scholarly journals Facing Thyroid Nodules in Paediatric Patients Previously Treated with Radiotherapy for Non-Thyroidal Cancers: Are Adult Ultrasound Risk Stratification Systems Reliable?

Cancers ◽  
2021 ◽  
Vol 13 (18) ◽  
pp. 4692
Author(s):  
Arnoldo Piccardo ◽  
Francesco Fiz ◽  
Gianluca Bottoni ◽  
Camilla De Luca ◽  
Michela Massollo ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Radiation Exposure ◽  
Thyroid Nodules ◽  
Paediatric Population ◽  
Classification Systems ◽  
Predictive Values ◽  
Paediatric Patients ◽  
The Us ◽  
History Of ◽  
Sensitivity Specificity

Thyroid nodule ultrasound-based risk stratification systems (US-RSSs) have been successfully used in adults to predict the likelihood of malignancies. However, their applicability to the paediatric population is unclear, especially in children with a history of radiation exposure, who are at a higher cancer risk. We tested the efficacy of three US-RSSs in this setting by retrospectively applying three classification systems (ACR-TIRADS, ATA and EU-TIRADS) to all paediatric patients referred for thyroid nodules and with a radiation exposure history. We compared the results with a reference standard (pathology or 36-month follow-up); sensitivity, specificity, positive and negative predictive values (PPV and NPV) and accuracy were calculated. A total of 52 patients were included; fourteen of them (27%) had papillary thyroid cancer (PTC) at the final histology. No significant differences across the US-RSSs were detected; specificity (range 95–97%) and NPV (range 88–93%) were particularly elevated. However, ACR-TIRADS, ATA and EU-TIRADS did not indicate the need for a biopsy in six (42.8%), seven (50%) and eight (57%) cases of PTC; in five cases, this lack of indication was due to a small (<1 cm) nodule size. In conclusion, US-RSSs show a high NPV and specificity in paediatric patients, whereas the cytology indication could be improved by reconsidering the dimensional criterion.

scholarly journals Reducing the Number of Unnecessary Thyroid Biopsies While Improving Diagnostic Accuracy: Toward the “Right” TIRADS

2018 ◽  
Vol 104 (1) ◽  
pp. 95-102 ◽  
Author(s):  
Giorgio Grani ◽  
Livia Lamartina ◽  
Valeria Ascoli ◽  
Daniela Bosco ◽  
Marco Biffoni ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Thyroid Nodules ◽  
False Negative ◽  
False Negative Rate ◽  
Needle Aspiration ◽  
Classification Systems ◽  
American Thyroid Association ◽  
Predictive Values ◽  
Korean Society ◽  
The Right

Abstract Context The prevalence of thyroid nodules in the general population is increasingly high, and at least half of those biopsied prove to be benign. Sonographic risk-stratification systems are being proposed as “rule-out” tests that can identify nodules that do not require fine-needle aspiration (FNA) cytology. Objective To comparatively assess the performances of five internationally endorsed sonographic classification systems [those of the American Thyroid Association, the American Association of Clinical Endocrinologists, the American College of Radiology (ACR), the European Thyroid Association, and the Korean Society of Thyroid Radiology] in identifying nodules whose FNAs can be safely deferred and to estimate their negative predictive values (NPVs). Design Prospective study of thyroid nodules referred for FNA. Setting Single academic referral center. Patients Four hundred seventy-seven patients (358 females, 75.2%); mean (SD) age, 55.9 (13.9) years. Main Outcome Measures Number of biopsies classified as unnecessary, false-negative rate (FNR), sensitivity, specificity, predictive values, and diagnostic ORs for each system. Results Application of the systems’ FNA criteria would have reduced the number of biopsies performed by 17.1% to 53.4%. The ACR Thyroid Imaging Reporting and Data System (TIRADS) allowed the largest reduction (268 of 502) with the lowest FNR (NPV, 97.8%; 95% CI, 95.2% to 99.2%). Except for the Korean Society of Thyroid Radiology TIRADS, all other systems exhibited significant discriminatory performance but produced significantly smaller reductions in the number of procedures. Conclusions Internationally endorsed sonographic risk stratification systems vary widely in their ability to reduce the number of unnecessary thyroid nodule FNAs. The ACR TIRADS outperformed the others, classifying more than half the biopsies as unnecessary with a FNR of 2.2%.

