Interobserver Variability and Diagnostic Performance in US Assessment of Thyroid Nodule According to Size

Park, S. J.; Choi, Yoon Jung; Kim, D. W.; Son, Eun Ju; Lee, H.; Yoon, Jung Hyun; Kim, E.-K.; Moon, Hee Jung; Kwak, Jin Young

doi:10.1055/s-0032-1325404

Cited by 44 publications

(30 citation statements)

References 9 publications

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“…The authors concluded that US surveillance may be appropriate for pediatric nodules stratified to less than high suspicion groups. US is also appealing with low intraobserver variability in performance [35]. It may be also possible to integrate an US stratification scheme with an adapted version of the TIRADS system as the TIRADS system has been well correlated with FNA results in adults [36].…”

Section: Discussionmentioning

confidence: 99%

Ultrasonography and the American Thyroid Association Ultrasound-Based Risk Stratification Tool: Utility in Pediatric and Adolescent Thyroid Nodules

Creo¹,

Alahdab²,

Nofal³

et al. 2018

Horm Res Paediatr

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Background: Pediatric thyroid nodules are more likely to be malignant compared to those in adults and may have different concerning ultrasound (US) features. Recent adult guidelines stratify malignancy risk by US features. Our aim is to (1) describe and confirm US features that predict pediatric malignancy, and (2) apply the Adult American Thyroid Association (ATA) Risk Stratification Guidelines to a large pediatric cohort. Methods: We identified 112 children with 145 thyroid nodules from 1996 to 2015. Two blinded pediatric radiologists independently read all US images, described multiple features, and reported their overall impression: benign, indeterminate, or malignant. Each nodule was assigned an ATA risk stratification category. Radiologists’ impressions and ATA risk stratification were compared to histology and cytology results. Results: Multiple US features including a solid composition, presence of microcalcifications, irregular margins, increased blood flow, and hypoechogenicity were associated with increased odds of malignancy. ATA risk stratification correlated with the radiologists’ overall impression (p < 0.001). The sensitivity for detecting malignancy was comparable between both ATA stratification (91%) and the radiologists’ overall impression (90%). The specificity of the radiologists’ malignant overall impression (80%) was better compared to the ATA high risk stratification (54%). Conclusions: At our institution, pediatric radiologists’ overall impressions had similar sensitivity but better specificity for detecting malignancy than the ATA risk stratification tool by our convention. However, neither US-based methods perfectly discriminated benign from malignant nodules, supporting the continued need for fine needle aspiration for suspicious nodules. Further work is needed to develop an US-based scoring system specific to pediatric patients.

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Section: Discussionmentioning

confidence: 99%

Ultrasonography and the American Thyroid Association Ultrasound-Based Risk Stratification Tool: Utility in Pediatric and Adolescent Thyroid Nodules

Creo¹,

Alahdab²,

Nofal³

et al. 2018

Horm Res Paediatr

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“…We found the poorest interobserver agreement when evaluating for the shape and margin of thyroid nodules, with ICC values of 0.36 and 0.19, respectively. Park et al examined the interobserver variability among 3 radiologists for 400 thyroid nodules and found that composition had the highest agreement, with a kappa value of 0.818, and margins and shape demonstrated the lowest agreement, with kappa values of 0.420 and 0.330, respectively, indicating fair agreement. Similarly, another study reported moderate agreement with regard to shape, echogenicity, calcification, and diagnostic categories (kappa = 0.42, 0.57, 0.55, and 0.55, respectively), and fair agreement for margin, echotexture, and capsule invasion (kappa = 0.34, 0.26, and 0.32, respectively) …”

Section: Discussionmentioning

confidence: 99%

TIRADS Interobserver Variability Among Indeterminate Thyroid Nodules: A Single‐Institution Study

