scholarly journals Could Negative Tc-99m-Methoxyisobutylisonitrile (MIBI) Scintigraphy Obviate the Need for Surgery for Bethesda III and IV Thyroid Nodules?

Surgeries ◽  
2021 ◽  
Vol 2 (3) ◽  
pp. 260-267
Author(s):  
Stella Armefti ◽  
Jasmin Mettler ◽  
Matthias Schmidt ◽  
Michael Faust ◽  
Marianne Engels ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
University Hospital ◽  
Molecular Testing ◽  
High Negative Predictive Value ◽  
Indeterminate Cytology ◽  
Sensitivity Specificity ◽  
Mibi Scintigraphy

In about 20% of all cases, the fine needle aspiration cytology (FNAC) results are equivocal, delivering the two common categories of indeterminate cytology, Bethesda III and IV. The observed rates of malignancy vary widely among institutions, with the urgent need for a more precise risk stratification. 99mcTc methoxyisobutylisonitrile scintigraphy (MIBI) is less expensive than molecular testing and has been shown to have a high negative predictive value. For this reason, the results of MIBI scintigraphy in adult patients with indeterminate FNAC were collected, and correlated with the final pathology reports of surgical specimens. Patients receiving FNAC, MIBI scintigraphy and surgery for sonographic suspicious hypofunctional thyroid nodules between 2015 and 2019 at the University Hospital of Cologne, Germany were identified. Sensitivity, specificity, positive predictive and negative predictive value of MIBI scintigraphy were calculated. Seventy-eight patients with sonographic suspicious hypofunctional thyroid nodules underwent surgery after interdisciplinary case discussion of both FNAC and MIBI results. In 49 (62.5%) cases, FNAC consisted of Bethesda III and IV results. In 39 (79.6%) of these cases, MIBI scintigraphy resulted in mismatch and intermediary results, but in only 4 (10.2%) of these cases was a carcinoma diagnosed. The negative predictive value of MIBI scintigraphy was 90–100%, respectively. Relying on the negative predictive value of MIBI match results might have obviated the need for surgery in 20.4% cases; one papillary microcarcinoma, however, would have been missed. MIBI scintigraphy has an underused potential for improving the diagnostic precision of hypofunctional thyroid nodules.

scholarly journals Clinical Diagnosis has a High Negative Predictive Value in Evaluation of Malignant Skin Lesions

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Maral Seyed Ahadi ◽  
Alireza Firooz ◽  
Hoda Rahimi ◽  
Mehrdad Jafari ◽  
Zohreh Tehranchinia
Keyword(s):  
Negative Predictive Value ◽  
Clinical Diagnosis ◽  
Predictive Value ◽  
Skin Lesions ◽  
University Hospital ◽  
Response To Treatment ◽  
Likelihood Ratios ◽  
Malignant Skin ◽  
High Negative Predictive Value ◽  
Sensitivity Specificity

Background. The increasing incidence of skin cancers in fair-skinned population and its relatively good response to treatment make its accurate diagnosis of great importance. We evaluated the accuracy of clinical diagnosis of malignant skin lesions by comparing the clinical diagnosis with histological diagnosis as the gold standard. Materials and Methods. In this retrospective study, we assessed all the pathology reports from specimens sent to a university hospital laboratory in 3 consecutive years from March 2008 to March 2010. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios were calculated for clinical diagnosis of malignant skin lesions stratified by their histological subtype. Results. A total 4,123 specimen were evaluated. The sensitivity and specificity for clinical diagnosis of malignancy were 90.48% and 82.85%, respectively, whereas the negative predictive value was shown to be 99.06%. The positive and negative likelihood ratios were 5.23 and 0.11, respectively. Conclusion. Pathological assessment of skin lesions remains the cornerstone of skin cancer diagnosis. The high NPV and the relatively low PPV indicate that clinical diagnosis is more efficient in ruling out malignancies rather than diagnosing them.

