Diagnostic Value of American Thyroid Association Guidelines,American College of Radiology Thyroid Imaging Reporting and Data System,and Chinese Thyroid Imaging Reporting and Data System Alone and Combined With BRAFV600E Mutation in Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance / 中国医学科学院学报

Objective To explore the diagnostic efficacy of American Thyroid Association(ATA)guidelines,American College of Radiology Thyroid Imaging Report and Data System(ACR-TIRADS),and Chinese Thyroid Imaging Reporting and Data System(C-TIRADS)alone and combined with BRAFV600E mutation in atypia of undetermined significance/follicular lesion of undetermined significance(AUS/FLUS).Methods A total of 138 patients who underwent ultrasound-guided fine needle aspiration(FNA)in the Chinese PLA General Hospital from January 2020 to May 2023 were selected.The clinicopathological and ultrasound characteristics were retrospectively analyzed for each nodule.Each nodule underwent preoperative BRAFV600E mutation testing and was diagnosed according to the ATA guidelines,ACR-TIRADS,and C-TIRADS.The diagnostic efficacy of ATA guidelines,ACR-TIRADS,and C-TIRADS alone and combined with BRAFV600E mutation was assessed based on the results of histopathological diagnosis.Results The 138 AUS/FLUS thyroid nodules included 45(32.6%)benign ones and 93(67.4%)malignant ones.The patient age(t=1.444,P=0.151),gender(χ2=0.259,P=0.611),and location of nodules(χ2=2.055,P=0.358)had no statistical significance for the differentiation between benign and malignant nodules,while nodule size(Z=2.500,P=0.012),echo(χ2=14.693,P<0.001),composition(χ2=17.075,P<0.001),aspect ratio ≥1(χ2=9.477,P=0.002),and microcalcification(χ2=6.892,P=0.009)were of significance for the differentiation.When applied alone,BRAFV600E mutation showed high specificity(95.56%)and positive predictive value(95.65%).Among the three ultrasound grading systems,ACR-TIRADS had the highest sensitivity(χ2=37.923,P<0.001;χ2=40.462,P<0.001)and accuracy(χ2=81.595,P<0.001;χ2=76.912,P<0.001),while C-TIRADS had the highest specificity(χ2=11.746,P<0.001;χ2=21.235,P<0.001).However,the three systems showed no statistically significant difference in the diagnostic efficiency when applied alone(Z=1.177,P=0.239;Z=0.213,P=0.831;Z=1.016,P=0.310).The combination of BRAFV600E mutation with ACR-TIRADS or C-TIRADS improved the diagnostic efficacy of BRAFV600E mutation in distinguishing the benign and malignant AUS/FLUS nodules(Z=2.107,P=0.035;Z=2.752,P=0.006).The combination of ATA guidelines with BRAFV600E mutation increased the diagnostic accuracy of BRAFV600E mutation(χ2=20.679,P<0.001),while it had no statistically significant difference in distinguishing the benign and malignant AUS/FLUS nodules(Z=1.321,P=0.186).The combination of ATA guidelines,ACR-TIRADS,or C-TIRADS with BRAFV600E mutation improved the diagnostic efficacy of ultrasound grading systems for AUS/FLUS nodules(Z=2.770,P=0.006;Z=2.770,P=0.006;Z=2.890,P=0.004).Specifically,ACR-TIRADS combined with BRAFV600E mutation showed the highest sensitivity(χ2=4.712,P=0.030;χ2=4.712,P=0.030),while C-TIRADS combined with BRAFV600E mutation showed the highest accuracy(χ2=77.627,P<0.001;χ2=85.827,P<0.001).However,there were no statistically significant differences in diagnostic performance between the combinations(Z=1.276,P=0.202;Z=0.808,P=0.419;Z=1.615,P=0.106).Conclusion ATA guidelines,ACR-TIRADS,and C-TIRADS combined with BRAFV600E mutation can improve the diagnostic efficacy of BRAFV600E mutation or ultrasound grading system alone in AUS/FLUS nodules,which can facilitate the further management and treatment of such patients.