Sahli

Sharma²,

Canner³

et al. 2018

J of Ultrasound Medicine

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Objectives-A high proportion of cytologically indeterminate, Afirma Gene Expression Classifier "suspicious" thyroid nodules are benign. The Thyroid Imaging Reporting and Data System (TIRADS), was proposed by the American College of Radiology in 2017 to help classify thyroid nodules based on ultrasound characteristics in a standardized fashion to guide management. We aim to determine the interobserver variability of TIRADS classification among cytologically indeterminate and Afirma suspicious nodules.Methods-We retrospectively queried cytopathology archives for thyroid fineneedle aspiration specimens obtained between February 2012 and September 2016 with associated (1) indeterminate diagnosis, (2) ultrasound imaging at our institution, (3) Afirma suspicious result, and (4) surgery at our institution. We compared the TIRADS variability of the 3 blinded radiologists using intraclass correlation coefficients.Results-Our cohort consisted of 127 nodules. Intraclass correlation coefficients can be interpreted as follows: less than 0.4, poor; 0.4 to 0.59, fair; 0.6 to 0.74, good; 0.75 to 1.00, excellent. The intraclass correlation coefficients of the raw TIRADS score and category variability was 0.561 (95% confidence interval [CI]: 0.464-0.651) or fair and 0.547 (95% CI, 0.449-0.640) or fair, respectively. When analyzing composition, echogenicity, shape, margin, and echogenic foci, the ICCs were 0.552 (95% CI, 0.454-0.643), fair; 0.533 (95% CI, 0.432-0.627), fair; 0.359 (95% CI, 0.248-0.469), poor; 0.192 (95% CI, 0.084-0.308), poor; and 0.549 (95% CI, 0.451-0.641), fair, respectively.Conclusions-Our results show that among the subset of cytologically indeterminate and Afirma suspicious nodules, TIRADS interobserver variability was fair. Shape and margin criteria were the biggest sources of disagreement. Large prospective studies are needed to evaluate the interobserver variability of TIRADS in this subset of thyroid nodules.

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“…Fifth, molecular markers such as BRAF V600E or RAS mutations are known to be helpful in the differential diagnosis of AUS/FLUS lesions, but were not used in our study. Lastly, 16 radiologists were involved in US examinations and image analysis, and interobserver variability among radiologists may have existed . Similarly, 5 cytopathologists were involved in cytological interpretation and the initial diagnosis of AUS/FLUS.…”

Section: Discussionmentioning

confidence: 99%

“…Lastly, 16 radiologists were involved in US examinations and image analysis, and interobserver variability among radiologists may have existed. [38][39][40] Similarly, 5 cytopathologists were involved in cytological interpretation and the initial diagnosis of AUS/FLUS. Although the Bethesda System provides standardized diagnostic terminology for thyroid cytopathology, morphological interpretation still remains subjective and interpretation of results has been known to vary significantly among readers, especially in nodules of indeterminate categories, 12,41,42 which may have affected our results.…”

Section: Discussionmentioning

confidence: 99%

Subcategorization of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS): a study applying Thyroid Imaging Reporting and Data System (TIRADS)

Yoon

Kwon

Kim

et al. 2016

Clinical Endocrinology

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Interobserver Variability and Diagnostic Performance in US Assessment of Thyroid Nodule According to Size

Abstract: Interobserver agreements were relatively good (k = 0.637) in final US assessment regardless of nodule size in experienced radiologists. High false-positive rate was observed in US assessment in nodules less than 5 mm in maximum diameter.

Cited by 44 publications

References 9 publications

Ultrasonography and the American Thyroid Association Ultrasound-Based Risk Stratification Tool: Utility in Pediatric and Adolescent Thyroid Nodules

Ultrasonography and the American Thyroid Association Ultrasound-Based Risk Stratification Tool: Utility in Pediatric and Adolescent Thyroid Nodules

TIRADS Interobserver Variability Among Indeterminate Thyroid Nodules: A Single‐Institution Study

Subcategorization of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS): a study applying Thyroid Imaging Reporting and Data System (TIRADS)

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