Discriminating Malignancy in Thyroid Nodules: The Nomogram Versus the Kwak and ACR TI-RADS

2020 ◽  
Vol 163 (6) ◽  
pp. 1156-1165
Author(s):  
Juan Xiao ◽  
Qiang Xiao ◽  
Wei Cong ◽  
Ting Li ◽  
Shouluan Ding ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Diagnostic Study ◽  
Diagnostic Efficiency ◽  
Training Set ◽  
Multivariable Logistic Regression Model ◽  
Predictive Values ◽  
Validation Set ◽  
Sensitivity Specificity

Objective To develop an easy-to-use nomogram for discrimination of malignant thyroid nodules and to compare diagnostic efficiency with the Kwak and American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS). Study Design Retrospective diagnostic study. Setting The Second Hospital of Shandong University. Subjects and Methods From March 2017 to April 2019, 792 patients with 1940 thyroid nodules were included into the training set; from May 2019 to December 2019, 174 patients with 389 nodules were included into the validation set. Multivariable logistic regression model was used to develop a nomogram for discriminating malignant nodules. To compare the diagnostic performance of the nomogram with the Kwak and ACR TI-RADS, the area under the receiver operating characteristic curve, sensitivity, specificity, and positive and negative predictive values were calculated. Results The nomogram consisted of 7 factors: composition, orientation, echogenicity, border, margin, extrathyroidal extension, and calcification. In the training set, for all nodules, the area under the curve (AUC) for the nomogram was 0.844, which was higher than the Kwak TI-RADS (0.826, P = .008) and the ACR TI-RADS (0.810, P < .001). For the 822 nodules >1 cm, the AUC of the nomogram was 0.891, which was higher than the Kwak TI-RADS (0.852, P < .001) and the ACR TI-RADS (0.853, P < .001). In the validation set, the AUC of the nomogram was also higher than the Kwak and ACR TI-RADS ( P < .05), each in the whole series and separately for nodules >1 or ≤1 cm. Conclusions When compared with the Kwak and ACR TI-RADS, the nomogram had a better performance in discriminating malignant thyroid nodules.

scholarly journals The diagnosis of delirium in 80 emergency unit patients

1998 ◽  
Vol 56 (2) ◽  
pp. 176-183
Author(s):  
AFONSO CARLOS NEVES ◽  
RICARDO DE CASTRO CINTRA SESSO ◽  
HENRIQUE BALLALAI FERRAZ ◽  
SÍLVIO FRANCISCO ◽  
JOÃO BAPTISTA DOS REIS-FILHO
Keyword(s):  
Correct Diagnosis ◽  
Diagnostic Testing ◽  
Final Diagnosis ◽  
Initial Diagnosis ◽  
University Hospital ◽  
Emergency Unit ◽  
Predictive Values ◽  
Kappa Test ◽  
History Of ◽  
Sensitivity Specificity

We evaluated the initial and final diagnosis of 80 patients with delirium arriving at the emergence unit of a university hospital in a large Brazilian city over a period of 30 months up to December 1991. The diagnosis was based on the DSM-IIIR criteria. Patients with a known history of head trauma or epileptic seizure and patients younger than 13 years were excluded. Only patients with a disease of up to 7 days were included.The patients were subdivided into four etiologic groups: vascular; associated with the use of alcohol; infectious-parasitic; miscellaneous.The results showed a rate of correct diagnosis ranging from 65 to 80% with the use of kappa test (standard good to excelent). Sensitivity, specificity, positive predictive and negative predictive values had results showing different conditions for initial diagnosis in each group. This study can help the initial diagnosis of delirium and the choice for diagnostic testing.

Reliability of history of acetaminophen ingestion in intentional drug overdose patients

2010 ◽  
Vol 30 (1) ◽  
pp. 44-50 ◽  
Author(s):  
Yedidia Bentur ◽  
Yael Lurie ◽  
Ada Tamir ◽  
Daniel C Keyes ◽  
Fuad Basis
Keyword(s):  
Drug Overdose ◽  
The Other ◽  
Limited Resources ◽  
Suicidal Patient ◽  
History Taking ◽  
Predictive Values ◽  
Detailed History ◽  
History Of ◽  
The Difference ◽  
Sensitivity Specificity

The objective of this study was to determine the reliability of denial of acetaminophen ingestion in intentional drug overdose patients. All intentional drug overdose patients admitted to an emergency department who were able to provide a history were included. A detailed history was obtained on names, timing and number of medications ingested, and serum acetaminophen was assayed. Multidrug ingestion was defined as the reporting of ≥2 medications. Patients were considered ‘reliable’ if they reported acetaminophen ingestion and had detectable acetaminophen levels or the other way around. Validity parameters of acetaminophen history were assessed by sensitivity, specificity and positive and negative predictive values. A total of 154 patients were included. History was significantly more reliable in patients who denied ingestion of acetaminophen (n = 107) compared with patients who reported it (n = 47; 95.3% vs 65.9%, respectively; p < 0.0001, 95% CI of the difference 17.5%—41.2%). No suicidal patient who denied both acetaminophen and multidrug ingestions had a detectable acetaminophen level (negative predictive value 1, 95% CI 0.93—1.0). It is suggested that denial of both acetaminophen and multidrug ingestions by intentional drug overdose patients after a thorough history taking can be considered reliable for acetaminophen history. In facilities with limited resources, these patients may not require routine acetaminophen screening.