A retrospective study of reducing unnecessary thyroid biopsy for American College of Radiology Thyroid Imaging Reporting and Data Systems 4 assessment through applying shear wave elastography

ABSTRACT Objective The purpose of the study is to quantitatively assess shear-wave elastography (SWE) value in American College of Radiology Thyroid Imaging Reporting and Data Systems (ACR TI-RADS) 4. Materials and methods One hundred and fifty-two ACR TI-RADS 4 thyroid nodules undergoing SWE were included in the study. The mean (EMean), minimum (EMin) and maximum (EMax) of SWE elasticity were measured. Results The areas under the receiver operating characteristic (ROC) curves for SWE EMean, EMin and EMax in detecting benign and malignant nodules were 0.95, 0.83 and 0.84, respectively. Cut-off value of EMean ≤ 23.30 kPa is able to downgrade the lesion category to ACR TI-RADS 3 and cut-off value of EMean ≥ 52.14 kPa is able to upgrade the lesion category to ACR TI-RADS 5. Conclusions The EMean of SWE will probably identify nodules that have a high potential for benignity in ACR TI-RADS 4. It may help identify and select benign nodules while reducing unnecessary biopsy of benign thyroid nodules.

Applicational value of 2017 ACR TI-RADS stratification in diagnosing thyroid nodules / 北京大学学报(医学版)

OBJECTIVE@#To summarize and evaluate the value of applying the thyroid imaging reporting and data system (TI-RADS) released by American College of Radiology (ACR) in 2017 of the thyroid classification, and to propose an optimized classification method based on the result to facilitate more accurate and precise risk stratification of thyroid nodules.@*METHODS@#In the study, 342 thyroid nodules assessed by 2017 ACR TI-RADS were retrospectively analyzed. Each nodule had a score, and all the scores of nodules were compared with the pathological results. The proportion of malignant nodules in different scoring ranges was obtained. The diagnostic efficacy of all nodules, nodules above 1 cm and less than or equal to 1 cm was evaluated by ROC curve, respectively.@*RESULTS@#The AUC of all nodules, nodules above 1 cm and less than or equal to 1 cm were 0.907, 0.936 and 0.717, respectively. With the increase of the scores, the proportion of benign nodules decreased gradually, and the proportion of malignant nodules increased, especially nodules of 4-6 scores increased significantly. Based on the proportion of malignant nodules with 3 scores, the proportion of malignant nodules with 4, 5 and 6 scores increased 1.6, 3.8 and 5.3 times, respectively. The proportion of malignant nodules with 6-8 scores was 81%-84%, while the proportion of malignant nodules with 9 scores or more was 93%-94%. According to the distribution characteristics of malignant nodules, the classification of TI-RADS was adjusted. TI-RADS 4 was divided into TI-RADS 4a, TI-RADS 4b and TI-RADS 4c, corresponding to 4, 5 and 6-8 scores respectively, while the nodules with 9 scores or more were divided into TI-RADS 5.@*CONCLUSION@#2017 ACR TI-RADS has high diagnostic value for thyroid nodules above 1 cm, but it is not so effective for the nodules less than or equal to 1 cm. According to the proportion distribution of malignant nodules in different scoring ranges, appropriate adjustment of classification will be more accurate and precisely predict the malignant risk of nodules.

Combination of prostate imaging reporting and data system with the apparent diffusion coefficient map for the diagnosis of peripheral zone prostate cancer / 中南大学学报(医学版)

To explore the value of prostate imaging reporting and data system version 2 (PI-RADS V2) combined with quantitative parameters derived from apparent diffusion coefficient (ADC) map in the diagnosis of peripheral zone prostate cancer.
 Methods: A total of 50 patients who underwent prostate multiparametric MRI (mpMRI) with suspicious peripheral nodules were retrospectively enrolled, and all patients were biopsy-proven histologically. Two radiologists analyzed the position and category of peripheral zone lesions based on PI-RADS V2. Then 12 ADC quantitative parameters were calculated regarding each lesion on the ADC map by post-processing software. The lesions were divided into malignant group and benign group according to histopathological findings. The ADC quantitative parameters between groups were compared, and stepwise logistic regression analysis was used to build a discriminative model. Receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were performed to evaluate the diagnostic power and clinical benefit.
 Results: Twenty-eight peripheral zone prostate malignant lesions and 25 benign lesions were obtained finally. The area under the ROC curve, sensitivity and specificity to differentiate peripheral zone prostate malignant from benign lesions were as follows: 0.803, 60.71%, 92.00% (PI-RADS V2 score), 0.857, 89.29%, 76.00% (ADC model), and 0.891, 71.43%, 92.00% (combined model), respectively. The discriminative power of the combined model was significantly improved compared with PI-RADS V2 score (P=0.012). The combined model had relatively optimal overall net benefit, which outperformed the PI-RADS V2 score when threshold probability varied in the range of 0.05-0.27 and 0.46-0.81.
 Conclusion: PI-RADS V2 combined with quantitative analysis of ADC map improve the power in discriminating peripheral zone prostate cancer from benign lesions, and the clinical benefit as well.

