A systematic review and meta-analysis of the Kwak TIRADS for the diagnostic assessment of indeterminate thyroid nodules.

AIM: To explore the diagnostic usefulness of the Thyroid Imaging Reporting and Data System (TIRADS) classification proposed by Kwak in indeterminate nodules using a systematic literature review. MATERIAL AND METHODS: The PubMed, Cochrane database, ScienceDirect, and EMBASE databases were searched for relevant articles. A meta-analysis was performed to calculate pooled sensitivity, specificity, negative and positive likelihood ratios (LR- and LR+), diagnostic odds ratio (DOR), and area under the curve (AUC) from summarised receiver operating characteristic (SROC) curves. RESULTS: Six publications describing 1,096 nodules were analysed. Overall pooled sensitivity, specificity, LR+, LR-, DOR, and AUC for SROC were 0.913, 0.347, 1.396, 0.341, 5.832, and 0.7180, respectively. CONCLUSIONS: Kwak TIRADS classification with 3/4a cut-off for indeterminate lesions has high sensitivity but low specificity to exclude benign lesions. A higher Kwak TIRADS cut-off could help exclude larger numbers of benign lesions and lower the rate of unnecessary surgeries.

Maternal first trimester parameters in the prediction of excessive fetal growth in pregnant women with metabolic syndrome.

Metabolic syndrome (MS) and obesity is an important risk factor for fetal complications like excessive fetal growth manifested by large for gestational age (LGA) and macrosomia, which is a consequence of metabolic disturbances present in the first trimester of pregnancy. The aim of this prospective observational study is to analyze the relationship between the first trimester biochemical and anthropometric parameters of fetuses with the incidence of their macrosomia and LGA so to early predict such complications in women with symptoms of MS. A total of 124 Caucasian women in singleton pregnancies who fulfilled MS criteria were enrolled into the study group and compared to 30 healthy pregnant controls. Patients' blood was drawn and sampled for analysis at 11 - 13+6 weeks of gestation. Specific factors were analyzed in terms of influence on fetal growth and perinatal morbidity in both pregnancy groups. The maternal parameters obtained at first trimester that with respect to controls proved influential towards macrosomia defined as > 4000 g were: BMI and weight (28.0 versus 22 m/kg2; P < 0.001), (77.9 kg versus 60.8 kg; P < 0.001), fasting glucose (87.2 versus 82.1 mg/dl; P < 0.042), significantly higher s-E-selectin concentration (32.0 versus 24.5 ng/ml; P < 0.011) and lower adiponectin: (5.6 versus 9.1 µg/ml; P < 0.001). Similarly, the parameters for LGA fetuses were found to be: maternal weight (80.3 versus 60.8 kg; P < 0.001), BMI (28.7 versus 21.6 kg/m2; P < 0.001), fasting glucose (87.2 versus 82.4mg/dl; P < 0.022), increased s-E-selectin (30.8 versus 24.5 ng/ml; P < 0.022) and decreased adiponectin (6.3 versus 8.2 µg/ml; P < 0.024). We concluded that: 1) first trimester BMI with cut-off of 25.5 was significant risk factor for excessive fetal growth; 2) maternal glycemia, as well as adiponectin and soluble E-selectin serum concentration in the first trimester of pregnancy could be predictive of LGA and fetal macrosomia; 3) maternal weight at 11 - 13+6 weeks of pregnancy cut-off 67 kg had high sensitivity and specificity in detecting LGA and fetal macrosomia.