Purpose: The objective of the study was to design and implement an electronic synoptic report for thyroid sonography that incorporates the thyroid imaging reporting and data system (TIRADS) and assess potential for re...Purpose: The objective of the study was to design and implement an electronic synoptic report for thyroid sonography that incorporates the thyroid imaging reporting and data system (TIRADS) and assess potential for reducing unnecessary fine needle aspiration biopsies (FNAB) of thyroid nodules. Methods: The electronic synoptic report was developed using a relational database based on elements from TIRADS and a multidisciplinary consensus statement for thyroid reporting. A retrospective analysis of 138 patients with previously reported thyroid sonographic exams was evaluated for the presence of these elements. The electronic synoptic report calculates the TIRADS score and generates a formal report. Using the TIRADS score the potential decrease in unnecessary FNAB was estimated. Results: Key TIRADS elements were variously reported ranging from 43% for the thyroid nodule’s architecture as solid or cystic. Thyroid nodule echogenicity and calcification was commented in 27% and 23%, respectively. Other features of the TIRADS score were commented in 0% to 8% of the official reports. Estimated reduction for potentially reduced need for FNAB was 34.5%. Conclusions: This study is the first implementation of synoptic reporting using a relational database for sonography of thyroid nodules. Implementation of an electronic standardized synoptic reporting system may facilitate more accurate, and more comprehensive reporting for thyroid ultrasound scanning of thyroid nodules. The use of TIRADS was estimated to be able to potentially reduce the need for FNAB which was significant.展开更多
Background: The Canadian province of Saskatchewan introduced a pre-fine needle aspiration (FNA) clinic to review adherence of referrals for thyroid biopsy based on the guidelines of the American College of Radiology’...Background: The Canadian province of Saskatchewan introduced a pre-fine needle aspiration (FNA) clinic to review adherence of referrals for thyroid biopsy based on the guidelines of the American College of Radiology’s (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS) scoring system. The intention is to minimize low-yield biopsy rates by improving the quality of thyroid nodule investigation in Saskatchewan through this clinic. TI-RADS is a malignancy risk scoring system for thyroid nodules based on five sonographic characteristics: composition, echogenicity, shape, margin, and echogenic foci (calcium). Recommendations for intervention or clinical follow-up are further determined by the size of the nodule. Methods: Through a retrospective chart review of all thyroid biopsy referrals to the Royal University Hospital (RUH) in Saskatchewan between 22 March 2016 and 17 May 2018, the impact of the multidisciplinary pre-FNA clinic on appropriate thyroid biopsies in Saskatchewan was evaluated. Results: This study evaluated 252 referrals, 203 of which underwent FNA and 23 which received surgical biopsy. TI-RADS scores appended to thyroid biopsy referrals increased upon pre-FNA clinic initiation, yet score quality did not improve. Rates of malignant biopsies were lower than ACR-reporting suggesting inappropriate biopsy of low risk nodules perhaps by overcalling the TI-RADS score. The majority of FNA cytology matched final surgical pathology, with 78% of indeterminate FNAs being malignant, and all non-diagnostic FNAs being benign. Conclusions: The implementation of the pre-FNA clinic reduced the number of thyroid biopsies in Saskatchewan by 11% overall.展开更多
Background: Thyroid nodules are common and fine needle aspiration (FNA) or surgery is used to assess for malignancy. Thyroid Imaging, Reporting and Data System (TI-RADS) use ultrasound for non-invasive risk stratifica...Background: Thyroid nodules are common and fine needle aspiration (FNA) or surgery is used to assess for malignancy. Thyroid Imaging, Reporting and Data System (TI-RADS) use ultrasound for non-invasive risk stratification of thyroid nodules and reduce unnecessary biopsies. This project used an online calculator and education to facilitate the application of TI-RADS in clinical practice. Methods: Retrospective review defined the baseline reporting of thyroid nodule ultrasound features. Web-based resource and presentation were used to integrate TI-RADS in reporting thyroid ultrasounds and measure the improvements in comprehensive reporting of thyroid nodules and guiding management. Results: The percentage of thyroid ultrasound reporting using TI-RADS within six months increased from 0% to 27% during the project period. Reports with TI-RADS provided twice as many recommendations compared to reports without TI-RADS. Conclusion: Online TI-RADS calculator and education have successfully facilitated the integration of TI-RADS in thyroid ultrasound reporting to provide more accurate and comprehensive reports and guide management.展开更多
