Comparison of thyroid nodule FNA rates recommended by ACR TI-RADS, Kwak TI-RADS and ATA guidelines.

OBJECTIVES: To compare the differences among the thyroid imaging reporting and data system (TI-RADS) proposed by American College of Radiology (ACR TI-RADS), TI-RADS proposed by Kwak (Kwak TI-RADS), and American Thyroid Association (ATA) guidelines in the specificity, sensitivity and the unnecessary FNA rate (the UFR, the false positive rate) of recommended fine needle aspiration (FNA), and to observe the changes of the UFR in the KwakTI-RADS and ATA guidelines with the recommended FNA nodule size threshold. METHODS: The specificities, sensitivities and UFRs of recommended FNA in the ACR TI-RADS, ATA guidelines and Kwak TI-RADS were calculated and compared. The nodule sizes for recommended FNA of ATA guidelines and Kwak TI-RADS were systematically varied to establish new FNA thresholds. The specificities, sensitivities and UFRs of recommended FNA under the new models were calculated and compared to those in the ACR TI-RADS. RESULTS: For all thyroid nodules, the UFRs in the ACR TI-RADS, ATA guidelines and Kwak TI-RADS were 26.3%, 47.4% and 40.0%, respectively. The UFR in the ACR TI-RADS was lower than that in the others, and the specificity of recommended FNA in the ACR TI-RADS(73.7%) was higher than that in the others (all P < 0.001), but the sensitivity of recommended FNA in the ACR TI-RADS(89.3%) was lower than that in the others (all P < 0.001). When nodule sizes threshold of the recommended FNA for ATA guidelines Intermediate Suspicion, Low Suspicion, and Very Low Suspicion, and Kwak TI-RADS grade 4b and 4a were gradually increased, the UFRs gradually decreased. CONCLUSIONS: The UFRs of FNA recommended by the Kwak TI-RADS and ATA guidelines were higher than that of the ACR TI-RADS, and were affected by the recommended FNA nodule size threshold.

Comparison of diagnostic value of SWE, FNA and BRAF gene detection in ACR TI-RADS 4 and 5 thyroid nodules.

OBJECTIVES: To compare the diagnostic value of shear wave elastography (SWE), fine needle aspiration (FNA) and BRAF gene detection (BRAFV600E gene mutation detection) in ACR TI-RADS 4 and 5 thyroid nodules. METHODS: SWE images, FNA cytological results and BRAF detection results of ACR TI-RADS 4 and 5 thyroid nodules confirmed by pathology were analyzed retrospectively. The receiver operating characteristic (ROC) curve was drawn to determine the best cutoff value of SWE Emax. In the combined diagnosis of SWE, FNA and BRAF, firstly, the nodules with BRAF gene mutation were included in the positive ones, secondly, the nodules with benign and malignant FNA were included in the FNA + SWE or FNA + SWE + BRAF negative and positive ones respectively, finally, for FNA uncertain nodules: those whose SWE Emax were less than or equal to the cutoff value were included in FNA + SWE or FNA + SWE + BRAF negative ones, and those whose SWE Emax were greater than the cutoff value were included in positive ones. The diagnostic efficacy of SWE, FNA, SWE + FNA, FNA + BRAF and their combination in ACR TI-RADS 4 and 5 thyroid nodules were compared. RESULTS: The ROC curve showed that the best cutoff value of SWE Emax was 40.9 kpa, and the area under ROC curve (AUC) was 0.842 (0.800∼0.885). The sensitivity, specificity and accuracy of SWE were 76.3% (270/354), 75.5% (80/106) and 76.1% (350/460), respectively. The sensitivity, specificity and accuracy of FNA were 58.2% (206/354), 88.7% (94/106) and 65.2(300/460), respectively. The sensitivity, specificity and accuracy of FNA + BRAF were 95.5% (338/354), 88.7% (94/106) and 93.9% (432/460), respectively. The sensitivity, specificity and accuracy of SWE + FNA were 85.9% (304/354), 98.1% (104/106) and 88.7% (408/460), respectively. The sensitivity, specificity and accuracy of SWE + FNA + BRAF were 98.3% (348/354), 98.1% (104/106) and 98.3% (452/460), respectively. For the diagnostic accuracy, SWE + FNA + BRAF > FNA + BRAF > FNA + SWE > SWE > FNA, the difference was statistically significant (all P > 0.05). CONCLUSIONS: For ACR TI-RADS 4 and 5 thyroid nodules, SWE and FNA have high diagnostic efficiency. For the diagnostic accuracy, FNA + BRAF is better than FNA + SWE. FNA combination with BRAF gene detection further improves the diagnostic sensitivity and accuracy of FNA. The combined application of the three is the best.

Comparison of ACR TI-RADS, Kwak TI-RADS, ATA guidelines and KTA/KSThR guidelines in combination with SWE in the diagnosis of thyroid nodules.