Diagnostic value for the fine needle aspiration biopsy and contrast-enhanced ultrasound in thyroid imaging reported and data system Grade 4 nodules / 中南大学学报(医学版)

To study the clinical application value of ultrasound-guided fine needle aspiration biopsy (US-FNAB) and contrast-enhanced ultrasound (CEU) in the diagnosis of thyroid imaging reported and data system Grade 4 (TI-RADS 4) nodules.
 Methods: A retrospective analysis of 134 patients with thyroid nodules surgery were selected, and their results of preoperative color Doppler ultrasonography were TI-RADS 4. The data of US-FNAB and CEU before operation and the results of pathological section after operation were collected. The pathological results were taken as the gold standard, and the specimens obtained by US-FNAB puncture were used for HE staining and cytological diagnosis. The sensitivity, specificity, accuracy and the cost were calculated for CEU and US-FNAB, respectively. The diagnostic efficacy of the 2 methods was compared.
 Results: Of 134 thyroid nodules, there were 131 malignant nodules (97.76%) and 3 benign ones (2.24%). The sensitivity of US-FNAB and CEU were 87.02% and 93.89% respectively. The specificity of US-FNAB and CEU were 100.00% and 66.67%. The accuracy of US-FNAB and CEU were 87.31% and 93.28% respectively. Comparisons of the diagnostic accuracy were performed by χ2 test. There was no significant difference in sensitivity between CEU and US-FNAB (P>0.05). However, the sensitivity of US-FNAB and CEU were 87.50% and 100.00%, respectively, when the maximum diameter of nodule was less than 10 mm, and there was statistical significance (P0.05). The cost and risk of US-FNAB was higher than those of CEU.
 Conclusion: The sensitivity of US-FNAB is higher than that of CEU for thyroid nodules with the diameter larger than 10 mm. With high detection rate, good safety and low cost, CEU can still be used for thyroid nodules with the diameter less than 10 mm, which is diagnosed as negative nodules by US-FNAB.

Validação de um sistema de coleta de dados de úlcera por pressão no Brasil / Validation of a pressure ulcer data collection system in Brazil

A realização de estudo de tradução e/ou validação de instrumentos é uma alternativa para a comparação de dados epidemiológicos entre diferentes contextos. A partir da identificação da ausência de instrumentos validados e reconhecidos nacionalmente para coleta de dados de úlceras por pressão passíveis de aplicação rotineira nas instituições de saúde brasileiras, bem como de uma parceria internacional, o presente estudo propõe o desenvolvimento e a validação de um sistema de coleta de dados de úlcera por pressão, composto por instrumentos e protocolo de coleta de dados traduzidos e adaptados transculturalmente, e por material educativo e planilha online desenvolvidos. Para tanto, objetivou-se desenvolver e validar um sistema de coleta de dados de úlcera por pressão para a realidade brasileira. Trata-se de uma pesquisa metodológica, de abordagem quali-quantitativa, realizada em três fases: Fase 1 - Procedimentos teóricos: a. Tradução e adaptação transcultural do instrumento de coleta de dados (1, 2, 3 e 3a) desenvolvido nos países baixos - Zorgproblemen Prevalentiemeting Landelijke (LPZ), com posterior análise de itens, avaliação de juízes e pré-teste; b. Tradução livre do protocolo de coleta de dados da LPZ, e c. Elaboração do material educativo e planilha online para digitação dos dados. Fase 2 - Procedimentos empíricos: aplicação dos instrumentos de coleta de dados traduzidos e adaptados transculturalmente, do material educativo, do instrumento de avaliação dos coletadores, e digitação dos dados na planilha online - sistema de coleta de dados. Fase 3 - Procedimentos analíticos: estratégias estatísticas destinadas às análises das propriedades psicométricas dos instrumentos de coleta de dados (1, 2, 3 e 3a) resultantes da tradução e adaptação transcultural e da avaliação da aplicação dos componentes do sistema de coleta de dados para validação. Nos resultados, apresentaram-se os dados dessas fases, com ênfase à terceira, que diz respeito a validação do sistema de coleta de dados. Foram validados os instrumentos 1, 2, 3 e 3a, com inadequação do último citada apenas nas unidades críticas adulto, clínica médica e materno infantil. A planilha online não apresentou erros de salvamento ou dificuldades, e foi viável a exportação de dados em programa compatível com os pacotes estatísticos de análise e, o material educativo contribuiu para a aplicação do sistema. Conclui-se que o sistema de coleta de dados foi considerado validado para aplicação nas unidades que compõem as áreas crítica, clínica médica, cirúrgica adulto e pediatria, com aprovação superior a 80%. Não se recomenda a aplicação na área materno-infantil, devido às limitações em relação as especificidades da mulher em ciclo gravídico-puerperal.

