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likelihood ratio was 0.88 (95% CI 0.733–1.06), and the diagnostic odds ratio was 1.83 (95% CI 0.88–3.78). The sensitivities and specificities according to different cutoff values of the AP/T ratio to define TTW shape are plotted in online supplementary Figure
Center of Genomic Medicine, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
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nodules, FNA is the single best test for preoperative selection, but the issues of non-diagnostic and suspicious cytopathological findings remain to be solved. Other studies have evaluated the accuracy of FNA and conclude that sensitivity and specificity
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sensitivity and specificity of the technique [ 4 ], and makes it possible to take samples of the solid areas in cystic lesions. Despite fine-needle aspiration cytology (FNAC) being almost universally used to take thyroid samples and, accordingly, there being
Xi’an Hospital of Traditional Chinese Medicine, Xi’an, China
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evaluated using Deeks’ test for funnel plot asymmetry. Interstudy heterogeneity was assessed by the DerSimonian-Laird random-effects model and the index of inconsistency ( I 2 ). The combined estimates for sensitivity and specificity were performed by a
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thyroid nodules are benign, and 5–15% of them are thyroid malignancies. Fine-needle aspiration biopsy (FNAB) is a reliable, minimally invasive diagnostic method with high sensitivity and specificity in the evaluation of thyroid nodules [ 2 , 4 - 7
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Department of Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, China
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Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
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Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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). Previous studies have verified that FNA cytology, as the standard preoperative tool for the diagnosis of thyroid nodules, is characterized by outstanding diagnostic sensitivity and specificity compared with surgical histology. However, approximately 20
Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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.3.0) software. A summary receiver operating characteristic curve (SROC) was constructed for overall analysis, and the area under the SROC curve was calculated. We also conducted a meta-analysis of the models (38/47) with reported sensitivity and specificity and
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Objective. The ultrasound evaluation of thyroid nodules (TN) in patient selection for fine needle aspiration (FNA) requires both uniformly accepted definitions of each nodule characteristic and extensive experience of the examiner. We hypothesized that nodule echogenicity alone may provide comparable performance to the more complex approaches, in patient selection for FNA.
Patients and Methods. Seven highly experienced investigators from four countries evaluated, online, the ultrasound (US) video recordings of 123 histologically verified TN, by answering 17 nodule characteristics-related questions. The diagnostic performances of five TN image reporting and data systems (TIRADS) were compared to making decisions based alone on echogenicity of the nodule, for indicating FNA in 110 nodules ≥10 mm.
Results. In the 10 to 20 mm size range, the sensitivities and specificities of the five TIRADS systems in identifying malignant nodules was 80.5%-91.0%, and 31.4-50.9%, respectively. Had FNA been recommended in all hypoechoic nodules, disregarding other US characteristics, comparable sensitivity and specificity (87.5% and 43.4%, respectively) were obtained. Compared to nodules >20mm, a higher proportion of cancers were hypoechoic in the 10 to 20 mm size range (87.2% vs. 77.8%, p=0.05). In the 10-20 mm size range, compared to hypoechoic nodules, a significantly lower proportion of isoechoic nodules demonstrated suspicious findings (70.7% vs. 30.0%, p<0.05).
Conclusion. In contrast to >20 mm diameter nodules, the recommendation of FNA may rely on a single US feature, echogenicity, in the 10-20 mm size range. If independently confirmed in larger cohorts, this may simplify nodule evaluation in this size range.
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Background: Hypothyroidism due to non-compliance with levothyroxine therapy (pseudomalabsorption) is rare. The diagnosis is considered in patients with persistent severe hypothyroidism despite treatment with large doses of levothyroxine. Intestinal malabsorption, drug and dietary interference with levothyroxine absorption and nephrotic syndrome should be excluded. The diagnosis of pseudomalabsorption can be demonstrated by using “an oral 1,000 µg of levothyroxine test” showing a rapid decrease in thyroid-stimulating hormone and increase in thyroxine. There are however few data on the sensitivity and specificity of the test in large cohorts of hypothyroid patients. Treatment of pseudomalabsorption is controversial, with reports using parenteral, intramuscular or single weekly oral dosing of levothyroxine. Cases: We report 3 patients who presented with persistent clinical and biochemical signs of hypothyroidism despite replacement therapy with high doses of levothyroxine. Pseudomalabsorption was diagnosed by a systematic approach, including prior exclusion of digestive, liver and kidney diseases. A peroral challenge test was positive in all cases. Patients denied non-compliance, and a psychiatric approach was elusive. Two of the patients were treated successfully with a single supervised weekly 1,000-µg administration of levothyroxine, while non-supervised weekly administration resulted in hypothyroidism confirming pseudomalabsorption. Conclusions: Non-compliance with medical therapy should be considered in patients with treatment-refractory hypothyroidism. Supervised once weekly levothyroxine treatment is a safe and well-tolerated treatment option, obviating the need for parenteral administration of the drug. Apart from the medical treatment, there is also a need for psychiatric evaluation and care.
Department of Radiology, Jichi Medical University, School of Medicine, Shimotsuke, Tochigi, Japan
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Center for Frontier Medical Engineering, Chiba University, Yayoicho, Inage–ku, Chiba, Japan
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Objective
This study aimed to determine a standardized cut-off value for abnormal 18F-fluorodeoxyglucose (FDG) accumulation in the thyroid gland.
Methods
Herein, 7013 FDG–PET/CT scans were included. An automatic thyroid segmentation method using two U-nets (2D- and 3D-U-net) was constructed; mean FDG standardized uptake value (SUV), CT value, and volume of the thyroid gland were obtained from each participant. The values were categorized by thyroid function into three groups based on serum thyroid-stimulating hormone levels. Thyroid function and mean SUV with increments of 1 were analyzed, and risk for thyroid dysfunction was calculated. Thyroid dysfunction detection ability was examined using a machine learning method (LightGBM, Microsoft) with age, sex, height, weight, CT value, volume, and mean SUV as explanatory variables.
Results
Mean SUV was significantly higher in females with hypothyroidism. Almost 98.9% of participants in the normal group had mean SUV < 2 and 93.8% participants with mean SUV < 2 had normal thyroid function. The hypothyroidism group had more cases with mean SUV ≥ 2. The relative risk of having abnormal thyroid function was 4.6 with mean SUV ≥ 2. The sensitivity and specificity for detecting thyroid dysfunction using LightGBM (Microsoft) were 14.5 and 99%, respectively.
Conclusions
Mean SUV ≥ 2 was strongly associated with abnormal thyroid function in this large cohort, indicating that mean SUV with FDG–PET/CT can be used as a criterion for thyroid evaluation. Preliminarily, this study shows the potential utility of detecting thyroid dysfunction based on imaging findings.
