Examination of the role of dispositional and state suspicion in deceptive ratings and veracity judgments

Objective: The objective of this study was to analyze magnetic resonance imaging (MRI) BI-RADS® using criteria of high and low suspicion in relation to age group variables and imaging findings. Methodology: This is a cross-sectional retrospective study of analysis of breast MRI exams in an imaging clinic in the city of Goiânia, GO, from 2021 to 2022. The sample was divided according to the BI-RADS® classification into two groups, one with low suspicion for classifications 1, 2, and 3 and another one of high suspicion for classifications 0, 4, 5, and 6. The sample profile of patients with BI-RADS® MR low and high suspicion was tested by applying Pearson’s chi-square test, relative frequency, and absolute frequency, analyzed using the Statistical Package for Social Science (SPSS 26.0) with a significance of 5% (p<0.05). This study was approved by the research ethics committee. Results: A total of 307 exams with indications for MRI were evaluated. Data on the age of patients inferred that the mean was 49.1 years (standard deviation 11.5) and ranged from 24 to 83 years, and 61 (19.9%) were aged ≥60 years. When evaluating the BI-RADS® MRI results with the low and high suspicion criteria, women aged 60 years or older had a significant prevalence (p=0.03) of high suspicion. The concordant findings described in the examination report were breast lump (p<0.01), cyst (p<0.01), nonspecific enhancement (p<0.01), post-surgical alterations (p <0.01), fold of the implant (p=0.04), and inflammatory process (p=0.04), prevailing findings nodule (77%) for high suspicion and cyst (11.5%) for low suspicion. Conclusion: The association of BI-RADS® of high suspicion with age showed that patients aged ≥60 years are more likely to have high-risk lesions; in the exams, the breast lumps presented concordance for high suspicion and the cysts concordance for low suspicion.

2187 CORRELATING MULTIPARAMETRIC PROSTATE MRI (MP-MRI) SUSPICION FOR PROSTATE CANCER WITH MRI/ULTRASOUND (MR/US) FUSION GUIDED BIOPSY RESULTS AND GLEASON GRADE

Oral autoimmune bullous disorders show clinical overlap with diseases such as lichen planus and others that may cause desquamative gingivitis. As direct immunofluorescence is expensive, we sought to determine if routine histology alone would be sufficient to distinguish between oral autoimmune bullous disorders and mimics. We searched the records for patients with a suspected oral autoimmune bullous disorder who underwent biopsies for concurrent routine histologic evaluation and direct immunofluorescence and who had at least one follow-up visit. Cases were separated into high and low suspicion subgroups based on clinical findings. Within 148 cases, the sensitivity of routine histology alone was 0.810, with a negative predictive value of 0.889. However, the specificity was 0.989 with a positive predictive value of 0.979. Of the high suspicion cases, 57 (47.1%) were found to be consistent with an oral autoimmune bullous disorder, with a total of 11 histologic false negatives. 8 cases, all in the high suspicion subgroup, showed indeterminate direct immunofluorescence results. There were no histologic false negatives or inconclusive direct immunofluorescence results in the low suspicion subgroup. In patients with a low clinical suspicion for an oral autoimmune bullous disorder, it is reasonable and more cost-effective to evaluate the lesion with routine histology alone.

4656 Background: Gleason Sum (GS) predicts clinically significant prostate cancer (CAP) and prostate specific antigen (PSA) survival in men undergoing prostatectomy for CAP. BPH can also elevate PSA. Objective: evaluate prostate gland volume (PV) and American Urologic Symptom Score (AUASS) in men undergoing prostate needle biopsy (PNB) to detect CAP. Analysis endpoints: 1) CAP and 2) GS ≥7. Methods: From 1/2000–7/2005, 1,078 men undergoing PNB were prospectively examined. Urinary voiding symptoms were measured by AUASS. All men were examined by 1 surgeon: DRE and Transrectal Ultrasound (TRUS) were given levels of suspicion (LOS) from 1 = low suspicion (smooth DRE, homogeneous TRUS) to 5 = high suspicion (hard DRE, hypoechoic lesion). LOS ≥3 was abnormal. Prebiopsy parameters: PSA, DRE, age, race, biopsy history, prostate volume (PV), TRUS lesion, and AUASS. All men had 10-core biopsy. 1) Predictors for CAP were evaluated by Univariate (UVA) and multivariate (MVA) analysis (logistic regression) for 1,078 men. 2) Predictors for GS≥7 were evaluated in men with no prior biopsy (NOPB). Results: Median PSA = 5.4 ng/ml (mean 10.4), 38% and 52% had abnormal TRUS & DRE respectively. Mean patient age = 64 years. Mean AUASS = 10.4. Positive biopsy rate = 38%. AUASS: 47% had low symptoms scores (<7), 39% had moderate scores (8–19), and 14% had severe scores (20–35). UVA & MVA (N = 1,078) showed that PSA was not an independent predictor of CAP (p = 0.18), but abnormal DRE, age, low AUASS, no prior biopsy (NOPB), race (AA), abnormal TRUS, and low PV were all independent predictors (p < 0.03). Subset MVA analysis of men in PSA range of 2.5–10 (N = 738), demonstrated that low AUASS (p = 0.05) & low PV (p = 0.00001) were predictors of CAP, while DRE, NOPB, and age were also independent predictors. MVA of men with NOPB (N = 790), indicated that low PV, PSA, DRE, and Age were independent predictors for CAP (p < 0.0001). The multivariate risk of having GS ≥7 on biopsy was independently associate with both low PV (p = 0.001) and abnormal DRE (p = 0.001). The relationship between PV and GS ≥7 showed that for every 1 cc increase in gland volume the risk of GS ≥7 CAP decreases by 2.2%. Conclusions: Men with smaller prostates are more likely to have cancer and are more likely to have significant disease. No significant financial relationships to disclose.

