Specificity For Detection Of Malignancy Research Articles

Application of Thyroid Imaging Reporting and Data System (TIRADS) guidelines to thyroid nodules with cytopathological correlation and impact on healthcare costs.

To assess the application of American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) guidelines and the potential reduction of unnecessary fine-needle aspirate (FNA) and cost savings through examination of cytopathological correlation. All ultrasound-guided thyroid FNA performed between December 2017 and July 2019 at our institution were included in this study. Prior to performing each FNA, the nodules were scored according to ACR-TIRADS criteria with subsequent cytology scored according to Bethesda criteria. FNA request forms and preceding diagnostic ultrasound reports were analysed for clinical rationale behind each FNA. Collected data were applied to ACR-TIRADS, American Thyroid Association (ATA) and Korean TIRADS (K-TIRADS) criteria. Rate of reduction of unnecessary thyroid FNA and associated costs were subsequently calculated. A total of 125 patients and 146 nodules were evaluated. A malignancy rate of 7.5% was obtained. Sensitivity and specificity for detection of malignancy were 75% and 41% for ACR-TIRADS, 91% and 26% for ATA and 92% and 19% for K-TIRADS. Reduction in the rate of unnecessary FNA was most superior for ACR-TIRADS at 54.8%. Based on Australian Medicare Benefits Schedule item codes, a total of $18 452.70 might have been saved over the study period had ACR-TIRADS guidelines been uniformly followed. This study highlights the strengths and limitations of guidelines in the investigative pathway of thyroid nodules, including superiority of ACR-TIRADS in reducing the rate of unnecessary FNA. Continued education is needed towards application of guidelines among radiologists and referring clinicians, given the potential to reduce unnecessary FNA and achieve economic savings.

Improvement in MIA (OVA1) testing for detection of ovarian malignancy

Objective: The aim of this study was to determine whether reflex testing of multivariate index assay (MIA) OVA1 by MIA2G (Overa) can improve specificity in detection of malignancy in women with adnexal masses. MIA consists of 5 proteins to evaluate risk of malignancy in women with adnexal masses. MIA2G consists of 5 proteins with substitution of 2 different proteins than MIA. Algorithms have been developed and FDA approved for both tests to generate a risk score.

Computed Tomography–Navigated Transthoracic Core Biopsy of Pulmonary Lesions: Which Factors Affect Diagnostic Yield and Complication Rates?

Only a few studies have systematically evaluated risk factors for pneumothorax and pulmonary hemorrhage in computed tomographically (CT)-guided transthoracic lung biopsy (TLB). We evaluated the diagnostic yield of CT-guided TLB and determined risk factors for pneumothorax and hemorrhage. One hundred seventy-two CT-guided TLBs were performed on 159 patients (mean age 66 +/- 11 years; 72% male) using a 16-gauge core biopsy needle. Lesion and patient characteristics, lung function analysis, CT signs of emphysema, histopathologic diagnoses, and complications were recorded. Statistical analysis was performed with multivariate regression analysis. Histopathologic diagnosis was established in 153 cases (89%). Although lesion size was higher (47 +/- 29 vs. 43 +/- 35 mm, P = .191) and depth was lower (22 +/- 23 vs. 6 +/- 23 mm, P = .350) in procedures with histopathologic diagnosis, no parameter showed significant impact on diagnostic yield. Sensitivity and specificity for detection of malignancy were 93% and 100%, respectively, whereas positive and negative predictive values were 100% and 88%. Overall accuracy was 95%. Pneumothorax occurred in 45 procedures (26%). Hemorrhage was recorded in 17 procedures (10%). There was higher frequency of pneumothorax in smaller lesions (35 +/- 23 vs. 50 +/- 31 mm, P = .003; odds ratio = .96) and greater depth (29 +/- 29 vs. 20 +/- 19 mm, P = .05; odds ratio = 1.03). CT signs of emphysema revealed higher incidence of hemorrhage (35% vs. 23%; P = .04; odds ratio=41.03). Other parameters were nonsignificant. The high diagnostic yield of CT-guided TLB was not affected by lesion characteristics or emphysema. Pneumothorax rate was influenced by lesion size and depth. Hemorrhage was associated with CT signs of emphysema.

