Development and validation of a prediction model for consistency of pituitary adenoma: the PiTCon score.

PURPOSE: Pituitary adenomas (PAs) usually have a soft consistency, facilitating gross total resection. However, 5-13% of PAs with fibrous consistency are challenging to remove entirely and are accompanied by greater morbimortality. This study aims to identify the clinical and radiological characteristics that correlate with PA fibrous consistency preoperatively. A simple scoring system has been proposed to predict incidence of fibrous PAs. MATERIALS AND METHODS: Consecutive interventions (226) were analyzed, all performed through an endoscopic endonasal transsphenoidal approach. Univariable and multivariable logistic regression analysis was performed. Hosmer-Lemeshow test and receiver operating characteristic (ROC) curves were assessed to evaluate the model. A point scoring system (PiTCon) was derived based on the multivariable regression model. Our study aimed to identify the clinical and radiological characteristics that correlate with fibrous tumor consistency preoperatively. RESULTS: The best diagnostic accuracy for predicting PA consistency consisted of five predictive factors: age, compressive symptoms, panhypopituitarism, craniocaudal extension of the PA in mm, and prior surgery. The multivariable model achieved good discrimination with an area under the curve (AUC) of the ROC curve being 0.82 and the 95% CI 0.76 to 0.88. Internal validation yielded an optimism-adjusted C-statistic of 0.80 (95% CI 0.74 to 0.86). A point scoring system (PiTCon score) was designed using the best predictive model. CONCLUSIONS: PA consistency can be estimated preoperatively regarding clinical and radiological characteristics. We propose a point-based scoring system (PiTCon score) that can better guide neurosurgeons in clinical decision-making and surgical risk assessment and help establish and describe patient prognosis.

Criterios sobre la utilización y requerimientos técnicos de la ecografía tiroidea en los servicios de endocrinología y nutrición / Consensus statement for use and technical requirements of thyroid ultrasound in endocrinology units

La ecografía se ha convertido en un instrumento imprescindible en la asistencia a los pacientes con enfermedades tiroideas. La detección de los nódulos tiroideos se ha incrementado con el uso generalizado de la misma, siendo la herramienta principal para su detección, orientación diagnóstica, seguimiento y, en ocasiones, también terapéutica. Los Grupos de Trabajo de Cáncer de Tiroides y de Técnicas ecográficas de la Sociedad Española de Endocrinología y Nutrición han promovido este documento en el que se resumen los requisitos necesarios para la mejor práctica clínica posible con esta técnica. Los objetivos del trabajo incluyen encuadrar su utilización dentro de la especialidad, los requisitos técnicos y legales necesarios, las situaciones clínicas de su aplicación, los niveles de conocimiento y aprendizaje, la responsabilidad asociada, la comunicación estandarizada de resultados e integración en los sistemas de información hospitalarios, posicionando la técnica ecográfica dentro de la cartera de servicios en las actuales unidades de Endocrinología y Nutrición (AU)

Thyroid nodule detection has increased with widespread use of ultrasound, which is currently the main tool for detection, monitoring, diagnosis and, in some instances, treatment of thyroid nodules. Knowledge of ultrasound and adequate instruction on its use require a position statement by the scientific societies concerned. The working groups on thyroid cancer and ultrasound techniques of the Spanish Society of Endocrinology and Nutrition have promoted this document, based on a thorough analysis of the current literature, the results of multicenter studies and expert consensus, in order to set the requirements for the best use of ultrasound in clinical practice. The objectives include the adequate framework for use of thyroid ultrasound, the technical and legal requirements, the clinical situations in which it is recommended, the levels of knowledge and learning processes, the associated responsibility, and the establishment of a standardized reporting of results and integration into hospital information systems and endocrinology units (AU)