Comparison of Multimodal Ultrasound Imaging with Conventional Ultrasound Risk Stratification Systems in Presurgical Risk Stratification of Thyroid Nodules.

BACKGROUND: Ultrasonography (US) is an indispensable tool in the management of thyroid nodules, not only for assessing tumor characteristics but also to assign risk of malignancy and guide in management. Various guidelines and US-based risk stratification systems have been proposed for this purpose. This study aims to compare the diagnostic performances of multimodal US-based risk scores (French TIRADS, TMC-RSS) with conventional US-based scoring systems (Korean TIRADS, ACR-TIRADS, ATA risk stratification). MATERIAL AND METHODS: A total of 168 nodules from 139 patients were studied and categorized in each of the risk stratification systems. Sensitivity, specificity, positive and negative predictive values, and accuracy of each system were computed. ROC curves were plotted and area under curve (AUC) for each scoring system noted. RESULTS: Thirty five (21%) of the 168 nodules were malignant on final histopathological examination. TMC-RSS fared the best in predicting malignant nodules with a sensitivity of 96.2% and specificity of 88.6%, while the PPV and NPV were 97% and 86.1%, respectively. The AUC for TMC-RSS was 0.924 (95% CI, 0.860-0.988; P < 0.001). CONCLUSION: Multimodal US-based risk stratification incorporating non-grayscale characteristics in addition to conventional systems like the TMC-RSS improves the diagnostic performance of ultrasound imaging of thyroid nodules.

Large Adrenal Lesion Series in a Tertiary Care Center in Northern India: Diagnostic and Operative Challenges.

Large adrenal tumors pose varied challenges to surgeons in terms of diagnosis, planning surgical approach, and also intra-operative difficulties in resection. The aim of this study is to discuss challenges in the management of large and difficult adrenal lesions. A retrospective analysis was done on data of all patients with large adrenal lesions/paragangliomas managed from 1 June 2016 to 30 August 2018. Forty-eight patients with adrenal lesions underwent treatment in 2 years duration. Pain in the abdomen was the most common presentation. Mean age was 34.4 years (range 2-60), female to male (23:25) and right to left side to bilateral tumor 30:16:2. Thirty-one (64.6%) patients had large adrenal masses (size > 6 cm). Surgical approaches included open transperitoneal adrenalectomy (n = 20) and laparoscopic transperitoneal (n = 9 and 2 others had conversion to open procedure). Challenges faced are described in the table below: [Table: see text] There were no major peri-operative morbidities, but two patients died in perioperative period. Large adrenal tumors pose a challenge in surgical planning, approach, and resection and need careful planning and multidisciplinary team approach to have the best outcomes.

Barriers to Timely Diagnosis and Management of Breast Cancer: Observations from a Tertiary Referral Center in Resource Poor Setting.

Breast cancer (BC) is the most common cancer among females worldwide, with over 2 million cases diagnosed every year. In India, it is the most common malignancy overall (15.4%) and accounts for about 27% female cancers. Morbidity and mortality remain high despite improvements in BC therapeutics. Conventionally, a gap of more than 3 months between noticing symptoms and commencing treatment is considered delay in BC management. Delays make BC an important public health problem and lead to poor outcomes. This study aims to identify patient perceived barriers to BC management. A self-designed structured questionnaire consisting of questions pertaining to multiple aspects of BC presentation and management was prepared. The study was conducted from October 2017 to September 2018 and results were analyzed. A delay of 3 months or more was seen in 284 of the 435 patients (65.3%), among which 179 was patient delay, 69 due to provider delay, and 36 due to a combined contribution of both factors. Provider factors were associated with prolonged delay. Misdiagnosis at first consult was the most common factor perceived by patients as a barrier, followed by delay in referral, distance from hospitals, lack of information, financial constraints, and logistic issues. A significant patient and provider delay exists in BC management which prevents effective early therapy. Effective tackling of these barriers may result in the betterment of BC management outcomes. Robust screening, education of patients and providers, and awareness promotion and infrastructure development will be useful in this regard.