cancer screening for high-risk individuals. New solid nodules after baseline screening are common and have a high lung cancer probability. Currently, no evidence exists concerning the risk stratification of non-resolving new solid nodules at first LDCT screening after initial detection.MethodsIn the Dutch-Belgian Randomized Lung Cancer Screening (NELSON) trial, 7295 participants underwent the second and 6922 participants the third screening round. We included participants with solid nodules that were registered as new or <15 mm³ (study detection limit) at previous screens and received additional screening after initial detection, thereby excluding high-risk nodules according to the NELSON management protocol (nodules ≥500 mm3).ResultsOverall, 680 participants with 1020 low-risk and intermediate-risk new solid nodules were included. A total of 562 (55%) new solid nodules were resolving, leaving 356 (52%) participants with a non-resolving new solid nodule, of whom 25 (7%) were diagnosed with lung cancer. At first screening after initial detection, volume doubling time (VDT), volume, and VDT combined with a predefined ≥200 mm3 volume cut-off had high discrimination for lung cancer (VDT, area under the curve (AUC): 0.913; volume, AUC: 0.875; VDT and ≥200 mm3 combination, AUC: 0.939). Classifying a new solid nodule with either ≤590 days VDT or ≥200 mm3 volume positive provided 100% sensitivity, 84% specificity and 27% positive predictive value for lung cancer.ConclusionsMore than half of new low-risk and intermediate-risk solid nodules in LDCT lung cancer screening resolve. At follow-up, growth assessment potentially combined with a volume limit can be used for risk stratification.Trial registration numberISRCTN63545820; pre-results.

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MRI Radiological Predictors of Requiring Microscopic Lumbar Discectomy After Lumbar Disc Herniation

Global Spine Journal ◽

10.1177/2192568219856345 ◽

2019 ◽

Vol 10 (1) ◽

pp. 63-68 ◽

Cited By ~ 1

Author(s):

Christopher G. Varlotta ◽

David H. Ge ◽

Nicholas Stekas ◽

Nicholas J. Frangella ◽

Jordan H. Manning ◽

...

Keyword(s):

Risk Factors ◽

Disc Herniation ◽

Lumbar Disc ◽

Binary Logistic Regression ◽

Primary Treatment ◽

Nonoperative Treatment ◽

Lumbar Discectomy ◽

Binary Logistic Regression Analysis ◽

Chi Square ◽

Cutoff Values

Study Design: Retrospective cohort study. Objective: To investigate radiological differences in lumbar disc herniations (herniated nucleus pulposus [HNP]) between patients receiving microscopic lumbar discectomy (MLD) and nonoperative patients. Methods: Patients with primary treatment for an HNP at a single academic institution between November 2012 to March 2017 were divided into MLD and nonoperative treatment groups. Using magnetic resonance imaging (MRI), axial HNP area; axial canal area; HNP canal compromise; HNP cephalad/caudal migration and HNP MRI signal (black, gray, or mixed) were measured. T test and chi-square analyses compared differences in the groups, binary logistic regression analysis determined odds ratios (ORs), and decision tree analysis compared the cutoff values for risk factors. Results: A total of 285 patients (78 MLD, 207 nonoperative) were included. Risk factors for MLD treatment included larger axial HNP area ( P < .01, OR = 1.01), caudal migration, and migration magnitude ( P < .05, OR = 1.90; P < .01, OR = 1.14), and gray HNP MRI signal ( P < .01, OR = 5.42). Cutoff values for risks included axial HNP area (70.52 mm2, OR = 2.66, P < .01), HNP canal compromise (20.0%, OR = 3.29, P < .01), and cephalad/caudal migration (6.8 mm, OR = 2.43, P < .01). MLD risk for those with gray HNP MRI signal (67.6% alone) increased when combined with axial HNP area >70.52 mm2 (75.5%, P = .01) and HNP canal compromise >20.0% (71.1%, P = .05) cutoffs. MLD risk in patients with cephalad/caudal migration >6.8 mm (40.5% alone) increased when combined with axial HNP area and HNP canal compromise (52.4%, 50%; P < .01). Conclusion: Patients who underwent MLD treatment had significantly different axial HNP area, frequency of caudal migration, magnitude of cephalad/caudal migration, and disc herniation MRI signal compared to patients with nonoperative treatment.