Irreversible electroporation(IRE)is a new cancer ablation technology,but methods to improve IRE-induced therapeutic immunity are only beginning to be investigated.We developed a mouse model bearing large primary(300 m...Irreversible electroporation(IRE)is a new cancer ablation technology,but methods to improve IRE-induced therapeutic immunity are only beginning to be investigated.We developed a mouse model bearing large primary(300 mm^(3))and medium distant(100 mm^(3))EG7 lymphomas engineered to express ovalbumin(OVA)as a nominal tumor antigen.We established experimental protocols including IRE alone and IRE combined with Toll-like receptor(TLR)3/9 agonists(poly I:C/CpG)(IRE+pIC/CpG),PD-1 blockade(IRE+PD-1 blockade),or both(IRE+Combo)to investigate therapeutic effects on primary and distant EG7 tumors and conversion-promoting effects on the immunotolerant tumor microenvironment(TME).We demonstrated that IRE alone simulated very weak OVA-specific CD8^(+)T cell responses and did not inhibit primary tumor growth.IRE+pIC/CpG synergistically stimulated more efficient OVA-specific CD8^(+)T cell responses and primary tumor growth inhibition than IRE+PD-1 blockade.IRE+pIC/CpG played a major role in the modulation of immune cell profiles but a minor role in the downregulation of PD-L1 expression in the TME and vice versa for IRE+PD-1 blockade.IRE+Combo cooperatively induced potent OVA-specific CD8^(+)T cell immunity and rescued exhausted intratumoral CD8^(+)T cells,leading to eradication of not only primary tumors but also untreated concomitant distant tumors and lung metastases.IRE+Combo efficiently modulated immune cell profiles,as evidenced by reductions in immunotolerant type-2(M2)macrophages,myeloid-derived suppressor-cells,plasmacytoid dendritic cells,and regulatory T cells and by increases in immunogenic M1 macrophages,CD169^(+)macrophages,type-1 conventional dendritic cells,and CD8^(+)T cells,leading to conversion of immunotolerance in not only primary TMEs but also untreated distant TMEs.IRE+Combo also showed effective therapeutic effects in two breast cancer models.Therefore,our results suggest that IRE+Combo is a promising strategy to improve IRE ablation therapy in cancer.展开更多
文摘Purpose: The objective of the study was to design and implement an electronic synoptic report for thyroid sonography that incorporates the thyroid imaging reporting and data system (TIRADS) and assess potential for reducing unnecessary fine needle aspiration biopsies (FNAB) of thyroid nodules. Methods: The electronic synoptic report was developed using a relational database based on elements from TIRADS and a multidisciplinary consensus statement for thyroid reporting. A retrospective analysis of 138 patients with previously reported thyroid sonographic exams was evaluated for the presence of these elements. The electronic synoptic report calculates the TIRADS score and generates a formal report. Using the TIRADS score the potential decrease in unnecessary FNAB was estimated. Results: Key TIRADS elements were variously reported ranging from 43% for the thyroid nodule’s architecture as solid or cystic. Thyroid nodule echogenicity and calcification was commented in 27% and 23%, respectively. Other features of the TIRADS score were commented in 0% to 8% of the official reports. Estimated reduction for potentially reduced need for FNAB was 34.5%. Conclusions: This study is the first implementation of synoptic reporting using a relational database for sonography of thyroid nodules. Implementation of an electronic standardized synoptic reporting system may facilitate more accurate, and more comprehensive reporting for thyroid ultrasound scanning of thyroid nodules. The use of TIRADS was estimated to be able to potentially reduce the need for FNAB which was significant.
