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Purpose To compare the biopsy rate and diagnostic accuracy before and after applying the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) criteria for thyroid nodule evaluation. Materials and Methods In this retrospective study, eight radiologists with 3-32 years experience in thyroid ultrasonography (US) reviewed US features of 100 thyroid nodules that were cytologically proven, pathologically proven, or both in December 2016. The radiologists evaluated nodule features in five US categories and provided biopsy recommendations based on their own practice patterns without knowledge of ACR TI-RADS criteria. Another three expert radiologists served as the reference standard readers for the imaging findings. ACR TI-RADS criteria were retrospectively applied to the features assigned by the eight radiologists to produce biopsy recommendations. Comparison was made for biopsy rate, sensitivity, specificity, and accuracy. Results Fifteen of the 100 nodules (15%) were malignant. The mean number of nodules recommended for biopsy by the eight radiologists was 80 ± 16 (standard deviation) (range, 38-95 nodules) based on their own practice patterns and 57 ± 11 (range, 37-73 nodules) with retrospective application of ACR TI-RADS criteria. Without ACR TI-RADS criteria, readers had an overall sensitivity, specificity, and accuracy of 95% (95% confidence interval [CI]: 83%, 99%), 20% (95% CI: 16%, 25%), and 28% (95% CI: 21%, 37%), respectively. After applying ACR TI-RADS criteria, overall sensitivity, specificity, and accuracy were 92% (95% CI: 68%, 98%), 44% (95% CI: 33%, 56%), and 52% (95% CI: 40%, 63%), respectively. Although fewer malignancies were recommended for biopsy with ACR TI-RADS criteria, the majority met the criteria for follow-up US, with only three of 120 (2.5%) malignancy encounters requiring no follow-up or biopsy. Expert consensus recommended biopsy in 55 of 100 nodules with ACR TI-RADS criteria. Their sensitivity, specificity, and accuracy were 87% (95% CI: 48%, 98%), 51% (95% CI: 40%, 62%), and 56% (95% CI: 46%, 66%), respectively. Conclusion ACR TI-RADS criteria offer a meaningful reduction in the number of thyroid nodules recommended for biopsy and significantly improve the accuracy of recommendations for nodule management. RSNA, 2018 Online supplemental material is available for this article.

Accepted for publication 9 February 1989. tumour. These findings were then analysed in relation to operative and eventual outcome. MethodsAll endoscopically removed neoplastic colorectal polyps greater than 1 cm diameter were retrieved from three hospitals in the West Midlands for the five year period 1981 to 1985. A total of 367 neoplastic polyps were examined. All slides and reports were reviewed by two pathologists (SM and JN). The majority of polyps, 297, were completely removed small adenomas showing only mild or moderate dysplasia. A further 36 showed severe dysplasia, and the remaining 34 showed invasive carcinoma.The 34 polyps with invasive carcinoma were subjected to further study. Excluded from this study were polyps arising in patients with a known colorectal carcinoma (past or synchronous), familial adenomatous polyposis, and cases without full follow up details.The adenomatous element was classified as either tubular, tubulovillous, or villous according to standard histopathologic criteria. Other factors noted were the degree of epithelial dysplasia, the degree of differentiation of the carcinoma (well, moderately, 1385 on 10 May 2018 by guest. Protected by copyright.

An unusual case of intestinal spirochaetosis is described. The rectum of a 34-year-old male, suffering from Crohn's disease and ankylosing spondylitis, was heavily infested by spirochaetes. Both absorptive and goblet cells were colonized. Spirochaetes were found not only on the luminal surface of these cells, but also within the cytoplasm, in occasional macrophages within the lamina propria and, even more surprisingly, within the occasional Schwann cell. The significance of these findings is discussed.

Using a silver staining technique, nucleolar organizer region-associated proteins (AgNORs) have been studied in paraffin sections of 15 benign gastric ulcers, seven early gastric cancers, 13 gastric adenocarcinomas and 10 control cases. A significant difference in the mean number of AgNORs per nucleus was found when control and benign groups were compared with the malignant group. However, there was an overlap between each category. Further studies are warranted to determine if this may be of value in differentiating regenerative epithelium from early malignancy.