M. Migda

Use of the Kwak Thyroid Image Reporting and Data System (K-TIRADS) in differential diagnosis of thyroid nodules: systematic review and meta-analysis

PurposeThe purpose of this systematic literature review was to assess the usefulness of the Thyroid Image Reporting and Data System (K-TIRADS) classification proposed by Kwak for differentiation of thyroid nodules.Material and methodsFour literature databases were searched for relevant articles through early January 2017. A meta-analysis was performed to calculate pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-) and diagnostic odds ratio (DOR). The area under the curve (AUC) from the pooled receiver operating characteristic (ROC) was used to assess the usefulness of this classification for differentiation of thyroid nodules. Meta-analysis was conducted by using meta-analysis software.ResultsWe analysed six publications describing 10,926 nodules. Pooled sensitivity, specificity, LR+, LR-, DOR, and AUC for pooled ROC were 0.983 (95 % CI 0.976–0.989), 0.552 (95 % CI 0.542–0.562), 2.666 (95 % CI 1.692–4.198), 0.05 (95 % CI 0.035–0.072), 51.020 (95 % CI 15.241–170.79) and 0.938, respectively.ConclusionsKwak TIRADS has high sensitivity and low specificity. Thus, it is very useful to discard the benign cases and to reduce the number of biopsies.Key Points• Routine, adequate standardization of thyroid nodules ultrasound classification is mandatory.• Kwak TIRADS parameters are accurate for differentiating focal thyroid lesions.• Kwak TIRADS system is simple to apply.• Kwak TIRADS system may become a useful diagnostic tool.

Evaluation of Four Variants of the Thyroid Imaging Reporting and Data System (TIRADS) Classification in Patients with Multinodular Goiter

Purpose The goal this study was to evaluate the utility of four variants of the Thyroid Imaging Reporting and Data System (TIRADS) in the differentiation of focal lesions in individuals with multinodular goiter. Materials and Methods The study was approved by the Local Bioethical Committee. Each patient gave informed consent before enrolment. A total of 163 nodules in 124 patients with multinodular goiter were evaluated by ultrasound. B-mode and PD imaging and strain elastography were performed. Archived images were evaluated via retrospective analysis using four different proposed TIRADS classifications Results Sensitivity and specificity of the Horvath, Park, Kwak, and Russ classifications were 0.625 and 0.769, 0.813 and 0.864, 0.938 and 0.667, and 0.875 and 0.293, respectively. Positive and negative predictive values were 0.227 and 0.95, 0.394 and 0.977, 0.234 and 0.99, and 0.119 and 0.956, respectively. Receive operating characteristic analysis suggests that the best differentiation potential was demonstrated by the Kwak classification with an area under the curve (AUC) of 0.896, followed by the Park (AUC = 0.872), Horvath (AUC = 0.774), and Russ (AUC = 0.729) classifications. Conclusion The TIRADS classification proposed by Kwak can be a useful tool in daily practice for the evaluation of thyroid cancer in individuals with multinodular goiter, particularly for selecting cases that require biopsy, which may improve and simplify clinical decision making. To adopt a definitive, comprehensive variant of the TIRADS classification with potential for universal, practical application, further prospective studies that include improvement of the lexicon and evaluation of the full spectrum of thyroid malignancy are warranted.

EP25.09: Comparison of diagnostic value of using GIRADS system and ovarian malignancy marker Ca-125 in the preoperational adnexal tumours assessment

Objectives: The aim was to assess the clinical usefulness and diagnostic performance by additional measurement of CA 125 in combination with ultrasound findings for preoperative assessment of adnexal masses. Methods: This was a retrospective study assessing 215 adnexal masses in 215 women preand postmenopausal over a 24-month period in Gynecological Oncology Unit. Seventy-three (34%) women were premenopausal and 142 (66%) women were premenopausal. Patients were evaluated with transvaginal ultrasound according to the Gynecologic Imaging Report and Data System (GI-RADS) classification. Serum concentration of CA 125 was measured before surgical procedure. The definitive diagnosis was confirmed by pathological examination of the excised lesions. Results: Of the 215 tumours, 53 were malignant and 162 benign. The overall assessment of GIRADS was: sensitivity 94%, specificity 72%, PPV 52.6%, NPV 97.5%, OR 43.3. For GIRADS and Ca 125 >30 IU/ml: sensitivity 66%, specificity 93.8%, PPV 77.8%, NPV 89.4%, OR 29.6. For GIRADS and Ca 125 >39,6 IU/ml: sensitivity 96.2%, specificity 65.4%, PPV 47.7%, NPV 98.1%, OR 48.2. Conclusions: Additional measurement of CA 125 can improve the GI-RADS system in the overall assessment of adnexal by increasing sensitivity and negative predictive value.

