scholarly journals The role of elastosonography, gray-scale and colour flow Doppler sonography in prediction of malignancy in thyroid nodules

2014 ◽  
Vol 48 (4) ◽  
pp. 348-353 ◽  
Author(s):  
Idil Gunes Tatar ◽  
Aydin Kurt ◽  
Kerim Bora Yilmaz ◽  
Mehmet Doğan ◽  
Baki Hekimoglu ◽  
...  
Keyword(s):  
Predictive Value ◽  
Thyroid Nodules ◽  
Diagnostic Algorithm ◽  
Strain Ratio ◽  
Gray Scale ◽  
Elasticity Score ◽  
Benign Nodules ◽  
Results Orientation ◽  
Work Up

AbstractBackground. Ultrasound is as a noninvasive method commonly used in the work-up of thyroid nodules. This study aimed to evaluate the usefulness of sonographic and elastosonographic parameters in the discrimination of malignancy.Patients and methods. 150 thyroid nodules were evaluated by gray-scale, Doppler and elastosonography. The cytological analysis revealed that 141 nodules were benign and 9 were malignant.Results. Orientation of the nodule was the only sonographic parameter associated with malignancy (p = 0.003). In the strain ratio analysis the best cut-off point was 1.935 to discriminate malignancy (p = 0.000), with 100% sensitivity, 76% specificity, 100% negative predictive value, 78.5% positive predictive value and 78% accuracy rate. There was a statistically significant correlation between the elasticity score and malignancy (p = 0.001). Most of the benign nodules had score 2 and 3, none of them displayed score 5. On the other hand, none of the malignant nodules had score 1 and 2, most of them displaying score 5.Conclusions. A change in the diagnostic algorithm of the thyroid nodules should be considered integrating the elastosonographic analysis

scholarly journals MON-526 Comparison of ACR-TIRADS to American Thyroid Association Guidelines: Can We Choose Wisely Without Missing Malignancy?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Ilana Jaye Halperin ◽  
Judy Qiang
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
American Thyroid Association ◽  
Biopsy Result ◽  
Data Set ◽  
Benign Nodules ◽  
Work Up

Abstract Thyroid ultrasound has been widely used to determine which nodules need further work up. The goal of this study was to apply the new ACR-TIRADs criteria to a retrospective data set and compare the outcomes to the ATA scoring system. Methods: In a retrospective study, ultrasonographic images of the all nodules biopsied in 2015 were reviewed by radiologists, blinded to fine needle aspiration (FNA) biopsy result, using a checklist to report the image. The checklist was prepared based on 2015 ATA guideline. The ultrasonographic characteristics of thyroid nodules were compared with the result of biopsy to determine positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity of checklist in predicting malignancy. These results were published previously. The same data was then reviewed using the ACR-TiRADS tool to assess the number of US and FNA that would been avoided and the number of non-benign cytologies that would have been avoided had these criteria guided care in 2015. Results: 419 thyroid nodules were reviewed 7.1% were malignant, 10.3% were FLUS and 78.3% were benign. Sensitivity of the ACR-TIRADs and ATA respectively was to detect non-benign nodules was 70% and 97% Specificity was 29% and 11%. Positive predictive value was 18% and 9% whereas Negative predictive value was 81% and 98%. 28% of the FNAs done in 2015 could have been avoiding if applying the TIRADs criteria, however 15 non-benign and 8 malignant cases would have been missed.Conclusion: The TIRADs approach adds value to the system by reducing many unnecessary biopsies but clinicians need to use their own judgement as some non-benign cases will be missed.

scholarly journals ROLE OF HYSTEROSALPINGOGRAPHY IN MANAGEMENT OF FEMALE INFERTILITY AND ITS LAPAROSCOPIC CORRELATION

2019 ◽  
pp. 1-2
Author(s):  
(prof.) Alka Agrawal
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Uterine Cavity ◽  
Fallopian Tubes ◽  
Radiographic Technique ◽  
Invasive Techniques ◽  
Work Up ◽  
Tubal Pathology

