The Impact of Prostate Imaging Reporting and Data System Version 2.1 and Prostate-Specific Antigen Density in the Prediction of Clinically Significant Prostate Cancer.

OBJECTIVE: The aim of this study was to evaluate the diagnostic performance of multiparametric magnetic resonance imaging for clinically significant prostate cancer and to determine whether applying Prostate Imaging Reporting and Data Systems version 2.1 score could improve the diagnostic pathway besides the biochemical characteristics. MATERIALS AND METHODS: In this study, 199 patients with clinically suspected prostate cancer who underwent multiparametric magnetic resonance imaging were included. Logistic regression analyses and receiver operating characteristic curve were performed to determine independent predictors and to compare diagnostic performance of indicators for clinically significant prostate cancer. Two models were established. In model 1, the diagnostic performance of prostate-specific antigen- and prostatespecific antigen density-derived parameters were evaluated. In model 2, the prediction potential of model 1 plus Prostate Imaging Reporting and Data Systems version 2.1 score was analyzed. RESULTS: Sixty-four patients were positive for clinically significant prostate cancer by histopathological analysis (32.1%). In model 1, a prostate-specific antigen density >0.15 was labeled as the strongest predictor of malignancy. In model 2, a prostatespecific antigen density >0.15, a Prostate Imaging Reporting and Data Systems score ≥3, and a Prostate Imaging Reporting and Data Systems score ≥4 demonstrated the strongest association with malignancy. Among these parameters, a Prostate Imaging Reporting and Data Systems score ≥4 (P=.003) was found to be the most robust predictor for malignancy, followed by a Prostate Imaging Reporting and Data Systems score ≥3 (P=.012). The multivariate analysis revealed higher accuracy in model 2 (76.9%) than in model 1 (67.8%). The area under curve values with respect to prostatespecific antigen, prostate-specific antigen density, model 1, and model 2 were 0.632, 0.741, 0.656, and 0.798, respectively. CONCLUSION: These results indicated that Prostate Imaging Reporting and Data Systems version 2.1 score and prostate-specific antigen density are independent predictors for the presence of clinically significant prostate cancer. Both prostate-specific antigen density and Prostate Imaging Reporting and Data Systems version 2.1 score should be risen to prominence in the decision of biopsy instead of PSA.

The reference intervals of thyroid stimulating hormone in healthy individuals with normal levels of serum free thyroxine and without sonographic pathologies.

INTRODUCTION: The aim of the present study was to investigate the reference intervals for thyroid stimulating hormone (TSH) in healthy individuals with normal levels of serum free thyroxine (fT4) and without sonographic pathologies, and determine the effects of age, gender, and residence on the TSH reference intervals. SUBJECTS AND METHODS: This research was a population-based study conducted in 70 regions. The random sampling method was used to select the 1095 subjects of the study among inhabitants aged 18 and above. Patients who had a previous history of thyroid disease and had been taking medication were excluded from the study as this may have affected their fT4 or TSH levels. In addition, subjects who had serum fT4 without a reference range and abnormal ultrasonography findings were also excluded. A total of 408 subjects were used for establishing the reference intervals for TSH. RESULTS: The data for TSH in the study group were not normally distributed according to the Kolmogorov-Smirnov index. The geometric mean was 1.62 mIU/L, the median was 1.40 mIU/L, and the 95% reference intervals were 0.38-4.22 mIU/L. The median TSH level was higher in females compared to males (p < 0.05). In the female subjects 2.5th percentile of TSH was lower and 97.5th percentile was higher than those of males. The reference intervals of TSH were of lower values in subjects over 50 years old (p < 0.001). DISCUSSION: Studies suggest that determination of the TSH reference intervals may differ due to environmental influences or due to age, gender, and race. It is suggested that the lower limit of normal TSH for the adult Turkish population would be 0.38 mIU/L and the upper limit similar to the traditional value of 4.2 mIU/L. If each clinician uses their population-specific reference interval for TSH, thyroid function abnormalities can be accurately estimated.

Thyroid dysfunctions and sonographic characteristics in northern Turkey: a population-based study.

BACKGROUND AND OBJECTIVES: In this study, it was aimed to investigate thyroid functions, sonographic characteristics of thyroid gland, relation of thyroid functions, and cardiovascular risk factors in adult population living in northern Turkey. DESIGN AND SETTINGS: The study was conducted in 70 areas (12 urban and 58 rural) in the province of Tokat in northern Turkey from 2005 to 2006. PATIENTS AND METHODS: The study included about 530000 inhabitants of 18 years and older. Demographic characteristics and thyroid sonographic findings were noted for each subject, and blood samples were collected for measuring serum lipids and thyroid function tests. RESULTS: A total of 1095 subjects (541 males, 554 females) were included, and their mean age (SD) was 41.4 (17) years. Mean thyrotropin (TSH) and free T4 levels (SD) were 1.5 (1.6) micro IU/mL and 1.2 (0.1) ng/dL, respectively, in males, and 2.2 (6.6) micro IU/mL and 1.2 (0.3) ng/dL, respectively, in females (P < .05). According to mean TSH levels, the prevalence of overt hypothyroidism, overt hyperthyroidism, subclinical hypothyroidism, and subclinical hyperthyroidism was detected as 1.6%, 0.5%, 2.7%, and 4.9%, respectively. Nodular goiter, multi-nodular goiter, and thyroid heterogeneity were determined as 13.8, 32.1, and 15.6%, respectively. The correlation between cardiovascular risk factors and serum TSH levels was not statistically significant (P > .05). The age was independently and significantly associated with serum TSH levels (P < .0001). CONCLUSION: In terms of high prevalence of thyroid dysfunction and nodular goiter, thyroid diseases must be concluded as a public health problem, and accurate and effective strategies must be identified.

[Unilateral congenital aplasia of the submandibular gland]. / Submandibüler bezin tek tarafli dogustan aplazisi.

Aplasia of the major salivary glands is very uncommon, whereas isolated aplasia of unilateral submandibular gland is even rarer. In this article, we report a 55-year-old female case in whom unilateral aplasia of the left submandibular gland was detected incidentally by ultrasonography with no other congenital comorbidities in the light of literature data.