Image-guided fine-needle aspiration (FNA) studies of axillary lymph nodes (LN) to evaluate breast carcinoma have shown high specificity but variable sensitivity. The purposes of this study were to evaluate the performance of axillary LN FNA depending on clinicoradiologic findings and to document how treatment varied according to FNA results. The study cohort consisted of consecutive axillary LN FNA cases over a 4-year period, in which subsequent treatment was known. Clinicoradiologic assessment was classified as "low suspicion" or "high suspicion" and cytopathologic findings as "positive," "negative," or "indeterminate". The test performance for each, using surgical pathology outcome as the "gold standard," was calculated. The impact of axillary LN FNA on subsequent management decisions was analyzed. Of the 163 cases, axillary FNA was positive in 94 of 163 (58%), negative in 55 of 163 (34%), and atypical/nondiagnostic in 14 of 163 (8%). A clinicoradiologic assessment of "high suspicion" had a positive predictive value (PPV) of 88%, whereas a "low suspicion" assessment had a negative predictive value (NPV) of only 68%. In contrast, the PPV and NPV of axillary LN FNA were 98.7% and 81.8%, respectively. Whereas all of the FNA-nonpositive cases were managed surgically, surgery was deferred in 26 of 94 of the FNA-positive cases, including 11 cases of neoadjuvant treatment. Most of the remaining (65 of 68) FNA-positive patients were spared sentinel lymph node biopsy. Image-guided LN FNA is highly sensitive and specific for lymph node involvement by breast carcinoma and plays a role both in sparing sentinel lymph node biopsy and in triaging cases for systemic therapy.

Background: We analysed the feasibility of the 9th ACCP-guidelines recommendation of starting therapeutic anti- coagulation in patients with a high suspicion of deep vein thrombosis (DVT) and tried to answer the question as to whether it generates a relevant over- or under-use of anti-coagulants in the period prior to the definitive diagnosis. Patients and methods: From March to May 2013 we included 98 consecutive out-patients (mean age 63 ± 17 years, 39 males) suspected of DVT, classifying them according to the 9th ACCP-guidelines recommendations into two groups with high and low clinical suspicion. Those with a high suspicion (Wells Score ≥ 2 and elevated DDimer concentration) initially received Rivaroxaban 15 mg orally. Results: Out of the 80 patients with a high clinical suspicion, 15 (19%) received therapeutic anti-coagulation without any medical necessity because DVT was finally excluded. Out of the 10 patients with a low clinical suspicion, 2 (20%) with a finally proven DVT might have benefited from initial therapeutic anti-coagulation. Females were at a slightly higher risk of receiving therapeutic anti-coagulation unnecessarily. Out of the 45 females with a high clinical suspicion, who received therapeutic anti-coagulation, DVT was excluded in 9 (20%). In males it was 6 (17%) out of 35 patients. The costs for those 80 patients accepting initial anti-coagulation by taking Rivaroxaban 15 mg were €312. By using Certoparin 8000 I.E. the cost would have been €792, which is 150% higher compared to Rivaroxaban within in the same period. Conclusion: Defining patients to have a high suspicion for DVT by Wells score and DDimer is associated with an over-use of therapeutic anticoagulation in almost every fifth patients.