BACKGROUND : Infertility nowadays has become a medical as well as social problem.Laboratory findings alone is inconclusive in diagnosing infertility.HSG is the radiographic technique for evaluation of uterine cavity & fallopian tubes..Direct visualization of abdominal and pelvic organs in laparoscopy allows a definite diagnosis where clinical examination & less invasive techniques such as ultrasound & HSG fail to identify the abnormality. AIMS & OBJECTIVES :To determine the role of HSG in the evaluation of infertility & to correlate its findings with laparoscopy. METHODS : 75 infertile females aged between 20-40 years were included. HSG & laparoscopy was performed in all patients & findings were analysed. RESULTS : Sensitivity of HSG was 80 %,specificity was 76 % with positive predictive value 63%, negative predictive value 88 % in detecting tubal pathology. Sensitivity of HSG in detecting uterine pathology was 67%, specificity 73%, positive predictive value 39% and negative predictive value 89%. CONCLUSION : HSG has reasonably good sensitivity & specificity in diagnosing tubal & uerine pathology while laparoscopy has diagnostic as well as therapeutic approach.Hence they are complimentary to each other in infertility work up.

Real-world Comparison of Afirma GEC and GSC for the Assessment of Cytologically Indeterminate Thyroid Nodules

2019 ◽  
Vol 105 (3) ◽  
pp. e428-e435 ◽  
Author(s):  
Vicente T San Martin ◽  
Lima Lawrence ◽  
James Bena ◽  
Nabil Z Madhun ◽  
Eren Berber ◽  
...  
Keyword(s):  
Test Performance ◽  
Predictive Value ◽  
Preoperative Diagnosis ◽  
Thyroid Nodules ◽  
Gene Sequencing ◽  
Surgical Excision ◽  
Molecular Tests ◽  
Academic Center ◽  
Indeterminate Nodules ◽  
Benign Nodules

Abstract Context Molecular tests have improved the accuracy of preoperative diagnosis of indeterminate thyroid nodules. The Afirma Gene Sequencing Classifier (GSC) was developed to improve the specificity of the Gene Expression Classifier (GEC). Independent studies are needed to assess the performance of GSC. Objective The aim was to compare the performance of GEC and GSC in the assessment of indeterminate nodules. Design, Settings, and Participants Retrospective analysis of Bethesda III and IV nodules tested with GEC or GSC in an academic center between December 2011 and September 2018. Benign call rates (BCRs) and surgical outcomes were compared. Histopathologic data were collected on nodules that were surgically resected to calculate measures of test performance. Results The BCR was 41% (73/178) for GEC and 67.8% (82/121) for GSC (P < .001). Among specimens with dominant Hürthle cell cytology, the BCR was 22% (6/27) for GEC and 63.2% (12/19) for GSC (P = .005). The overall surgery rate decreased from 47.8% in the GEC group to 34.7% in the GSC group (P = .025). One GEC-benign and 3 GSC-benign nodules proved to be malignant on surgical excision. GSC had a statistically significant higher specificity (94% vs 60%, P < .001) and positive predictive value (PPV) (85.3% vs 40%, P < .001) than GEC. While sensitivity and negative predictive value (NPV) dropped with GSC (97.0% vs 90.6% and 98.6% vs 96.3%, respectively), these differences were not significant. Conclusions GSC reclassified more indeterminate nodules as benign and improved the specificity and PPV of the test. These enhancements appear to be resulting in fewer diagnostic surgeries.

scholarly journals Benign Aspirates on Follow-Up FNA May Be Enough in Patients with Initial Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Ga Ram Kim ◽  
Jung Hyun Yoon ◽  
Eun-Kyung Kim ◽  
Hee Jung Moon ◽  
Jin Young Kwak
Keyword(s):  
Thyroid Nodules ◽  
Surgical Excision ◽  
Needle Aspiration ◽  
Risk Of Malignancy ◽  
Benign Nodules ◽  
Benign Thyroid Nodules ◽  
Benign Thyroid ◽  
Undetermined Significance

Background.Management of thyroid nodules with benign aspirates following atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is not well established. We reviewed the risk of malignancy and the role of ultrasound (US) features among thyroid nodules with benign results following initial AUS/FLUS diagnoses.Methods.From December 2009 to February 2011, a total of 114 nodules in 114 patients diagnosed as benign on follow-up fine-needle aspiration (FNA) after AUS/FLUS results were included in our study. Eight among 114 nodules were confirmed pathologically and 106 were clinically observed by a follow-up FNA or US. Suspicious US features were defined as markedly hypoechogenicity, irregular or microlobulated margin, presence of microcalcifications, and taller than wide shape.Results.There were 110 (96.5%) benign nodules and 4 (3.5%) malignant nodules. Two (4.8%) among 42 nodules without suspicious US features and 2 (2.8%) out of 72 nodules with suspicious US features were confirmed as malignancy, but there were no significant associations between the malignancy rate and US features (P=0.625).Conclusion.Clinical follow-up instead of surgical excision or continuous repeat FNA may be enough for benign thyroid nodules after AUS/FLUS. The role of US features might be insignificant in the management of these nodules.