scholarly journals Varicella zoster virus in American Samoa: seroprevalence and predictive value of varicella disease history in elementary and college students

2013 ◽  
Vol 142 (5) ◽  
pp. 1002-1007 ◽  
Author(s):  
A. MAHAMUD ◽  
J. LEUNG ◽  
Y. MASUNU-FALEAFAGA ◽  
E. TESHALE ◽  
R. WILLIAMS ◽  
...  
Keyword(s):  
College Students ◽  
Elementary Students ◽  
Varicella Zoster Virus ◽  
American Samoa ◽  
Varicella Vaccination ◽  
Igg Antibodies ◽  
Predictive Values ◽  
Varicella Zoster ◽  
The Us ◽  
History Of

SUMMARYThe epidemiology of varicella is believed to differ between temperate and tropical countries. We conducted a varicella seroprevalence study in elementary and college students in the US territory of American Samoa before introduction of a routine varicella vaccination programme. Sera from 515 elementary and 208 college students were tested for the presence of varicella-zoster virus (VZV) IgG antibodies. VZV seroprevalence increased with age from 76·0% in the 4–6 years group to 97·7% in those aged ⩾23 years. Reported history of varicella disease for elementary students was significantly associated with VZV seropositivity. The positive and negative predictive values of varicella disease history were 93·4% and 36·4%, respectively, in elementary students and 97·6% and 3·0%, respectively, in college students. VZV seroprevalence in this Pacific island appears to be similar to that in temperate countries and suggests endemic VZV circulation.

scholarly journals Reliability and Validity of the Modified Dental Anxiety Scale in Turkish Patients

2005 ◽  
Vol 33 (2) ◽  
pp. 252-259 ◽  
Author(s):  
D İlgüy ◽  
M İlgüy ◽  
S Dinçer ◽  
G Bayirli
Keyword(s):  
Dental Treatment ◽  
Dental Anxiety ◽  
Reliability And Validity ◽  
Anxiety Scale ◽  
Predictive Values ◽  
History Of ◽  
Sensitivity Specificity ◽  
Turkish Patients

We aimed to determine dental anxiety among Turkish patients and assess the sensitivity, specificity, positive/negative predictive values and reliability of the Modified Dental Anxiety Scale (MDAS) and Corah's Dental Anxiety Scale (DAS). Patients referred to our clinic for dental treatment who had a history of dental anxiety were included in the study. 294 randomly selected patients (mean age 38.8 years) completed a questionnaire combining Corah's DAS and MDAS. They were retested 15 days later. The prevalence of dental anxiety was found to be 9.9% (29/294) for Corah's DAS at the cut-off point ≥ 15 and 8.8% (26/294) for the MDAS at the cut-off point ≥ 19. Both dental anxiety scales gave acceptable sensitivity, specificity, positive and negative predictive values at these cut-off points.

scholarly journals AIBx, artificial intelligence model to risk stratify thyroid nodules

2021 ◽  
Author(s):  
Johnson Thomas ◽  
Tracy Haertling
Keyword(s):  
Artificial Intelligence ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Classification Systems ◽  
Image Similarity ◽  
Ultrasound Images ◽  
Similarity Model ◽  
Sensitivity Specificity

AbstractBackgroundCurrent classification systems for thyroid nodules are very subjective. Artificial intelligence (AI) algorithms have been used to decrease subjectivity in medical image interpretation. 1 out of 2 women over the age of 50 may have a thyroid nodule and at present the only way to exclude malignancy is through invasive procedures. Hence, there exists a need for noninvasive objective classification of thyroid nodules. Some cancers have benign appearance on ultrasonogram. Hence, we decided to create an image similarity algorithm rather than image classification algorithm.MethodsUltrasound images of thyroid nodules from patients who underwent either biopsy or thyroid surgery from February of 2012 through February of 2017 in our institution were used to create AI models. Nodules were excluded if there was no definitive diagnosis of benignity or malignancy. 482 nodules met the inclusion criteria and all available images from these nodules were used to create the AI models. Later, these AI models were used to test 103 thyroid nodules which underwent biopsy or surgery from March of 2017 through July of 2018.ResultsNegative predictive value of the image similarity model was 93.2%. Sensitivity, specificity, positive predictive value and accuracy of the model was 87.8%, 78.5%, 65.9% and 81.5% respectively.ConclusionWhen compared to published results of ACR TIRADS and ATA classification system, our image similarity model had comparable negative predictive value with better sensitivity specificity and positive predictive value. By using image similarity AI models, we can eliminate subjectivity and decrease the number of unnecessary biopsies. Using image similarity AI model, we were able to create an explainable AI model which increases physician’s confidence in the predictions.