Contemporary Management of Thyroid Nodules

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Kristen Kobaly ◽  
Caroline S. Kim ◽  
Susan J. Mandel
Keyword(s):  
Thyroid Nodules ◽  
Cervical Lymphadenopathy ◽  
Standard Technique ◽  
Clinical History ◽  
Needle Aspiration ◽  
Annual Review ◽  
Publication Date ◽  
Molecular Testing ◽  
Risk Of Malignancy ◽  
Indeterminate Cytology

Thyroid nodules are common in the general population, with higher prevalence in women and with advancing age. Approximately 5% of thyroid nodules are malignant; the majority of this subset represents papillary thyroid cancer. Ultrasonography is the standard technique to assess the underlying thyroid parenchyma, characterize the features of thyroid nodules, and evaluate for abnormal cervical lymphadenopathy. Various risk stratification systems exist to categorize the risk of malignancy based on the ultrasound appearance of a thyroid nodule. Nodules are selected for fine-needle aspiration biopsy on the basis of ultrasound features, size, and high-risk clinical history. Cytology results are classified by the Bethesda system into six categories ranging from benign to malignant. When cytology is indeterminate, molecular testing can further risk-stratify patients for observation or surgery. Surveillance is indicated for nodules with benign cytology, indeterminate cytology with reassuring molecular testing, or non-biopsied nodules without a benign sonographic appearance. Expected final online publication date for the Annual Review of Medicine, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

scholarly journals ACR TI-RADS and ATA US scores are helpful for the management of thyroid nodules with indeterminate cytology

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Thayse Lozovoy Madsen Barbosa ◽  
Cleo Otaviano Mesa Junior ◽  
Hans Graf ◽  
Teresa Cavalvanti ◽  
Marcus Adriano Trippia ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Needle Aspiration ◽  
Molecular Testing ◽  
American Thyroid Association ◽  
Institutional Review ◽  
The Us ◽  
Risk Of Malignancy ◽  
Indeterminate Cytology

Abstract Background Cytologically indeterminate thyroid nodules currently present a challenge for clinical decision-making. The main aim of our study was to determine whether the classifications, American College of Radiology (ACR) TI-RADS and 2015 American Thyroid Association (ATA) guidelines, in association with The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), could be used to stratify the malignancy risk of indeterminate thyroid nodules and guide their clinical management. Methods The institutional review board approved this retrospective study of a cohort of 140 thyroid nodules in 139 patients who were referred to ultrasound-guided fine-needle aspiration cytology (FNAC) from January 2012 to June 2016 with indeterminate cytological results (44 Bethesda III, 52 Bethesda IV and 44 Bethesda V) and in whom pre-FNAC thyroid US images and histological results after surgery were available. Each included nodule was classified by one radiologist blinded to the cytological and histological diagnoses according to the ACR TIRADS scores and the US patterns as recommended in the 2015 ATA guidelines. The risk of malignancy was estimated for Bethesda, TI-RADS scores, ATA US patterns and their combination. Results Of the 140 indeterminate thyroid nodules examined, 74 (52.9%) were histologically benign. A different rate of malignancy (p < 0.001) among Bethesda III, IV and V was observed. The rate of malignancy increased according to the US suspicion categories (p < 0.001) in both US classifications (TI-RADS and ATA). Thyroid nodules classified as Bethesda III and the lowest risk US categories (very low, low and intermediate suspicion by ATA and 2, 3 and 4a by TI-RADS) displayed a sensitivity of 95.3% for both classifications and a negative predictive value of 94.3 and 94.1%, respectively. The highest risk US categories (high suspicion by ATA and 4b,4c and 5 by TI-RADS) were significantly associated with cancer (odds ratios [ORs] 14.7 and 9.8, respectively). Conclusions Ultrasound classifications, ACR TI-RADS and ATA guidelines, may help guide the management of indeterminate thyroid nodules, suggesting a conservative approach to nodules with low-risk US suspicion and Bethesda III, while molecular testing and surgery should be considered for nodules with high-risk US suspicion and Bethesda IV or V.

