CẮT TÚI MẬT NỘI SOI: TIÊU CHUẨN SIÊU ÂM TIÊN LƯỢNG KHÓ

Abstract

Purpose: Laparoscopic cholecystectomy (LC) has become the treatment of choice for cholelithiasis. Still some patients required conversion to open cholecystectomy (OC). Our aim was to develop a standardized Ultrasound based scoring system for preoperative prediction of difficult LC.

 Methods and materials: Ultrasound findings of 300 patients who underwent LC were reviewed retrospectively. Four parameters (time taken, biliary leakage, duct or arterial injury, and conversion) were analyzed to classify LC as easy or difficult. The following ultrasound findings were analyzed: GB wall thickness, pericholecystic collection, distended GB, impacted stones, multiple stones, CBD diameter and liver size. Out of seven parameters, four were statistically significant in our study. A score of 2 was assigned for the presence of each significant finding and a score of 1 was assigned for the remaining parameters to a total score of 11. A cut-off value of 5 was taken to predict easy and difficult LC.

 Results: 66 out of 83 cases of difficult LC and 199 out of 217 cases of easy LC were correctly predicted on the basis of scoring system. A score of >5 had sensitivity 80.7% and specificity 91.7% for correctly identifying difficult LC. Prediction came true in 78.8% difficult and 92.6% easy cases. US findings of GB wall thickness, distended GB, impacted stones and dilated CBD were found statistically significant.

Conclusion: This indigenous scoring system is effective in predicting conversion risk of LC to OC. Patients having high risk may be informed and scheduled appropriately and decision to convert to OC in case of anticipated difficulty may be taken earlier.

ª 2017, Elsevier Taiwan LLC and the Chinese Taipei Society of Ultrasound in Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).

TI-RADS REDUCES BIOPSY

Thyroid Imaging Reporting and Data System Reduces Biopsies

• Diagnostic Imaging Staff

Apr 18, 2018

• Thyroid Disorders

Criteria from the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) offers a meaningful reduction in the number of thyroid nodules recommended for biopsy, according to a study published in the journal Radiology. 

Researchers from several states performed a retrospective study to compare the biopsy rate and diagnostic accuracy before and after applying ACR TI-RADS criteria for thyroid nodule evaluation. Eight radiologists with three to 32 years of experience in thyroid ultrasonography were asked to review the ultrasound features of 100 thyroid nodules that were cytologically proven and/or pathologically proven. Nodules evaluated in five US categories and biopsy recommendations were provided based on the radiologists’ practice patterns without knowledge of ACR TI-RADS criteria. Three other expert radiologists were reference standard readers for the imaging findings. ACR TI-RADS criteria were retrospectively applied to the features assigned by the eight radiologists to produce biopsy recommendations. Comparison was made for biopsy rate, sensitivity, specificity, and accuracy.

The results showed 15 of the 100 nodules (15 percent) were malignant. The mean number of nodules recommended for biopsy by the eight radiologists was 80 ± 16 (standard deviation) based on their own practice patterns and 57 ± 11 with retrospective application of ACR TI-RADS criteria.

Without ACR TI-RADS criteria:
Sensitivity  95 percent
Specificity  20 percent
Accuracy  28 percent

With ACR TI-RADS criteria:
Sensitivity 92 percent
Specificity 44 percent
Accuracy 52 percent

Expert consensus:
Sensitivity 87 percent
Specificity 51 percent
Accuracy 56 percent

The researchers noted that although fewer malignancies were recommended for biopsy with ACR TI-RADS criteria, the majority met the criteria for follow-up US. Only three of 120 (2.5 percent) malignancy encounters required no follow-up or biopsy. Expert consensus recommended biopsy in 55 of 100 nodules with ACR TI-RADS criteria.

Not only did the ACR TI-RADS criteria offer a meaningful reduction in the number of thyroid nodules recommended for biopsy, the researchers wrote, they significantly improve the accuracy of recommendations for nodule management.