文摘Background: The Canadian province of Saskatchewan introduced a pre-fine needle aspiration (FNA) clinic to review adherence of referrals for thyroid biopsy based on the guidelines of the American College of Radiology’s (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS) scoring system. The intention is to minimize low-yield biopsy rates by improving the quality of thyroid nodule investigation in Saskatchewan through this clinic. TI-RADS is a malignancy risk scoring system for thyroid nodules based on five sonographic characteristics: composition, echogenicity, shape, margin, and echogenic foci (calcium). Recommendations for intervention or clinical follow-up are further determined by the size of the nodule. Methods: Through a retrospective chart review of all thyroid biopsy referrals to the Royal University Hospital (RUH) in Saskatchewan between 22 March 2016 and 17 May 2018, the impact of the multidisciplinary pre-FNA clinic on appropriate thyroid biopsies in Saskatchewan was evaluated. Results: This study evaluated 252 referrals, 203 of which underwent FNA and 23 which received surgical biopsy. TI-RADS scores appended to thyroid biopsy referrals increased upon pre-FNA clinic initiation, yet score quality did not improve. Rates of malignant biopsies were lower than ACR-reporting suggesting inappropriate biopsy of low risk nodules perhaps by overcalling the TI-RADS score. The majority of FNA cytology matched final surgical pathology, with 78% of indeterminate FNAs being malignant, and all non-diagnostic FNAs being benign. Conclusions: The implementation of the pre-FNA clinic reduced the number of thyroid biopsies in Saskatchewan by 11% overall.
文摘Background: Thyroid nodules are common and fine needle aspiration (FNA) or surgery is used to assess for malignancy. Thyroid Imaging, Reporting and Data System (TI-RADS) use ultrasound for non-invasive risk stratification of thyroid nodules and reduce unnecessary biopsies. This project used an online calculator and education to facilitate the application of TI-RADS in clinical practice. Methods: Retrospective review defined the baseline reporting of thyroid nodule ultrasound features. Web-based resource and presentation were used to integrate TI-RADS in reporting thyroid ultrasounds and measure the improvements in comprehensive reporting of thyroid nodules and guiding management. Results: The percentage of thyroid ultrasound reporting using TI-RADS within six months increased from 0% to 27% during the project period. Reports with TI-RADS provided twice as many recommendations compared to reports without TI-RADS. Conclusion: Online TI-RADS calculator and education have successfully facilitated the integration of TI-RADS in thyroid ultrasound reporting to provide more accurate and comprehensive reports and guide management.
文摘Irreversible electroporation(IRE)is a new cancer ablation technology,but methods to improve IRE-induced therapeutic immunity are only beginning to be investigated.We developed a mouse model bearing large primary(300 mm^(3))and medium distant(100 mm^(3))EG7 lymphomas engineered to express ovalbumin(OVA)as a nominal tumor antigen.We established experimental protocols including IRE alone and IRE combined with Toll-like receptor(TLR)3/9 agonists(poly I:C/CpG)(IRE+pIC/CpG),PD-1 blockade(IRE+PD-1 blockade),or both(IRE+Combo)to investigate therapeutic effects on primary and distant EG7 tumors and conversion-promoting effects on the immunotolerant tumor microenvironment(TME).We demonstrated that IRE alone simulated very weak OVA-specific CD8^(+)T cell responses and did not inhibit primary tumor growth.IRE+pIC/CpG synergistically stimulated more efficient OVA-specific CD8^(+)T cell responses and primary tumor growth inhibition than IRE+PD-1 blockade.IRE+pIC/CpG played a major role in the modulation of immune cell profiles but a minor role in the downregulation of PD-L1 expression in the TME and vice versa for IRE+PD-1 blockade.IRE+Combo cooperatively induced potent OVA-specific CD8^(+)T cell immunity and rescued exhausted intratumoral CD8^(+)T cells,leading to eradication of not only primary tumors but also untreated concomitant distant tumors and lung metastases.IRE+Combo efficiently modulated immune cell profiles,as evidenced by reductions in immunotolerant type-2(M2)macrophages,myeloid-derived suppressor-cells,plasmacytoid dendritic cells,and regulatory T cells and by increases in immunogenic M1 macrophages,CD169^(+)macrophages,type-1 conventional dendritic cells,and CD8^(+)T cells,leading to conversion of immunotolerance in not only primary TMEs but also untreated distant TMEs.IRE+Combo also showed effective therapeutic effects in two breast cancer models.Therefore,our results suggest that IRE+Combo is a promising strategy to improve IRE ablation therapy in cancer.