The role of endoscopic ultrasound and endoscopic ultrasound‐guided fine‐needle aspiration in distinguishing pancreatic cystic lesions

Distinguishing mucinous from nonmucinous cystic lesions of the pancreas often constitutes a diagnostic dilemma. The clinical management differs between such lesions; therefore it is important to make an accurate preoperative diagnosis. Various centers have reported conflicting results regarding their ability to detect mucin-producing neoplastic cells and appropriately reach a diagnosis based on endoscopic ultrasound (EUS) guided FNA. The aim of this study is to assess the ability of EUS-FNA cytology to diagnose and differentiate mucinous from nonmucinous pancreatic cystic lesions. We reviewed records of patients who underwent EUS of pancreatic cystic lesions. If FNA was performed and mucinous neoplasm was suspected, aspirate was evaluated for cytomorphology and presence of mucin. FNA results were compared to final histologic diagnosis if surgery was performed. Cytologic diagnosis was provided for 28/30 (93%). By comparing EUS-FNA diagnoses with final surgical pathology, FNA accurately diagnosed in 10/11 cases with sensitivity and specificity for detection of malignancy of 100 and 89, respectively, while the accuracy for identification of mucinous cystic neoplasms was 100%. Our results indicate that in the appropriate clinical and imaging setting, EUS-FNA cytology with analysis for mucin production by tumor cells is an important test in distinguishing pancreatic cystic lesions and guiding further management.

Management of incidentally discovered adrenal masses and risk of malignancy

Abstract Background Incidentally discovered adrenal masses larger than 1 cm are relatively frequent, but the correct management of such lesions is not well established. Methods Between 1980 and 1999, 158 patients (73 men (46 per cent) and 85 women (54 per cent), of median age 53 years) with adrenal incidentalomas larger than 2 cm were observed. Sixty-eight patients (43 per cent) underwent adrenalectomy. The reasons for surgery were: (1) suspicious appearance on computed tomography (CT) or magnetic resonance imaging (MRI) or no uptake at 75-selenium-norcholesterol scintigraphy (NCS) (n = 22), (2) increase in size of more than 1 cm (n = 15), (3) subclinical endocrine hyperfunction (n = 14), (4) size greater than 5 cm (n = 12) and (5) suspicious imaging-guided fine-needle aspiration cytology (FNAC) (n = 5). Results Pathological examination showed 39 adrenocortical adenomas (57 per cent), 20 adrenal malignancies (29 per cent) (15 carcinomas, three unsuspected metastases and two non-functioning malignant phaeochromocytomas) and nine various benign lesions (13 per cent). All masses increased in size were benign. Seven malignant tumours were 3–4 cm and 14 benign lesions were 5–6 cm in size. Sensitivity and specificity in detection of malignancy were 100 and 100 per cent for NCS (n = 34) and FNAC (n = 9), 75 and 94 per cent for CT (n = 68), and 88 and 100 per cent for MRI (n = 26) respectively. Conclusion To differentiate benign and malignant incidentalomas NCS and FNAC are more sensitive than CT and MRI, while the size criteria are of little value.

Endoscopic ultrasound–guided, 18-gauge, fine needle aspiration biopsy of the pancreas using a 2.8 mm channel convex array echoendoscope

Background : Previous studies have reported on endoscopic ultrasound–guided, fine needle aspiration biopsy using 22- to 25-gauge needles. We evaluated the histologic and cytologic yield of endoscopic ultrasound–guided, fine needle aspiration biopsy of the pancreas using an 18-gauge, Menghini-type core needle. Methods : Fine needle aspiration biopsy was performed in conjunction with a prototype 2.8 mm channel convex array echoendoscope. The core specimen was placed in formalin for cell block, and residual material was expelled on slides for cytology. Definitive diagnosis was established by surgery or clinical follow-up. Results : Of 45 patients who underwent fine needle aspiration biopsy, the needle failed to penetrate indurated pancreatic lesions in five. An average of 2.6 passes were performed in the remaining patients. Sufficient material for a histologic and/or cytologic diagnosis was obtained in 40 patients (histologic and cytologic yield of 68% and 75%, respectively). Combining the results of histology and cytology, the sensitivity and specificity for detection of malignancy was 76% and 100%, respectively. Histology confirmed the cytologic findings in 35 patients, providing additional tissue specific information. In three cases histology established a diagnosis of malignancy where cytology was not conclusively malignant. However, in three cases of surgically confirmed malignancy histology failed to detect malignancy, whereas cytology showed suspicious or malignant cells. The sensitivity of histology and cytology alone in detecting malignancy was 53% and 70%, respectively. Mild pancreatitis occurred after pancreatic fine needle aspiration biopsy in one patient. Conclusion : Core specimens for histology can be safely obtained using an 18-gauge needle. Histology provides tissue-specific information that complements cytology, but histology is less sensitive than cytology in detecting malignancy. (Gastrointest Endosc 1998;47:121-7)