Studies on tool translation and/ or validation can be used to compare epidemiological data between different contexts. Since there are no validated and nationally recognized tools to collect data from pressure ulcers that can be applied frequently in Brazilian health care facilities, and no international partnerships, this study proposes the development and validation of a pressure ulcer data collection system that comprehends tools and a data collection protocol that were translated and transculturally adapted, and also comprises an educational content and online spreadsheet. In order to achieve these goals, a pressure ulcer data collection system to be used in the Brazilian reality was developed and validated. It is a methodological research, of qualitative and quantitative approach, developed in three stages: Stage 1 - Theoretical procedures: translation and transcultural adaptation of the data collection tool (1, 2, 3 and 3a) developed in the Netherlands - (Zorgproblemen Prevalentiemeting Landelijke (LPZ), with item analysis, judges analysis and pre-test; b. Free translation of the LPZ's data collection protocol, and c. Development of the educational material and online spreadsheet to data entry. Stage 2 - Empirical procedures: Implementation of the translated and transcultural adapted data collection tool, of the educational content, of the collectors evaluation tool, and entry of the data collected on the online spreadsheet - data collection system. Stage 3 - analytical procedures: statistical strategies used to analyze the psychometrical properties of the data collection tools (1, 2, 3 and 3a) which were the result of the translation, transcultural adaptation and evaluation of the data collection system's components implementation in order to validate them. As results, data from these stages are presented, with more emphasis in the third stage, regarding to the data collection system validation. Tools 1, 2, 3 and 3a were validated, with a citation of inadequacy only in adult critical unit, clinical unit and mother-infant unit. The online spreadsheet did not present any difficulties on its use or mistakes in the data registration, the exportation to statistical and analysis softwares were possible, and the educational content contributed to the implementation of the data collection system. It is concluded that the data collection system was considered validated to be implemented in critical units, clinical units, adult and child surgery units, with more than 80% of approval. Its implementation on maternal-child units is not recommended because of the limitations regarding specificities of women in labor, delivery and puerperal processes.

Prototype system to manage data on coloproctology surgery

OBJECTIVE: To develop a prototype system to manage data on coloproctology surgery, aiming at Data Quality (DQ) and the adoption of a DQ monitoring process, which is nonexistent in most biomedical systems. METHODS: The construction of the prototype was separated into five steps: analysis of an existing system (legacy), the analysis of requirements and specifications for the new prototype, the development of the model, definition of technologies and the development of a prototype. RESULTS: The analysis of the legacy system revealed several limitations and inconsistencies, which can result in problems concerning the DQ. Therefore, actions to prevent these problems are already being executed at the step of developing the prototype, such as the creation of interactive and more elaborate interfaces, the use of validation mechanisms on data fields and the proposal of a process to monitor inconsistencies and incompleteness in patients' data. CONCLUSION: The adoption of DQ mechanisms on system development results in building a reliable and consistent database, to assist tasks such as management, scientific research and future intelligent data analysis methods. Future work includes subjective evaluations of DQ indicating the adequacy of the prototype for the users' needs. (AU)

OBJETIVO: Desenvolvimento de um protótipo para gerenciamento de dados de cirurgia coloproctológica, visando à Qualidade de Dados (QD), e a adoção de um processo de monitoramento da QD, inexistente na maioria dos sistemas biomédicos. MÉTODOS: A construção do protótipo foi dividida em cinco etapas: análise de um sistema existente (legado), levantamento dos requisitos para o novo protótipo, elaboração de modelos, definição das tecnologias e desenvolvimento do protótipo. RESULTADOS: A análise do sistema legado revelou diversas limitações e inconsistências que podem resultar em problemas de QD. Sendo assim, medidas para prevenir esses problemas estão sendo adotadas, já na etapa do desenvolvimento do protótipo, como a criação de interfaces mais elaboradas e interativas, a utilização de mecanismos de validação dos campos de dados e a proposta de um processo para monitoramento das inconsistências e incompletudes dos dados dos pacientes. CONCLUSÃO: A adoção de medidas de QD no desenvolvimento de sistemas resulta na construção de uma base de dados confiável e consistente, contribuindo com as tarefas de gerenciamento, pesquisas científicas e futuras aplicações de métodos de análise inteligente de dados. Trabalhos futuros incluem avaliações subjetivas de QD que indiquem o nível de adequação do protótipo às necessidades dos usuários. (AU)