scholarly journals FNAC IN THE MANAGEMENT OF SOLITARY THYROID NODULE

2006 ◽  
Vol 13 (04) ◽  
pp. 596-603
Author(s):  
SOHAIL RAZA ◽  
HAMAD RAZA ◽  
ZAHID SAEED ◽  
Mubasher Ahmed
Keyword(s):  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Fine Needle Aspiration Biopsy ◽  
Cost Effective ◽  
Needle Aspiration ◽  
Military Hospital ◽  
Solitary Thyroid Nodule ◽  
Benign Nodules ◽  
Histopathological Results

Objective: To determine the significant role of FNAC upon other diagnosticmodalities in pre-operative investigations of patients presenting with solitary thyroid nodules and to compare the postoperative histopathological results with the results of FNAC. Design: A Comparative study. Place and Duration ofStudy: Department of Surgery Combined Military Hospital Quetta and Combined Military Hospital Rawalpindi fromDecember 1999 to December 2001. Patients and Methods: In this study 46 patients with solitary thyroid nodule werestudied. Only 2 patients were toxic while remaining 44 were with euthyroid. In this study only one case was suspectedto be malignant clinically out of 5 malignant cases. All 46 patients under went thyroid scanning, ultrasound examinationand fine needle aspiration biopsy and the diagnostic accuracy was assessed. Results: 36 patients (78.26%) wereoperated while 10(21.73%) were managed conservatively. There were 5(10.86%) malignant nodules while 41(89.13%)were benign. All the 5 cases with malignancy were with ‘cold’ nodules on scan as most of others, while ‘solid’ onultrasound examination and so were most of other benign nodules. All cases diagnosed malignant pre-operatively onFNAC, proved to be malignant on histopathology after surgery and the others diagnosed as benign on FNAC provedto be benign. Conclusion: This study shows that conventional investigations for evaluation of solitary thyroid nodulesare inaccurate in identifying the malignant from the benign nodules and their routine use in such patients should beabandoned, while the use of FNAC should be encouraged more in our hospitals as this technique is with high degreeof sensitivity and specificity, cost effective and safe.

A STUDY ON THE ROLE OF SALINE SONOSALPINGOGRAPHY AS A TEST FOR TUBAL PATENCY IN THE ASSESSMENT OF INFERTILITY

2021 ◽  
pp. 80-82
Author(s):  
Bishnu Prasad Das ◽  
Manoj Kumar Majumdar ◽  
Chumi Deka
Keyword(s):  
Predictive Value ◽  
High Sensitivity ◽  
Fallopian Tubes ◽  
Perfect Agreement ◽  
Tubal Patency ◽  
Primary Health ◽  
Infertility Patients ◽  
Work Up ◽  
Tubal Pathology

Background: Tubal pathology is one of the major causes of infertility and evaluation of fallopian tubes forms an essential part of work up of infertility patients. The aim of the study was to evaluate tubal patency by Saline Sonosalpingography and compare the results with that of hysterosalpingography. Methods: A total of 22 patients with primary infertility and 13 patients with secondary infertility attending our Obstetrics and Gynecology department were recruited for the study from July 2019 to June 2020. All the study subjects underwent Saline Sonosalpingography on day 7 to day 9 and Hysterosalpingography on 7th to 11th day of the menstrual cycle. Data was collected and compared to assess the sensitivity and specicity of Sonosalpingography with Hysterosalpingography as reference standard. Results: Sonosalpingography (SSG) has 98.18% sensitivity and 66.67% specicity in comparison to hysterosalpingography (HSG). Analysis of the raw data gave positive predictive value of 91.52% and negative predictive value of 90.9%. Near perfect agreement (Cohen's Kappa coefcient =0.9) was seen between the results of the two methods (SSG and HSG). Conclusions: Sonosalpingogrpahy has a high sensitivity for tubal patency and is less invasive. It is found to be a reliable and relatively less expensive diagnostic procedure in the management of infertility in females. Easy availability and accessibility of ultrasound in all primary health care centres denitely can prove superior to conventional method of diagnosis of tubal patency in such patient.