128 Background: We aim to evaluate the correlation between multiparametric prostate MRI (MP-MRI) suspicion for seminal vesicle invasion (SVI) and pathology on MRI/US fusion-guided biopsy, as well as radical prostatectomy (RP). Methods: 822 patients underwent MP-MRI and MRI/US fusion-guided biopsy. 24 patients underwent targeted seminal vesicle biopsies. 5 patients had MRI findings suspicious for bilateral SVI, for a total of 29 lesions. MP-MRI targets were scored as low, moderate, or high suspicion for PCa involvement according to the validated NIH scoring system. Patient demographics were reviewed and positive predictive values (PPVs) of pre-biopsy suspicion levels were calculated with respect to correlative biopsy pathology and final RP pathology. Results: At the time of MP-MRI, the median age was 64 years with a median PSA of 10.74 ng/ml (Table). Thirteen (54.2%) had not been previously diagnosed with PCa. Of the 29 SV lesions on imaging, MP-MRI suspicions of low, moderate, and high were assigned to 3, 18, and 8 lesions, respectively. The PPVs of these MRI suspicion levels, confirmed by MRI/US fusion biopsy, were 0%, 77.7%, and 62.5%, respectively. The 3 patients in the low suspicion cohort all underwent RP, confirming targeted biopsy findings. Of those with moderate or high suspicion of SVI on MP-MRI, only 5 underwent RP, with a targeted biopsy accuracy of 80%. The overall accuracy of targeted SV biopsy was 87.5% (7/8) on final RP pathology. Conclusions: MP-MRI suspicion of SVI correlates highly with findings on targeted SV biopsy and final RP pathology, thus potentially playing a vital role in future preoperative staging for PCa. [Table: see text]

PROSPECTIVE EVALUATION OF ENDORECTAL MAGNETIC RESONANCE IMAGING TO DETECT TUMOR FOCI IN MEN WITH PRIOR NEGATIVE PROSTASTIC BIOPSY: A PILOT STUDY

PROSPECTIVE EVALUATION OF ENDORECTAL MAGNETIC RESONANCE IMAGING TO DETECT TUMOR FOCI IN MEN WITH PRIOR NEGATIVE PROSTASTIC BIOPSY: A PILOT STUDY

Clinicopathologic criteria were used to group 68 cats according to high, moderate, or low suspicion of having feline leukemia virus (FeLV)-related disease. Peripheral blood samples were tested for FeLV antigen by enzyme-linked immunosorbent assay (ELISA) and for FeLV DNA by polymerase chain reaction (PCR). There was no significant difference between ELISA and PCR results in the 68 cats. In the high-suspicion group, 46%(11/24) of cytopenic cats were test positive (ELISA and PCR) and 87% (13/15) with hemopoietic neoplasms were test-positive. Also within the high suspicion group, test-positive cats were 2.5 times more likely to die within the 1 year follow-up period than were test-negative (ELISA and PCR) cats. Among cats in the moderate-suspicion group, 15% (2/13) were test-positive, and none (0/16) of the cats in the low suspicion group was test positive. The relative risk of a positive test (ELISA and PCR) in the high suspicion group was 3.7 times that for the moderate-suspicion group and 22.8 times that for the low suspicion group. There was no significant difference in the relative risk of a positive test result between the moderate and low suspicion groups. The results indicate that FeLV detection by PCR can be adapted for diagnostic purposes using peripheral blood samples, however, results do not differ significantly from FeLV ELISA results. Also, a proportion of cats with a high suspicion of having FeLV-related cytopenia and hemopoietic tumors are negative for both circulating FeLV antigen and DNA. These cats may not have FeLV-related disease, or FeLV may exist in a disease-producing but nonreplicating form ultimately detectable by PCR in tissues other than peripheral blood.

The purpose of this study was to examine the utility of direct immunofluorescence (DIF) testing for the characteristic immunoglobulin A deposits of dermatitis herpetiformis (DH) in patients stratified into high and low clinical suspicion subgroups. We retrospectively analyzed the results of H&E and DIF testing in 77 cases of suspected DH and separated them into high and low clinical suspicion subgroups based on clinical impression at the time of biopsy. The overall sensitivity and specificity of routine (H&E) histologic evaluation were 0.75 and 0.951, respectively. Although there were 13 cases of DH (of 36 total cases) in the high clinical suspicion subgroup, there were only three (of 41 total cases) in the low clinical suspicion subgroup. In the high clinical suspicion subgroup, the positive predictive value (PPV) was 0.9, and the negative predictive value (NPV) was 0.846. Alternatively, the PPV was 0.6 and the NPV was 1.0 for the low clinical suspicion subgroup. Histologic false negatives did occur, but all were in patients within the high clinical suspicion subgroup. It is anticipated that the NPV and PPV will vary due to differing clinical practice characteristics; however, in patients with a low clinical suspicion for DH, these data argue that it may be reasonable to first perform a biopsy for routine histologic evaluation before requesting DIF analysis.