Can preoperative ultrasound predict extrathyroidal extension of differentiated thyroid cancer?

2021 ◽  
Author(s):  
Livia Lamartina ◽  
Sophie Bidault ◽  
Julien Hadoux ◽  
Joanne Guerlain ◽  
Elizabeth Girard ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Thyroid Nodules ◽  
Extrathyroidal Extension ◽  
Predictive Values ◽  
Median Size ◽  
Preoperative Ultrasound ◽  
Ultrasound Evaluation ◽  
Initial Surgery ◽  
Sensitivity Specificity

Objective The presence of extrathyroidal extension (ETE) is generally considered an indication for total thyroidectomy for differentiated thyroid cancer. The accuracy of neck ultrasound for the diagnosis of ETE is controversial. The aim of this study was to assess the diagnostic accuracy of preoperative ultrasound evaluation of ETE. Methods Retrospective and observational study of consecutive patients operated between 2016 and 2019 for cytologically suspicious or indeterminate thyroid nodules. US images obtained preoperatively were retrospectively reviewed to identify signs of minimal or gross ETE. Histology was considered the gold standard for diagnosis of ETE. The sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and accuracy of US were evaluated. Results A cohort of 305 patients (75% females, median age 48 years) with 378 nodules (median size 18 mm) was studied. Seventy-five percent of the nodules (n=228) were malignant on histology and ETE was present in 106 cases (28%): 83 minimal ETE and 23 gross ETE. Suspicion of minimal ETE on preoperative ultrasound was found in 50 (13%) with a sensitivity of 30%, a specificity of 93%, a PPV 62% and a NPV of 78%, with an accuracy of 76%. Gross ETE on ultrasound was found in 19 (5%) nodules with a sensitivity of 78%, a specificity of 99.7% a PPV 94.7% an NPV of 98.6% and an accuracy of 98%. Conclusions Preoperative US is very specific and accurate in diagnosing gross ETE which impacts the extent of initial surgery for thyroid cancers.

A STUDY OF CYTOHISTOPATHOLOGICAL CORRELATION OF VARIOUS THYROID LESION IN HADOTI REGION

2019 ◽  
Vol 3 (10) ◽  
Author(s):  
Dr. Savita Kumari ◽  
Dr. Rakesh Kr. Singh ◽  
Dr. Naresh N Rai ◽  
Dr. Neelu Vashisht ◽  
Dr. Sunil Kr Bairwa
Keyword(s):  
Radiation Exposure ◽  
Iodine Deficiency ◽  
Clinical Finding ◽  
Thyroid Nodules ◽  
Elderly Persons ◽  
Thyroid Lesion ◽  
History Of ◽  
Common Clinical Finding

Thyroid nodules are a common clinical finding, with an estimated prevalence ranging from 3% to 7%.1 Thyroid nodules are more common in elderly persons, in women, in those with iodine deficiency, and in those with a history of radiation exposure.

scholarly journals Long-term sequelae secondary to snakebite envenoming: a single centre retrospective study in a Costa Rican paediatric hospital

2020 ◽  
Vol 4 (1) ◽  
pp. e000735
Author(s):  
Helena Brenes-Chacon ◽  
Jose M Gutierrez ◽  
Kattia Camacho-Badilla ◽  
Alejandra Soriano-Fallas ◽  
Rolando Ulloa-Gutierrez ◽  
...  
Keyword(s):  
Costa Rica ◽  
Functional Limitation ◽  
Paediatric Population ◽  
Costa Rican ◽  
Paediatric Hospital ◽  
Paediatric Patients ◽  
Time Period ◽  
History Of

ObjectivesAlthough devastating acute effects associated with snake envenoming are well described, the long-term sequelae resulting from these envenomings have not been adequately addressed, especially in the paediatric population. The aim of our study is to describe the clinical characteristics among paediatric patients in Costa Rica who developed long-term sequelae secondary to snakebite envenoming.DesignRetrospective descriptive study of paediatric patients under 13 years who were admitted with a history of a recent snakebite at the National Children’s Hospital in Costa Rica from January 2001 to December 2014.ResultsWe enrolled 74 patients admitted to our centre due to envenoming, and separated those who did not develop sequelae (50 patients) from those who did (24 patients). Of those who presented acute complications during hospitalisation, local wound infection and clinically diagnosed compartmental syndrome were significantly higher in the group that developed sequelae thereafter. Hypertrophic scars (66.7%), functional limitation of affected limb (37.5%) and the need of skin graft (37.5%) were the most common sequelae. The median follow-up of patients with long-term sequelae after discharge was 25.4 months (5.6–59.4). No deaths were reported during this time period.ConclusionsGiven the high economic, personal and healthcare burden that entails follow-up of these patients, efforts should be carried out to prevent the factors associated with sequelae among the affected population.

Sign in / Sign up

Export Citation Format

Share Document