Personalized objects can optimize the diagnosis of EMCS in the assessment of functional object use in the CRS-R: a double blind, randomized clinical trial.

BACKGROUND: Behavioral assessment has been acted as the gold standard for the diagnosis of disorders of consciousness (DOC) patients. The item "Functional Object Use" in the motor function sub-scale in the Coma Recovery Scale-Revised (CRS-R) is a key item in differentiating between minimally conscious state (MCS) and emergence from MCS (EMCS). However, previous studies suggested that certain specific stimuli, especially something self-relevant can affect DOC patients' scores of behavioral assessment scale. So, we attempted to find out if personalized objects can improve the diagnosis of EMCS in the assessment of Functional Object Use by comparing the use of patients' favorite objects and other common objects in MCS patients. METHODS: Twenty-one post-comatose patients diagnosed as MCS were prospectively included. The item "Functional Object Use" was assessed by using personalized objects (e.g., cigarette, paper) and non-personalized objects, which were presented in a random order. The rest assessments were performed following the standard protocol of the CRS-R. The differences between functional uses of the two types of objects were analyzed by the McNemar test. RESULTS: The incidence of Functional Object Use was significantly higher using personalized objects than non-personalized objects in the CRS-R. Five out of the 21 MCS studied patients, who were assessed with non-personalized objects, were re-diagnosed as EMCS with personalized objects (χ2 = 5, df = 1, p < 0.05). CONCLUSIONS: Personalized objects employed here seem to be more effective to elicit patients' responses as compared to non-personalized objects during the assessment of Functional Object Use in DOC patients. TRIAL REGISTRATION: Clinical Trials.gov: NCT02988206 ; Date of registration: 2016/12/12.

Diagnostic performances of the KWAK-TIRADS classification, elasticity score, and Bethesda System for Reporting Thyroid Cytopathology of TI-RADS category 4 thyroid nodules.

OBJECTIVE: To explore the value of the KWAK Thyroid Imaging Reporting and Data System (KWAK-TIRADS), elasticity score (ES), and Bethesda System for Reporting Thyroid Cytopathology (BSRTC) in the diagnosis of suspicious thyroid nodules. MATERIALS AND METHODS: The study included 392 cases of TI-RADS category 4 thyroid nodules that underwent thyroidectomy between January 2017 and October 2019. All patients underwent ultrasonography, ultrasound elastography, and fine-needle aspiration cytology (FNAC) before surgery. The nodules were classified into different categories based on the KWAK-TIRADS, ES, and BSRTC. Patients were divided into two groups based on postoperative pathological characteristics. The sensitivity (Se), specificity (Sp), and area under the receiver operating characteristic (ROC) curve were calculated. Student's t-test and Pearson chi-square test were used to compare diagnostic performance. RESULTS: There were 159 patients in the benign group and 233 in the malignant group. The percentage of malignant nodules in KWAK-TIRADS categories 4a, 4b, and 4c were 44.3%, 64.8%, and 92.9%, respectively. The percentages of malignant nodules in ES 2, 3, 4, and 5 were 0%, 37.1%, 93.8%, and 100%, respectively. The percentage of malignant nodules in BSRTC levels I, II, III, IV, V and VI were 57.1%, 2.8%, 9.9%, 76.6%, 99.1%, and 100%, respectively. Among those methods, the BSRTC had better diagnostic efficiency than the KWAK-TIRADS and ES (Sp 81.1%, Se 93.6%, and AUC 0.918, P<0.01). Among the combined methods, KWAK-TIRADS+ES+BSRTC was more effective than KWAK-TIRADS+ES, KWAK-TIRADS+BSRTC, and ES+BSRTC (Sp 93.7%, Se 91.4%, and AUC 0.967, P<0.01). CONCLUSION: The combination of KWAK-TIRADS, ES, and BSRTC can improve the accuracy of identifying category 4 thyroid nodules.