Feasibility of using high-frequency skin ultrasound (HFSU) in vulvar skin assessment – initial report with the description of HFSU anatomy.

Objectives: High-frequency skin ultrasound (HFSU) allows for an extremely detailed assessment of the skin layers (epidermis, dermis, and hypodermis), as well as skin appendages (hair follicles, glands, and vessels). The aim of the study was to evaluate vulvar structures using HFSU and its utility as a diagnostic tool. Material and methods: The study group consisted of 50 women (22 preand 28 post-menopausal), aged 1881 years, without clinical symptoms of vulvar pathology. The following regions were assessed: mons pubis, labia majora, labia minora, external urethra orifice, and posterior commissure. Statistical analysis of epidermis and dermis for mons pubis, labia majora and minora was performed. Results: Comparison of the epidermis (EP) and dermis (DER) of mons pubis (MP), labia majora (VLM), labia minora (VLm) between the preand postmenopausal groups showed no statistically significant differences. Further comparison of EP and DER deemed the following results: for the premenopausal group EP MP vs. EP VLM (p=0.0884) and DER MP vs. DER VLm (p=0.8874), for the postmenopausal group EP MP vs. EP VLM (p=0.5755) and DER MP vs. DER VLm (p=0.3606), and without grouping EP MP vs. EP VLM (p=0.0988) and DER MP vs. DER VLm (p=0,5092), and showed no statistical differences. As for rest of the measured parameters, the p-value was <0.05. Conclusions: HFSU allows for precise imaging and measurement of vulvar epidermis and dermis.

Components of metabolic syndrome in the first trimester of pregnancy as predictors of adverse perinatal outcome.

OBJECTIVES It is the prospective observational study aimed at early prediction of pregnancy complications in women with symptoms of MS. MATERIAL AND METHODS 124 Caucasian women in singleton pregnancies 11th to the 13th wks 6 days of gestation with MS criteria compared to 30 healthy controls. Perinatal maternal and fetal results were analyzed. RESULTS Increased in the MS group were: age (32.9 y vs. 28.6 y; p = 0,00), weight 11 to 13 + 6 weeks of gestation (79.0 kg vs. 59.7 kg; p = 0.00), BMI (29 kg/m² vs. 21.6 kg/m²; p = 0.00), waist-hip ratio (WHR) (0.9 vs. 0.8; p = 0.00). Maternal serum parameters were higher in the MS group: LDL-cholesterol (124.1 vs. 109.6 mg/dL; p = 0.02), t-PA (2556.8 vs. 1949.5 pg/mL; p < 0.00), GGTP (16.8 vs. 13.3 IU/L; p = 0.02) and lower values for: adiponectin (6.4 vs. 7.5 μg/mL; p = 0.01), SHBG (273.4 vs. 338.4 nmol/L; p = 0.001). MS group neonates higher body weight (3594.4 vs. 3312.2 g; p = 0.01), significantly frequent macrosomic neo-nates (> 4000 g) (20.9% vs. 6.6%; p = 0.042), GDM (12% vs. 0; p = 0.019). CONCLUSIONS Higher E-selectin serum concentration, GGTP and lower SHBG in first trimester are additionally to fasting maternal glucose, higher BMI and maternal age predictive for GDM. Higher E-selectin, fasting glucose, increased BMI and lower adiponectin serum concentration in first trimester are significant predictors of fetal macrosomia. Maternal BMI > 24.5 kg/m² is the best predictor of increased risk of fetal macrosomia and gestational diabetes mellitus.