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Is clinical stage T2c prostate cancer intermediate- or high-risk disease? Results from the SEARCH database.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.5_suppl.123 ◽

2012 ◽

Vol 30 (5_suppl) ◽

pp. 123-123

Author(s):

Abhay A Singh ◽

Leah Gerber ◽

Stephen J. Freedland ◽

William J Aronson ◽

Martha K. Terris ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Risk Stratification ◽

Predictive Accuracy ◽

Cox Model ◽

Clinical Stage ◽

Prostate Cancer Risk ◽

Clinical Staging ◽

Intermediate Risk ◽

Concordance Index

123 Background: Clinical stage T2c is a nebulous factor in the algorithm for prostate cancer risk stratification. According to D’Amico risk stratification cT2c is high-risk category where NCCN guidelines place this stage in intermediate-risk. As diagnostic work up with the use of MRI continues to escalate clinical staging may become more important. As cT2c represents a possible decision fork in treatment decisions we sought to investigate which risk group the clinical behavior of cT2c tumors more closely resembles. Methods: We retrospectively analyzed data from 1089 men who underwent radical prostatectomy (RP) from 1988 to 2009 who did not have low-risk CaP from the SEARCH database. We compared time to BCR between men with cT2c disease, those with intermediate-risk (PSA 10-20 ng/ml or Gleason sum (GS) =7), and those with high-risk (PSA>20 ng/ml, GS 8-10, cT3) using Cox regression models adjusting for age, race, year of RP, center, and percent cores positive. We also compared predictive accuracy of two Cox models wherein cT2c was considered either intermediate- or high-risk by calculating concordance index c. Results: A total of 68 men (3.4%) had cT2c tumors. After a median follow-up of 47.5 months, there was no difference in BCR risk between men with intermediate-risk CaP and those with cT2c tumors (HR=0.90; p=0.60). In contrast, there was a trend for men with high-risk CaP to have nearly 50% increased BCR risk compared to men with cT2c tumors (HR=1.50; 95% CI=0.97-2.30; p=0.07) which did not reach statistical significance. Concordance index c was higher in the Cox model wherein cT2c tumors were considered intermediate-risk (c=0.6147) as opposed to high-risk (c=0.6106). Conclusions: BCR risk for patients with clinical stage T2c was more comparable to men who had intermediate-risk CaP than men with high-risk. In addition, a model which incorporates cT2c disease as intermediate-risk has better predictive accuracy. These findings suggest men with cT2c disease should be offered treatment options for men with intermediate-risk CaP. As clinical staging more routinely incorporates MRI there is the potential to better identify bilateral organ-confined CaP and further establish risk classification.

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High Risk First Degree Relatives of Type 1 Diabetics: An Association with Increases in CXCR3+T Memory Cells Reflecting an Enhanced Activity of Th1 Autoimmune Response

International Journal of Endocrinology ◽

10.1155/2014/589360 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Tanja Milicic ◽

Aleksandra Jotic ◽

Ivanka Markovic ◽

Katarina Lalic ◽

Veljko Jeremic ◽

...

Keyword(s):

High Risk ◽

Binary Logistic Regression ◽

Low Risk ◽

Autoimmune Response ◽

Binary Logistic Regression Analysis ◽

Memory Cells ◽

Recent Onset ◽

First Degree Relatives ◽

Enhanced Activity

We analyzed the level of (a) CXCR3+(Th1) and CCR4+(Th2) T memory cells (b) interferon-γinducible chemokine (IP-10)(Th1) and thymus and activation-regulated chemokine (TARC)(Th2), in 51 first degree relatives (FDRs) of type 1 diabetics (T1D) (17 high risk FDRs (GADA+, IA-2+) and 34 low risk FDRs (GADA−, IA-2−)), 24 recent-onset T1D (R-T1D), and 18 healthy subjects. T memory subsets were analyzed by using four-color immunofluorescence staining and flowcytometry. IP-10 and TARC were determined by ELISA. High risk FDRs showed higher levels of CXCR3+and lower level of CCR4+T memory cells compared to low risk FDRs (64.98 ± 5.19 versus 42.13 ± 11.11; 29.46 ± 2.83 versus 41.90 ± 8.58%, resp.,P<0.001). Simultaneously, both IP-10 and TARC levels were increased in high risk versus low risk FDRs (160.12 ± 73.40 versus 105.39 ± 71.30; 438.83 ± 120.62 versus 312.04 ± 151.14 pg/mL,P<0.05). Binary logistic regression analysis identified the level of CXCR3+T memory cells as predictors for high risk FDRs, together with high levels of IP-10. The results imply that, in FDRs, the risk for T1D might be strongly influenced by enhanced activity of Th1 and diminished activity of Th2 autoimmune response.

