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Additional detection of Bethesda greater than or equal to III cytology in cold thyroid nodules beyond American College of Radiology Thyroid Imaging Reporting and Data System risk stratification

2026-05-18T00:00:00Z

Title: Additional detection of Bethesda greater than or equal to III cytology in cold thyroid nodules beyond American College of Radiology Thyroid Imaging Reporting and Data System risk stratification Authors: Lavender I.; Nandurkar D. Abstract: Background Cold thyroid nodules identified on nuclear medicine scintigraphy have historically been associated with increased malignancy risk. However, contemporary practice relies primarily on ultrasound risk stratification systems such as the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) to guide fine needle aspiration (FNA). The additional value of scintigraphy beyond ultrasound risk stratification remains uncertain. Aim To determine whether scintigraphy identifies nodules with Bethesda greater than or equal to III cytology beyond ACR TI-RADS FNA criteria. Methods A retrospective review of thyroid nodules undergoing ultrasound, nuclear medicine scintigraphy, and FNA was performed. Nodules with reduced uptake were classified as cold nodules. Cytology was classified using the Bethesda System, with Bethesda greater than or equal to III considered clinically significant. Results A total of 235 cold thyroid nodules were identified. Of these, 169 met ACR TI-RADS FNA criteria, with 34 (20.1%) demonstrating Bethesda greater than or equal to III cytology. Sixty-six nodules below TI-RADS FNA thresholds underwent FNA because of cold scintigraphic findings, of which seven (10.6%) demonstrated Bethesda greater than or equal to III cytology. Overall, seven of 41 nodules (17.1%) with Bethesda greater than or equal to III cytology were identified solely because of scintigraphic appearance. Conclusion Most Bethesda greater than or equal to III cytology occurred in nodules already meeting ACR TI-RADS FNA criteria. Cold scintigraphy identified few additional nodules below ultrasound FNA thresholds, suggesting limited additional detection beyond ultrasound risk stratification.

Predicting visual function before glaucoma onset from baseline optical coherence tomography scans using deep learning.

2026-04-22T00:00:00Z

Title: Predicting visual function before glaucoma onset from baseline optical coherence tomography scans using deep learning. Authors: Chaurasia A.K.; Wang C.; Toohey P.W.; Chen C.Y.; MacGregor S.; Bennett M.T.; Verma N.; Craig J.E.; McCartney P.J.; Sarossy M.G.; Hewitt A.W. Abstract: Background The visual field (VF) test results of many eyes with glaucoma progress despite treatment. This suggests that some eyes are either untreated or that the management of intraocular pressure (IOP) does not influence the outcome. In this work, we explore whether future VF parameters can be predicted from a baseline optical coherence retinal nerve fibre layer (OCT-RNFL) scan using a deep learning model. Methods The model was developed using 1792 eyes from 1610 patients, and externally validated on 151 eyes from a second centre using the same Zeiss Cirrus machine and 281 eyes from a third centre using scans obtained from a different (Heidelberg Spectralis) machine. The Vision Transformers (ViT)-based regression model was trained on baseline OCT-RNFL scans to predict three key VF indices (follow-up interval: 4.74 +/- 2.59 years). Model performance was evaluated using Mean Absolute Error (MAE) and Root Mean Square Error (RMSE), with 95% confidence intervals (CI). Results The model achieved an overall MAE of 2.07 (95% CI: 1.91-2.22) and RMSE of 2.87 (95% CI: 2.60-3.14) on the internal validation set. On external validation, the model showed comparable performance with an MAE of 2.07 (95% CI: 1.8-2.35) for the external validation (Zeiss OCT) cohort and 2.11 (95% CI: 1.93-2.31) for the external validation (Heidelberg OCT) cohort. Saliency maps revealed that the inner and outer RNFL layers were key structures in driving the model's predictions. Conclusions Our ViT-based regression model effectively predicts key VF indices objectively from a single OCT-RNFL scan, with strong performance across two OCT devices, offering a novel tool for predicting glaucoma progression.Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license.

