title: Increasing diagnostic accuracy for thyroid nodules by an integrated multivariate approach: a methodological study.
abstract: OBJECTIVE
  Current guidelines for diagnostic management of thyroid nodules are based on a linear approach, using categorial classifications to cluster diagnostic findings and they still lead to unnecessary surgery. A diagnostic scoring system, based on clinical, cytological and ultrasound findings is described.
  
  
  METHODS
  Two groups of patients (168 and 55 pts) were used to compute a multivariate model and the discriminating threshold by ROC curves. The performance of the derived scoring system was assessed by a simulation on a third group of 60 patients, who had undergone surgery according to current guidelines.
  
  
  RESULTS
  The scoring system displayed a sensitivity of 100%, specificity 53.3%, positive and negative predictive values of 68.1% and 100%. According to the scoring system, 16 out of 60 operations would have been saved.
  
  
  CONCLUSIONS
  A scoring system can take into account in a more accurate way the full informative content of the fine-grained description of diagnostic and clinical features.
authors: Depts of Surgery, "Sapienza" University, Rome, Italy. fabrizio.consorti@uniroma1.it
authors: F
authors: F
authors: Consorti
authors: V
authors: V
authors: Cozza
authors: M
authors: M
authors: Loponte
authors: S
authors: S
authors: Mardente
authors: F
authors: F
authors: Milazzo
authors: L
authors: L
authors: Scardella
authors: A
authors: A
authors: Antonaci
mesh_terms: D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D003661:Decision Support Techniques; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013959:Thyroid Diseases / Q000175:diagnosis; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000601:surgery; D016606:Thyroid Nodule / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy; D014463:Ultrasonography; D019564:Unnecessary Procedures