Isolated demyelinating syndromes: comparison of CSF oligoclonal bands and different MR imaging criteria to predict conversion to CDMS

2001 ◽  
Vol 7 (6) ◽  
pp. 359-363 ◽  
Author(s):  
M Tintoré ◽  
A Rovira ◽  
L Brieva ◽  
E Grivé ◽  
R Jardí ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
High Sensitivity ◽  
Oligoclonal Bands ◽  
High Negative Predictive Value ◽  
Csf Oligoclonal Bands ◽  
Sensitivity Specificity

Aim of the study: To evaluate and compare the capacity of oligoclonal bands (OB) and three sets of MR imaging criteria to predict the conversion of clinically isolated syndromes (CIS) to clinically definite multiple sclerosis (CDMS). Patients and methods: One hundred and twelve patients with CIS were prospectively studied with MR imaging and determination of OB. Based on the clinical follow-up (conversion or not conversion to CDMS), we calculated the sensitivity, specificity accuracy, positive and negative predictive value of the OB, and MR imaging criteria proposed by Paty et al, Fazekas et al and Barkhof et al. Results: CDMS developed in 26 (23.2%) patients after a mean follow-up of 31 months (range 12-62). OB were positive in 70 (62.5%) patients and were associated with a higher risk of developing CDMS. OB showed a sensitivity of 81%, specificity of 43%, accuracy of 52%, positive predictive value (PPV) of 30% and negative predictive value (NPV) of 88%. Paty and Fazekas criteria showed the same results with a sensitivity of 77%, specificity of 51%, accuracy of 57%, positive predictive value of 32% and negative predictive value of 88%. Barkhof criteria showed a sensitivity of 65%, specificity of 70%, accuracy of 69%, PPV of 40% and NPV of 87%. The greatest accuracy was achieved when patients with positive OB and three or four Barkhof's criteria were selected. Conclusions: We observed a high prevalence of OB in CIS. OB and MR imaging (Paty's and Fazekas' criteria) have high sensitivity. Barkhof's criteria have a higher specificity. Both OB and MR imaging criteria have a high negative predictive value.

scholarly journals Comparison of Elastographic Strain Index and Thyroid Fine-Needle Aspiration Cytology in 631 Thyroid Nodules

2013 ◽  
Vol 98 (12) ◽  
pp. 4790-4797 ◽  
Author(s):  
Flavia Magri ◽  
Spyridon Chytiris ◽  
Valentina Capelli ◽  
Margherita Gaiti ◽  
Francesca Zerbini ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Fine Needle Aspiration ◽  
Predictive Value ◽  
Fine Needle Aspiration Cytology ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Aspiration Cytology ◽  
Strain Index ◽  
Fine Needle ◽  
Needle Aspiration Cytology

Context: Ultrasound (US) elastography (USE) was recently been reported as a sensitive, noninvasive tool for identifying thyroid cancer. However, the accuracy of this technique is hampered by the intra- and interoperator variability, some US features of the nodule, and the coexistence of autoimmune thyroid disease (ATD). Objectives: The purpose of this article was to assess the accuracy of USE findings in the differential diagnosis of thyroid nodules compared with other US features to evaluate its feasibility in the presence of ATDs and identify the strain index (SI) cutoff with the highest diagnostic performance. Design: We evaluated 528 consecutive patients for a total of 661 thyroid nodules. All nodules underwent fine-needle aspiration cytology (FNAC) and USE evaluation. The SI was calculated as a ratio of the nodule strain divided by the strain of the softest part of the surrounding normal tissue. Results: The median SI value was significantly higher in THY4 and THY5 than in THY2 nodules in ATD-positive, ATD-negative, and ATD-unknown patients. The cutoff of SI for malignancy was estimated to be 2.905 by receiver operating characteristic curve analysis in a screening set (379 FNAC results), and then tested in a replication set (252 FNAC results). In all cases, a SI value of ≥2.905 conferred to the nodule a significantly greater probability of being malignant. This SI cutoff had the greatest area under the curve, sensitivity, and negative predictive value, compared with the conventional US features of malignancy. Conclusion: The elastographic SI has a high sensitivity, specificity, and negative predictive value for the diagnosis of thyroid malignancy both in the presence and in the absence of ATD. If our data on USE are also confirmed in THY3 nodules, FNAC could be avoided in a number of thyroid nodules with certain features.