OBJECTIVE: To compare the diagnostic efficacy of ACR TI-RADS, Kwak TI-RADS, ATA guidelines and KTA/KSThR guidelines in combination with shear wave elastography (SWE) for thyroid nodules. METHODS: The retrospective study included 566 thyroid nodules with maximum diameter≥5 mm which confirmed by FNA cytology or/and surgical pathology. The sensitivity, specificity, accuracy, Youden index of diagnosis of thyroid nodules by ACR TI-RADS, Kwak TI-RADS, ATA guidelines, KTA/KSThR guidelines and SWE were calculated. The ROC curve was drawn to determine the cut-off values of the four ultrasound classification systems and SWE Emax. The diagnostic efficacy of the four ultrasound classification systems in combination with SWE were calculated and compared with those of pre-combination. RESULTS: The ROC curves indicated that the cut-off value of ACR TI-RADS, Kwak TI-RADS, ATA guidelines, KTA/KSThR guidelines and Emax of SWE was TR5, 4c, high-suspicion, high-suspicion, and 41.7 kPa, respectively, and the area under the ROC curve (AUC) was 0.907(0.879-0.934), 0904(0.876-0.932), 0.894(0.863-0.924), 0.888(0.856-0.919), 0.886(0.859-0.913), respectively. After combination with SWE, the the sensitivities of the four ultrasound classification systems for the diagnosis of nodules were improved, and the differences were statistically significant (all P≤0.001); the specificities were decreased, but the differences were not statistically significant (all P > 0.05); the accuracies were improved, but only the difference of ACR TI-RADS was statistically significant (x2 = 4.45, P = 0.035); the differences in the AUCs were not significant (all P > 0.05). CONCLUSIONS: The four ultrasound classification systems and SWE all had high performance in the diagnosis of thyroid nodules. The four classification systems in combination with SWE were all beneficial to the differential diagnosis of nodules, and ACR TI-RADS in combination with SWE was more effective, especially for TR3 and TR4 nodules.

SWE combined with ACR TI-RADS categories for malignancy risk stratification of thyroid nodules with indeterminate FNA cytology.

OBJECTIVES: To compare the diagnostic efficacy of shear wave elastography (SWE) comnined with ACR TI-RADS categories for malignancy risk stratification of thyroid nodules with interminate FNA cytology. METHODS: The clinical data, sonographic features, ACR TI-RADS grading and shear wave elastography images of 193 patients of surgical pathologically proven thyroid nodules with interminate FNA cytology were retrospectively analyzed. The diagnostic efficacy of ACR TI-RADS categories, the maximum Young's modulus (Emax) of SWE and the combination of the two were calculated respectively. RESULTS: The ROC curves were drawn using surgical pathology results as the gold standard. The ROC curves indicated that the cut-off value of ACR TI-RADS and Emax of SWE was TR5 and 41.2 kPa respectively, and the area under the ROC curve (AUC) was 0.864 (95% CI: 0.879-0.934) and 0.858 (95% CI: 0.796-0.920) respectively. The diagnostic sensitivity, specificity and accuracy of ACR TI-RADS was 81.4% (127/156), 84.8% (31/37), and 81.9% (158/193), respectively. That of SWE Emax was 80.8% (126/156), 78.4% (29/37), and 80.3% (155/193), respectively. After SWE combined with ACR TI-RADS, the sensitivity, specificity and accuracy was 94.2% (147/156), 75.7% (28/37), and 90.7% (175/193), respectively. CONCLUSIONS: ACR TI-RADS classification system and shear wave elastography had high diagnostic efficacy for thyroid nodules with interminate FNA cytology. The combination of the two could improve diagnostic sensitivity and accuracy, and could help to differentiate benign and malignant thyroid nodules with interminate FNA cytology.

Parathyroid hormone measurement and 99Tcm-MIBI imaging for hyperparathyroidism diagnosis / 中华核医学杂志

Objective To evaluate 99Tcm-MIBI imaging in patients with hyperparathyroidism and its correlation with serum intact PTH level. Methods Seventy patients with suspicious hyperparathyroidism underwent 99Tcm-MIBI imaging and serum intact PTH measurement. Abnormal increased uptake lesion appeared at early phase and even more clearly at delayed phase was considered as the positive by 99Tcm-MIBI imaging. A cut-off value of PTH ＞ 88 ng/L was taken as the criteria for hyperparathyroidism diagnosis. The diagnostic efficacy of 99Tcm-MIBI imaging combined with serum PTH measurement was assessed according to post-surgical histopathology or clinical follow-up. For those operated patients, Pearson correlation coefficient between serum PTH and the gland volume was calculated. Results Hyperparathyroidism was confirmed in 38 patients by histopathology (n = 36) or follow-up (n = 2). The overall diagnostic accuracy of 99Tcm-MIBI imaging was 90.0% (63/70), in which the accuracy was 80.0% (12/15) for patients with normal serum PTH and 92.7% (51/55) for those with elevated serum PTH. False positive 99Tcm-MIBI imaging were found in 3 patients with normal serum PTH. The diagnostic accuracy of abnormally high serum PTH combined with 99Tcm-MIBI imaging was 94.3% (66/70). There was a positive correlation between serum PTH level and the volume of pathologic parathyroid glands (r = 0.782, P ＜ 0.001 ). Conclusions Serum PTH measurement may help to improve the diagnostic accuracy of 99Tcm-MIBI imaging in patients with hyperparathyroidism.

