Application of Thyroid Imaging Reporting and Data System (TIRADS) guidelines to thyroid nodules with cytopathological correlation and impact on healthcare costs.

AIMS: To assess the application of American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) guidelines and the potential reduction of unnecessary fine-needle aspirate (FNA) and cost savings through examination of cytopathological correlation. METHODS: All ultrasound-guided thyroid FNA performed between December 2017 and July 2019 at our institution were included in this study. Prior to performing each FNA, the nodules were scored according to ACR-TIRADS criteria with subsequent cytology scored according to Bethesda criteria. FNA request forms and preceding diagnostic ultrasound reports were analysed for clinical rationale behind each FNA. Collected data were applied to ACR-TIRADS, American Thyroid Association (ATA) and Korean TIRADS (K-TIRADS) criteria. Rate of reduction of unnecessary thyroid FNA and associated costs were subsequently calculated. RESULTS: A total of 125 patients and 146 nodules were evaluated. A malignancy rate of 7.5% was obtained. Sensitivity and specificity for detection of malignancy were 75% and 41% for ACR-TIRADS, 91% and 26% for ATA and 92% and 19% for K-TIRADS. Reduction in the rate of unnecessary FNA was most superior for ACR-TIRADS at 54.8%. Based on Australian Medicare Benefits Schedule item codes, a total of $18 452.70 might have been saved over the study period had ACR-TIRADS guidelines been uniformly followed. CONCLUSIONS: This study highlights the strengths and limitations of guidelines in the investigative pathway of thyroid nodules, including superiority of ACR-TIRADS in reducing the rate of unnecessary FNA. Continued education is needed towards application of guidelines among radiologists and referring clinicians, given the potential to reduce unnecessary FNA and achieve economic savings.

Complex and Hierarchical 2D Assemblies via Crystallization-Driven Self-Assembly of Poly(l-lactide) Homopolymers with Charged Termini.

Poly(l-lactide) (PLLA)-based nanoparticles have attracted much attention with respect to applications in drug delivery and nanomedicine as a result of their biocompatibility and biodegradability. Nevertheless, the ability to prepare PLLA assemblies with well-defined shape and dimensions is limited and represents a key challenge. Herein we report access to a series of monodisperse complex and hierarchical colloidally stable 2D structures based on PLLA cores using the seeded growth, "living-crystallization-driven self-assembly" method. Specifically, we describe the formation of diamond-shaped platelet micelles and concentric "patchy" block co-micelles by using seeds of the charge-terminated homopolymer PLLA24[PPh2Me]I to initiate the sequential growth of either additional PLLA24[PPh2Me]I or a crystallizable blend of the latter with the block copolymer PLLA42-b-P2VP240, respectively. The epitaxial nature of the growth processes used for the creation of the 2D block co-micelles was confirmed by selected area electron diffraction analysis. Cross-linking of the P2VP corona of the peripheral block in the 2D block co-micelles using Pt nanoparticles followed by dissolution of the interior region in good solvent for PLLA led to the formation of novel, hollow diamond-shaped assemblies. We also demonstrate that, in contrast to the aforementioned results, seeded growth of the unsymmetrical PLLA BCPs PLLA42-b-P2VP240 or PLLA20-b-PAGE80 alone from 2D platelets leads to the formation of diamond-fiber hybrid structures.