Role of Lifestyle and Risk Factor Modification Clinics in Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

2026-04-24T00:00:00Z

Title: Role of Lifestyle and Risk Factor Modification Clinics in Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Authors: Zhao Y.; Ha F.J.; Brown A.J.; Nerlekar N. Abstract: Background Incidence and recurrence of atrial fibrillation (AF) is associated with several lifestyle risk factors. Lifestyle and risk factor modification (LRFM) clinics could have a role in comprehensively addressing AF from a holistic patient-centred approach to improve clinical outcomes. Methods We performed a systematic review and meta-analysis of randomised controlled trials (RCTs) evaluating the role of LRFM clinics compared with usual care (UC) in patients with AF. The primary endpoint was atrial arrhythmia recurrence. Secondary endpoints were AF and heart failure (HF) related hospitalisation, cardiovascular death, stroke or transient ischaemic attack (TIA), and quality-of-life (QOL). Results A total of eleven RCTs with a total of 3364 patients were included (five RCTs performed in the context of AF ablation). Mean age was 58-73 years, 30% were female and 18% had persistent AF. Duration of follow-up ranged from 3-24 months. LRFM clinics significantly reduced the primary endpoint of arrhythmia recurrence compared with UC after catheter ablation (OR 0.34, 95% CI 0.23-0.51, p<0.001, I2=0%). LRFM clinics also reduced AF-related hospitalisation (OR 0.70, 95%CI 0.51-0.98, p=0.04, I2=21%) and improved QOL (mean improvement on Short Form 36 Questionnaire 8.90, 95% CI 7.6.91-10.90, p<0.001). There was no difference between LRFM clinics and UC for HF-related hospitalisation (p=0.16), cardiovascular deaths (p=0.79) or stroke/TIA (p=0.83). Conclusion In this meta-analysis of RCTs, LRFM clinics reduced AF recurrence after ablation, reduced AF-related hospitalisation and improved QOL. This study supports a comprehensive multidisciplinary lifestyle risk modification model of care to improve clinical outcomes in patients with AF.Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission.

Quality Matters: Linking Patterns of Care to Ovarian Cancer Survival in a National Gynae-Oncology Registry.

2026-04-21T00:00:00Z

Title: Quality Matters: Linking Patterns of Care to Ovarian Cancer Survival in a National Gynae-Oncology Registry. Authors: Naidoo M.; McNally O.; Scott C.L.; Friedlander M.; Cohen P.A.; Perera S.; Lloyd M.; Brand A.; Richardson G.; Bunting M.; Mohan R.; Oehler M.; Hyde S.; Jobling T.; Farrell R.; Rome R.; Zalcberg J. Abstract: PURPOSE - Ovarian cancer (OC) is a leading cause of gynecologic cancer mortality, with poor survival rates for advanced-stage disease. Comprehensive national data detailing contemporary patterns of care remain scarce. This study uses data from Australia's National Gynae-Oncology Registry (NGOR) to delineate current patterns of care against clinical quality indicators (CQIs) and correlate adherence to these measures with overall survival (OS).METHODS - This prospective study analyzed NGOR data for women with newly diagnosed epithelial OC across 47 sites between April 2017 and March 2024. Adherence to 15 predefined CQIs was assessed. OS, adjusted for key prognostic factors (Eastern Cooperative Oncology Group, age, stage, comorbidity), was estimated using Cox proportional hazards regression.RESULTS - A total of 3, 133 patients were included. In an adjusted multivariate analysis, significantly improved OS was associated with receiving first-line platinum-taxane doublet chemotherapy (hazard ratio [HR], 0.57 [95% CI, 0.47 to 0.68], P < .001), undergoing germline or somatic BRCA1/2 testing (HR, 0.66 [95% CI, 0.56 to 0.78], P < .001), and achieving no macroscopic residual disease after primary (HR, 0.48 [95% CI, 0.34 to 0.68], P < .001) or interval debulking surgery (HR, 0.56 [95% CI, 0.44 to 0.71], P < .001). Adjusted 5-year OS rates for International Federation of Gynecology and Obstetrics stages I, II, III, and IV were 87%, 76%, 42%, and 28%, respectively.CONCLUSION - This national registry reveals variations in CQI adherence. While survival for advanced-stage disease has improved, it remains suboptimal. Adherence to specific quality indicators-notably optimal surgical cytoreduction, standard first-line chemotherapy, and genetic testing-is significantly associated with improved survival. Continuous monitoring and targeted quality improvement initiatives are essential for enhancing survival for women with OC.Copyright © 2026 by American Society of Clinical Oncology