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Ignoring the elephant in the room: factors contributing to inadequate access to condoms and sources of condoms during novel coronavirus diseases 2019 in South Africa

10.1101/2020.09.11.20192849 ◽

2020 ◽

Author(s):

Obasanjo Afolabi Bolarinwa

Keyword(s):

South Africa ◽

Health Care Services ◽

National Income ◽

Binary Logistic Regression ◽

Binary Logistic Regression Analysis ◽

Chi Square ◽

Middle Income ◽

South Africans ◽

Novel Coronavirus ◽

Access To Contraception

AbstractEvidence has shown that the prescribed lockdown and physical distancing due to the novel coronavirus disease 2019 (COVID-19) have made accessing essential health care services much difficult in low-and middle-income countries (LMICs). Access to contraception is essential and should not be denied, even in a global crisis, because it is associated with several health benefits. It is paramount to maintain timely access to contraception without unnecessary barriers. Hence, this study examines the factors contributing to limited access to condoms and sources of condoms during the COVID-19 pandemic in South Africa (SA).The first secondary dataset on coronavirus from the National Income Dynamic Study (NIDS) conducted in SA during the coronavirus pandemic was employed in this study. This study involved 4,517 respondents. Data were analysed using frequency analysis, chi-square test and binary logistic regression analysis. Almost one-quarter of South Africans could not access condoms, and every 7 in 10 South Africans preferred public or government hospitals as a source of condoms. Female South Africans (aOR=0.86; 95% CI=0.69-1.08), those aged 35-45 (aOR=0.96; 95% CI=0.73-1.28) and those residing in KwaZulu-Natal province (aOR=0.30; 95% CI=0.17-0.52) were 14%, 4% and 70% respectively less likely to have access to condoms during the COVID-19 lockdown. Findings from the study suggest strategies and interventions that will be tailored towards non-obstruction of contraception access during the on-going COVID-19 or any future pandemic. Moreover, special consideration should be given to certain provinces, the uneducated and those in the 4th quintile of wealth-income in South Africa.

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Shear Wave Elastography and Thyroid Imaging Reporting and Data System (TIRADS) for the Risk Stratification of Thyroid Nodules—Results of a Prospective Study

Diagnostics ◽

10.3390/diagnostics12010109 ◽

2022 ◽

Vol 12 (1) ◽

pp. 109

Author(s):

Manuela Petersen ◽

Simone A. Schenke ◽

Jonas Firla ◽

Roland S. Croner ◽

Michael C. Kreissl

Keyword(s):

High Risk ◽

Risk Stratification ◽

Prospective Study ◽

Thyroid Nodules ◽

Shear Wave Elastography ◽

Low Risk ◽

Intermediate Risk ◽

Risk Class ◽

Benign Nodules ◽

A Prospective Study

Purpose: To compare the diagnostic performance of thyroid imaging reporting and data system (TIRADS) in combination with shear wave elastography (SWE) for the assessment of thyroid nodules. Methods: A prospective study was conducted with the following inclusion criteria: preoperative B-mode ultrasound (US) including TIRADS classification (Kwak-TIRADS, EU-TIRADS), quantitative SWE and available histological results. Results: Out of 43 patients, 61 thyroid nodules were detected; 10 nodules were found to be thyroid cancer (7 PTC, 1 FTC, 2 HüCC) and 51 were benign. According to Kwak-TIRADS the majority of benign nodules (47 out of 51, 92.2%) were classified in the low-risk- and intermediate-risk class, four nodules were classified as high-risk (7.8%). When using EU-TIRADS, the benign nodules were distributed almost equally across all risk classes, 21 (41.2%) nodules were classified in the low-risk class, 16 (31.4%) in the intermediate-risk class and 14 (27.4%) in the high-risk class. In contrast, most of the malignant nodules (eight out of ten) were classified as high-risk on EU-TIRADS. One carcinoma was classified as low-risk and one as intermediate-risk nodule. For SWE, ROC analysis showed an optimal cutoff of 18.5 kPa to distinguish malignant and benign nodules (sensitivity 80.0%, specificity 49.0%, PPV 23.5% and NPV 92.6%). The addition of elastography resulted in an increase of accuracy from 65.6% to 82.0% when using Kwak-TIRADS and from 49.2% to 72.1% when using EU-TIRADS. Conclusion: Our data demonstrate that the combination of TIRADS and SWE seems to be superior for the risk stratification of thyroid nodules than each method by itself. However, verification of these results in a larger patient population is mandatory.

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