Performance of current ultrasound-based malignancy risk stratification systems for thyroid nodules in patients with follicular neoplasms

Objectives To investigate the ability of the currently used ultrasound-based malignancy risk stratification systems for thyroid neoplasms (ATA, AACE/ACE/AME, K-TIRADS, EU-TIRADS, ACR-TIRADS and C-TIRADS) in distinguishing follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA). Additionally, we evaluated the ability of these systems in correctly determining the indication for biopsy. Methods Three hundred twenty-nine follicular neoplasms with definitive postoperative histopathology were included. The nodules were categorized according to each of six stratification systems, based on ultrasound findings. We dichotomized nodules into the positive predictive group of FTC (high and intermediate risk) and negative group of FTC based on the classification results. Missed biopsy was defined as neoplasms that were diagnosed as FTCs but for which biopsy was not indicated based on lesion classification. Unnecessary biopsy was defined as neoplasms that were diagnosed as FTAs but for whom biopsy was considered indicated based on classification. The diagnostic performance and missed and unnecessary biopsy rates were evaluated for each stratification system. Results The area under the curve of each system for distinguishing follicular neoplasms was < 0.700 (range, 0.511–0.611). The missed biopsy rates were 9.0–22.4%. The missed biopsy rates for lesions ≤ 4 cm and lesions sized 2–4 cm were 16.2–35.1% and 0–20.0%, respectively. Unnecessary biopsy rates were 65.3–93.1%. In ≤ 4 cm group, the unnecessary biopsy rates were 62.2–89.7%. Conclusion The malignancy risk stratification systems can select appropriate nodules for biopsy in follicular neoplasms, while they have limitations in distinguishing follicular neoplasms and reducing unnecessary biopsy. Specific stratification systems and recommendations should be established for follicular neoplasms. Key Points • Current ultrasound-based malignancy risk stratification systems of thyroid nodules had low efficiency in the characterization of follicular neoplasms. • The adopted stratification systems showed acceptable performance for selecting FTC for biopsy but unsatisfactory performance for reducing unnecessary biopsy.

Left Atrial Appendage Morphology With The Progression of Atrial Fibrillation

Left atrial appendage (LAA) size is crucial for determining the indication of transcatheter LAA closure. The aim of this study was to evaluate the differences in LAA morphology according to the types of atrial fibrillation (AF). A total of 340 patients (mean age: 65 ± 15 years) who underwent transesophageal echocardiography (TEE) were included. Patients were classified into non-AF (n = 105), paroxysmal AF (n = 86), persistent AF (n = 87), or long-standing persistent AF (n = 62). LAA morphology, including LAA ostial diameter and depth, was assessed using TEE. Patients with long-standing persistent AF had larger LAA ostial diameter and depth, greater LAA lobes, and lower LAA flow velocity. The maximum LAA ostial diameter was 19 ± 4 mm in patients with non-AF, 21 ± 4 mm in patients with paroxysmal AF, 23 ± 5 mm in patients with persistent AF, and 26 ± 5 mm in patients with long-standing persistent AF. LAA ostial diameter was increased by 2 or 3 mm with the progression of AF. LAA ostial diameter was correlated with LA volume index (r = 0.37, p < 0.01) and the duration of continuous AF (r = 0.30, p < 0.01), but not with age or the period from the onset of AF. In conclusion, LAA size, which is the determinant for selecting device size of transcatheter LAA closure, was increased with the progression of AF. Our findings have potential implications for therapeutic strategy of transcatheter LAA closure.

Left Atrial Appendage Morphology With the Progression of Atrial Fibrillation

Left atrial appendage (LAA) size is crucial for determining the indication of transcatheter LAA closure. The aim of this study was to evaluate the differences in LAA morphology according to the types of atrial fibrillation (AF). A total of 340 patients (mean age: 65 ± 15 years) who underwent transesophageal echocardiography (TEE) were included. Patients were classified into non-AF (n = 105), paroxysmal AF (n = 86), persistent AF (n = 87), or long-standing persistent AF (n = 62). LAA morphology, including LAA ostial diameter and depth, was assessed using TEE. Patients with long-standing persistent AF had larger LAA ostial diameter and depth, greater LAA lobes, and lower LAA flow velocity. The maximum LAA ostial diameter was 19 ± 4 mm in patients with non-AF, 21 ± 4 mm in patients with paroxysmal AF, 23 ± 5 mm in patients with persistent AF, and 26 ± 5 mm in patients with long-standing persistent AF. LAA ostial diameter was increased by 2 or 3 mm with the progression of AF. LAA ostial diameter was correlated with LA volume index (R = 0.37, P < 0.01) and the duration of continuous AF (R = 0.30, P < 0.01), but not with age or the period from the onset of AF. LAA size, which is the determinant for selecting device size of transcatheter LAA closure, was increased with the progression of AF. Our findings have potential implications for therapeutic strategy of transcatheter LAA closure.

Risk Factors for Tube Shunt Exposure: A Matched Case-Control Study

Purpose. To evaluate potential risk factors for developing tube shunt exposure in glaucoma patients.Patients and Methods. Forty-one cases from 41 patients that had tube shunt exposure from 1996 to 2005 were identified from the Robert Cizik Eye Clinic and Bascom Palmer Eye Institute. Each case was matched with 2 controls of the same gender and with tube shunts implanted within 6 months of the index case. Conditional logistic regression was used to determine risk factors.Results. The study cohort includes a total of 121 eyes from 121 patients. The mean age was 63.6 ± 19.7 years, ranging from 1 to 96 years. The average time to exposure was 19.29 ± 23.75 months (range 0.36–85.74 months). Risk factors associated with tube exposure were Hispanic ethnicity (P=0.0115; OR = 3.6; 95% CI, 1.3–9.7), neovascular glaucoma (P=0.0064; OR = 28.5; 95% CI, 2.6–316.9), previous trabeculectomy (P=0.0070; OR = 5.3; 95% CI, 1.6–17.7), and combined surgery (P=0.0381; OR = 3.7; 95% CI, 1.1–12.7).Conclusions. Hispanic ethnicity, neovascular glaucoma, previous trabeculectomy, and combined surgery were identified as potential risk factors for tube shunt exposure. These potential risk factors should be considered when determining the indication for performing tube shunt implantation and the frequency of long-term followup.