Improving the diagnosis of AUS/FLUS thyroid nodules using an algorithm with combination of BRAFV600E mutation analysis and ultrasound pattern-based risk stratification

2020 ◽  
pp. 1-13
Author(s):  
Ya-Fang Zhou ◽  
Yi-Feng Zhang ◽  
Hui-Jun Fu ◽  
Wei-Ping Yang ◽  
Chong-Ke Zhao ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Mutation Analysis ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Characteristic Curve ◽  
Diagnostic Algorithm ◽  
Needle Aspiration ◽  
American Thyroid Association ◽  
Brafv600e Mutation ◽  
Undetermined Significance

Purpose: To propose a diagnostic algorithm for improving the diagnosis of atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) thyroid nodules. Methods: This study retrospectively enrolled 77 consecutive patients with 81 AUS/FLUS nodules who underwent preoperative BRAFV600E mutation analysis. A new diagnostic algorithm was proposed that BRAFV600E mutation analysis for the Fine-needle aspiration cytology specimen was firstly carried out, in which positive BRAFV600E mutation indicated malignancy and classification of the nodules with negative BRAFV600E mutation was further performed based on ultrasound pattern-based risk stratification of American Thyroid Association Guidelines. The diagnostic performance of the new diagnostic algorithm was evaluated. Results: The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and area under the receiver operating characteristic curve (AUROC) of new diagnostic algorithm were 94.6%, 84.0%, 91.4%, 86.9%, 90.1%, and 0.893, respectively. The proposed diagnostic algorithm significantly increased the diagnostic performances (AUROC: 0.893 vs. 0.837 and 0.795), sensitivity (94.6% vs. 71.4% and 75.0%), and accuracy (90.1% vs. 79.0% and 77.8%) compared with BRAFV600E mutation analysis alone and ultrasound pattern-based risk stratification alone (all P <  0.05). Conclusion: The proposed diagnostic algorithm is helpful for improving the diagnosis of AUS/FLUS nodules, which might be as a routine approach.

scholarly journals Thyroid Ultrasound: State of the Art Part 1 – Thyroid Ultrasound reporting and Diffuse Thyroid Diseases

2017 ◽  
Vol 19 (1) ◽  
pp. 79 ◽  
Author(s):  
Manjiri Dighe ◽  
Richard Barr ◽  
Jörg Bojunga ◽  
Vito Cantisani ◽  
Maria Cristina Chammas ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
State Of The Art ◽  
Thyroid Diseases ◽  
World Federation ◽  
Thyroid Ultrasound ◽  
Therapeutic Work ◽  
Work Up ◽  
Thyroid Abnormalities

Accurate differentiation of focal thyroid nodules (FTL) and thyroid abnormalities is pivotal for proper diagnostic and therapeutic work-up. In these two part articles, the role of ultrasound techniques in the characterization of FTL and evaluation of diffuse thyroid diseases is described to expand on the recently published World Federation in Ultrasound and Medicine (WFUMB) thyroid elastography guidelines and review how this guideline fits into a complete thyroid ultrasound exam.

scholarly journals Thyroid Ultrasound: State of the Art. Part 2 – Focal Thyroid Lesions

2017 ◽  
Vol 19 (2) ◽  
pp. 195 ◽  
Author(s):  
Manjiri Dighe ◽  
Richard Barr ◽  
Jörg Bojunga ◽  
Vito Cantisani ◽  
Maria Cristina Chammas ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
State Of The Art ◽  
World Federation ◽  
Thyroid Ultrasound ◽  
Therapeutic Work ◽  
Work Up ◽  
Thyroid Abnormalities ◽  
Thyroid Lesions

Accurate differentiation of focal thyroid nodules (FTL) and thyroid abnormalities is pivotal for proper diagnostic and therapeutic work-up. In these two part articles, the role of ultrasound techniques in the characterization of FTL and evaluation of diffuse thyroid diseases is described to expand on the recently published World Federation in Ultrasound and Medicine (WFUMB) thyroid elastography guidelines and review how this guideline fits into a complete thyroid ultrasound exam.

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