478 chapter 12 Diagnostic accuracy The sensitivity of MD was 80% as compared to 93% of [18F]FDG-PET/CT (p=0.13). Specificity and BCR were higher for MD than [18F]FDG-PET/CT (p<0.001 and p<0.001, respectively) (Table 2). When the performance of [18F]FDG-PET/CT and MD were combined in non-oncocytic nodules (Table 3b), a MD-/[18F]FDG- test yielded 95% sensitivity, statistically similar to MD (p=0.06) and [18F]FDGPET/CT (p=1). Specificity of a MD-/[18F]FDG- test was lower than of MD (p<0.001) and [18F]FDG-PET/CT (p=0.03). A MD+/[18F]FDG+ test had 68% sensitivity, similar to MD (p=1) and [18F]FDG-PET/CT (p=0.06). Its 86% specificity was higher than the specificity of MD (p=0.03) or [18F]FDG-PET/CT (p<0.001). When the results of all successful MD (i.e., on cytology or histopathology, n=130, Figure 2) were considered, a similar 85% (95% CI, 69%-95%) sensitivity and 67% (56%-76%) specificity were Table 2. Test performance of MD and [18F]FDG-PET/CT in nodules with successful MD on cytology a. all nodules (n=115) MD [18F]FDG-PET/CT A priori ROM 26% Histopathology P value Test result Malignant or borderline Benign Malignant or borderline Benign Positive 24 26 28 50 Negative 6 59 2 35 MD on cytology (n=115), assuming nodules under active surveillance are benign, % (95% CI) Sensitivity 80 (61-92) 93 (78-99) .13 Specificity 69 (59-79) 41 (31-52) <0.001 PPV 48 (34-63) 36 (25-48) NPV 91 (81-97) 95 (82-99) BCR 57 (47-66) 32 (24-42) <0.001 MD on cytology, surgically confirmed cases (n=92), % (95% CI) Sensitivity 80 (61-92) 93 (78-99) .13 Specificity 66 (53-78) 24 (14-37) <0.001 PPV 53 (38-68) 37 (26-49) NPV 87 (74-95) 88 (64-99) b. non-oncocytic nodules, AUS+FN cytology (n=86) MD [18F]FDG-PET/CT A priori ROM 26% Histopathology P value Test result Malignant or borderline Benign Malignant or borderline Benign Positive 17 15 20 30 Negative 5 49 2 34 MD on cytology (n=86), assuming nodules under active surveillance are benign, % (95% CI) Sensitivity 77 (55-92) 91 (71-99) .22 Specificity 77 (64-86) 53 (40-66) .01 PPV 53 (35-71) 40 (26-55) NPV 91 (80-97) 94 (81-99) BCR 63 (52-73) 42 (31-53)
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