Bone scintigraphy used in the preoperative diagnosis of sacral tumor / 中华核医学杂志

Objective To evaluate the clinical significance of bone scintigraphy in the preoperative diagnosis of sacral tumor. Methods Preoperative 99Tcm-methylene diphosphonate (MDP) whole body bone scintigraphy was performed in total of 103 patients with sacral tumor for whole body survey and radionuclide uptake in the sacral tumor. Of these 103 patients,39 had SPECT. According to the osteoblastic reaction in bone SPECT studies,patterns of tumor with a "hot" lesion was defined as type Ⅰ,a "cold" lesion accompanied with partial uptake was defined as type Ⅱ,a purely "cold" lesion was defined as type Ⅲ,and a "cold" lesion with marginal uptake which produced "doughnut sign" was defined as type Ⅳ. Imaging interpretation was correlated with the final pathologic diagnosis. Results Of the 103 patients,18 ( 17.5% ) had polyostotic involvement. About 46.6% (48/103 ) in planar and 84.6% ( 33/39 ) in SPECT showed decreased uptake at sacrum. Of the bone metastatic patients (n =21 ) ,12 (51.7%) had sole metastasis to sacrum. Tumor with type Ⅰ (6/6) or type Ⅱ (16/19) uptake was likely to be a malignancy,whereas type Ⅲ uptake tended to occur in the benign disease in those patients without polyostotic involvement( 5/7 ),and type Ⅳ was all appeared in giant cell tumors( n = 5 ). Conclusions Preoperative bone scintigraphy is useful in examination of polyostotic involvement for the patients with sacral tumor,but it is limited for diagnosing isolated sacral metastatic disease. Tumor uptake on bone scintigraphy can be helpful in differential diagnosis of sacral tumor.

Value of (18)F-FDG imaging and serum tumor markers in the diagnosis of recurrent endometrial carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>Both (18)F-fluorodeoxyglucose (FDG) imaging and serum tumor marker measurements can be used in the post-therapy surveillance of recurrent endometrial carcinoma, but the relationship between those two methods has not been demonstrated yet. The purpose of this study was to compare the diagnostic efficiency of (18)F-FDG imaging and serum tumor marker measurements in the diagnosis of recurrent endometrial carcinoma, as well as to analyze the correlation between those two methods.</p><p><b>METHODS</b>Thirty-five patients with histopathologically confirmed endometrial carcinoma and suspected to have recurrent disease during post-therapy surveillance were included in this study. (18)F-FDG images from the thorax to the pelvis were obtained in all patients by using GE-Millennium VG Hawkeye system, and the abnormal FDG uptake was judged as tumor recurrence. Serum CA-125 and CP-2 were also measured for each patient by enzyme-linked immunoassay, and a cutoff value of 35 U/ml was taken as the criteria for predicting tumor recurrence. Based on the final clinical diagnosis, the efficiency of tumor markers (CA-125, CP-2) and (18)F-FDG imaging in the diagnosis of recurrent tumor was evaluated.</p><p><b>RESULTS</b>According to the histopathological diagnosis or follow-up examinations, tumor recurrence was confirmed in 13 of the 35 patients. Elevated serum level of CA-125 was found in 7 patients, serum CP-2 was increased in 9, and (18)F-FDG imaging was positive in 15. The diagnostic sensitivity, specificity and accuracy were 53.8%, 100% and 82.9% for the serum CA-125; 38.5%, 81.0% and 65.7% for the serum CP-2, and 100%, 90.9% and 94.3% for the (18)F-FDG imaging, respectively. The diagnostic coincidence rate between the (18)F-FDG imaging and serum CA-125 was 77.1% (Kappa = 0.50, P = 0.001), but no significant correlation was found between the (18)F-FDG imaging and serum CP-2. In the patients with true positive (18)F-FDG imaging, a positive correlation between the tumor volume and the serum CA-125 value was found (r = 0.89, P < 0.001), but no correlation was found between the tumor uptake and the serum CA-125 values.</p><p><b>CONCLUSION</b>For the post-therapy surveillance of patients with endometrial carcinoma, serum CA-125 is a high specific tumor marker for diagnosing recurrent disease and better than CP-2, but (18)F-FDG imaging is better than CA-125, and there is a positive correlation between tumor volume and serum CA-125 value.</p>