Judging truthfulness and detecting deception are critical in the criminal justice system as well as in many other applied contexts (e.g., clinical and business organizations). The ability to discriminate a truth-teller from a liar might be associated with the content of deception (e.g., emotional or high-stakes lies) or with the deceiver's characteristics, such as his/her level of confidence shown in lying. The two present studies aimed to manipulate the level of the sender’s confidence and to investigate its effect in deception vs. truthfulness judgments of written narratives varying in emotional content. A pilot sample (N = 124) assessed the stimuli validity of sixteen written narratives (Study 1): 8 deceptive vs. truthful narratives x four types of content (i.e., emotional/bereavement vs. emotional/car accident vs. emotional/quarrel vs neutral/holiday) with low confidence in the recall and 8 deceptive vs. truthful narratives x four types of content (i.e., emotional/bereavement vs. emotional/car accident vs. emotional/quarrel vs neutral/holiday) high in the confidence recall. An experimental sample (N = 428) was administered the two sequences of eight written narratives and for each narrative, veracity judgment, detection accuracy, and judgment confidence were assessed (Study 2). We found that the sender’s confidence, the veracity, and the content of the narratives affected receivers’ veracity judgments and detection accuracy. High confidence made receivers prone to judge bereavements and holiday narratives as truthful and quarrels narratives as deceptive. In addition, high confidence made judgments more accurate for truthful narratives on holidays compared with others, and for deceptive narratives on car accidents and quarrels than for other narratives. The present results are discussed in light of their practical implications for the legal field.

Chronic abdominal pain (CAP) is a common and challenging problem in pediatric primary and specialty care. We developed a diagnostic algorithm to organize workup for gastrointestinal causes of CAP and improve identification of patients who are low suspicion (LS) or high suspicion (HS) to have significant intestinal pathology identified with endoscopy. We retrospectively used this algorithm to categorize 150 outpatients with CAP as LS (n = 99) or HS (n = 51) and examined subsequent endoscopic findings for all patients. There were 6% significant diagnoses in the LS group compared with 34% in the HS group ( P < .0001). The LS group had no patients with celiac or inflammatory bowel disease. These results can be used to help a clinician approach CAP, and discuss with families the likelihood of endoscopy finding a cause for CAP based on LS or HS designation.

Health care cost continues to play a dominant role in our society. Technological advances are expensive, with the possible exception of stereotactic breast biopsy. We must learn other alternatives that give the same diagnostic accuracy at lower cost. The intention of this study was to find other acceptable alternatives to open excisional breast biopsies. Patients were referred to Baylor University Medical Center between May 1990 and June 1992 for stereotactic breast biopsy of nonpalpable mammographic abnormalities. Before stereotactic biopsy, lesions were categorized into low or high suspicion for malignancy based on screening mammography. Slides were reviewed by a pathologist and the histological diagnosis was compared with mammographic characterization. Benign histology confirming the low-suspicion mammographic abnormality demonstrated mammographic and histologic correlation. Mammographic follow-up was recommended. Two hundred twenty-five women underwent 250 stereotactic breast biopsies. Malignancy was diagnosed in 47 patients; the remaining 203 lesions were benign on pathological examination and are being followed regularly. Seventy-eight percent of the lesions were characterized as low suspicion for malignancy, and 22% were characterized as high suspicion. The average cost savings per lesion using stereotactic biopsy was $1,629. Stereotactic breast biopsy is an acceptable, less expensive alternative to open excisional biopsy for diagnosing nonpalpable mammographic findings.

Thyroid nodules with intermediate- and low-suspicion patterns are difficult to diagnose, based on the 2015 American Thyroid Association (ATA) stratification. We evaluated the performance of shear wave elastography (SWE) as an adjunctive tool to ultrasound (US) in predicting the malignancy of these thyroid nodules. Thyroid nodules (n = 270) collected from January to April 2018 with low or intermediate suspicion for malignancy were evaluated. The maximum SWE elasticity values (Emax) for the nodules were examined and subsequently confirmed by pathology. SWE and ATA guidelines, as well as a combination of the two, were applied. Combined with SWE, the diagnostic accuracy of the ATA categories was superior to the ATA categories alone (area under the curve, AUC 0.81 vs. 0.72, P < 0.05). Based on the ATA categories, the percentages of malignancy in the nodules with low and intermediate suspicion for malignancy were 21.1% (12/57) and 54.2% (13/24), respectively. After adjustments for the use of SWE, the nodules were restratified as very low, low, intermediate, and high suspicion of malignancy. The percentages of malignancy for the very low, low, intermediate, and high suspicion nodules were 0 (0/26), 27.3% (3/11), 37.8% (12/31), and 76.9% (10/13), respectively. SWE may be used to differentiate malignant and benign nodules in addition to the ATA pattern. Combined with the ATA pattern, SWE supplemented US for predicting nodules with low and intermediate suspicion of malignancy.