Impact of the Afirma Gene Expression Classifier Result on the Surgical Management of Thyroid Nodules with Category III/IV Cytology and Its Correlation with Surgical Outcome

2016 ◽  
Vol 60 (3) ◽  
pp. 205-210 ◽  
Author(s):  
Shweta Chaudhary ◽  
Yanjun Hou ◽  
Rulong Shen ◽  
Shveta Hooda ◽  
Zaibo Li
Keyword(s):  
Gene Expression ◽  
Predictive Value ◽  
Surgical Outcome ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Molecular Test ◽  
Gene Expression Classifier ◽  
Sensitivity Specificity ◽  
Undetermined Significance

Objective: The Afirma gene expression classifier (GEC) is a molecular test to further classify indeterminate fine-needle aspiration (FNA) as benign or suspicious for malignancy. Study Design: A total of 158 FNAs with Bethesda category III/IV cytology were sent for an Afirma GEC test. We correlated the Afirma GEC results with surgical outcome and also compared the data after Afirma's implementation with the data before. Results: Among the 158 FNAs, the Afirma result was benign in 63 (40%), suspicious in 85 (54%) and unsatisfactory in 10 (6%). In total, 73 (86%) suspicious Afirma cases had surgery and 28 (38%) showed carcinoma. In contrast, only 8 (13%) benign Afirma cases had surgery and all of them were benign. The sensitivity, specificity, negative predictive value and positive predictive value (PPV) of Afirma were 100, 15, 100 and 38%, respectively. The PPV was 20% in cases with follicular lesion of undetermined significance, but was 50% in cases suspicious for follicular neoplasm (SFN). The surgical excisional rate was significantly decreased in SFN cases after the Afirma test. Conclusions: The Afirma GEC is useful for further risk stratifying SFN cases.

scholarly journals Accuracy of Fine Needle Aspiration Biopsy in Diagnosing Parotid Gland Malignancy

2016 ◽  
Vol 31 (2) ◽  
pp. 24-26
Author(s):  
Kathleen Joy B. Santiago ◽  
Rodante A. Roldan ◽  
Samantha S. Castañeda
Keyword(s):  
Positive Predictive Value ◽  
Parotid Gland ◽  
Negative Predictive Value ◽  
Fine Needle Aspiration ◽  
Predictive Value ◽  
Fine Needle Aspiration Biopsy ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Fine Needle ◽  
Sensitivity Specificity

Objective: To determine the sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of FNAB in detecting parotid malignancies in our institution. Methods: Design:           Retrospective Chart Review Setting:           Tertiary Government Hospital Participants: Postoperative records of seventy six (76) patients with tumors of the parotid gland preoperatively diagnosed by FNAB. Results: The sensitivity of FNAB was 46%. The specificity and positive predictive value were both 100% and negative predictive value was 90%. Overall accuracy in diagnosing malignant parotid tumor was 91%. Conclusion: FNAB in this institution is a poor predictor of malignancy, having a sensitivity rate of only 46%. While this may serve as a basis for not recommending pre-operative FNAB for patients with parotid tumors in the interim, other factors should also be considered, including concerns with the actual performance and interpretion of FNAB in our institution. Keywords: Parotid neoplasm, Cancer of the parotid, fine needle aspiration biopsy, sensitivity, specificity, accuracy

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.

Sign in / Sign up

Export Citation Format

Share Document