Diagnostic performances and interobserver agreement according to observer experience: a comparison study using three guidelines for management of thyroid nodules

2017 ◽  
Vol 59 (8) ◽  
pp. 917-923 ◽  
Author(s):  
Jieun Koh ◽  
Soo-Yeon Kim ◽  
Hye Sun Lee ◽  
Eun-Kyung Kim ◽  
Jin Young Kwak ◽  
...  
Keyword(s):  
Interobserver Agreement ◽  
Thyroid Nodules ◽  
Lower Sensitivity ◽  
American Thyroid Association ◽  
Comparison Study ◽  
The Us ◽  
Observer Experience ◽  
Level Of Experience ◽  
Group Agreement ◽  
Higher Sensitivity

Background The differences regarding categorization of thyroid nodules among different guidelines may affect the diagnostic performances and agreement among observers. Purpose To compare the diagnostic performances and agreements between observers with various degree of experience when applying different guidelines for stratifying thyroid nodules using suspicious ultrasonography (US) features. Material and Methods This retrospective study included 370 thyroid nodules (≥10 mm). Four observers, grouped as experienced and inexperienced, evaluated the US features and made final assessments according to the Kim criteria, Thyroid Imaging Reporting and Data System (TIRADS) by Kwak et al., and the 2015 American Thyroid Association (ATA) guideline. Diagnostic performances and agreements among the two groups were compared. Results The Kim criteria shows higher specificity with significantly lower sensitivity when compared to TIRADS and the 2015 ATA guideline (all P < 0.001), regardless of the level of experience. The experienced group showed significantly higher specificity with the Kim criteria and the 2015 ATA guideline compared to the inexperienced group ( P < 0.001), and the inexperienced group showed significantly higher sensitivity using the Kim criteria ( P = 0.002). The experienced group showed significantly higher agreement than the inexperienced group when using TIRADS while higher agreement was seen when using the 2015 ATA guideline for the inexperienced group. Agreement was not significantly different for the Kim criteria according to observer experience. Conclusion The diagnostic performances and agreements show significant differences in risk stratification of thyroid nodules according to the three guidelines using suspicious US features and the level of experience of the observer.

scholarly journals ACR TI-RADS and ATA US scores are helpful for the management of thyroid nodules with indeterminate cytology

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Thayse Lozovoy Madsen Barbosa ◽  
Cleo Otaviano Mesa Junior ◽  
Hans Graf ◽  
Teresa Cavalvanti ◽  
Marcus Adriano Trippia ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Needle Aspiration ◽  
Molecular Testing ◽  
American Thyroid Association ◽  
Institutional Review ◽  
The Us ◽  
Risk Of Malignancy ◽  
Indeterminate Cytology

Abstract Background Cytologically indeterminate thyroid nodules currently present a challenge for clinical decision-making. The main aim of our study was to determine whether the classifications, American College of Radiology (ACR) TI-RADS and 2015 American Thyroid Association (ATA) guidelines, in association with The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), could be used to stratify the malignancy risk of indeterminate thyroid nodules and guide their clinical management. Methods The institutional review board approved this retrospective study of a cohort of 140 thyroid nodules in 139 patients who were referred to ultrasound-guided fine-needle aspiration cytology (FNAC) from January 2012 to June 2016 with indeterminate cytological results (44 Bethesda III, 52 Bethesda IV and 44 Bethesda V) and in whom pre-FNAC thyroid US images and histological results after surgery were available. Each included nodule was classified by one radiologist blinded to the cytological and histological diagnoses according to the ACR TIRADS scores and the US patterns as recommended in the 2015 ATA guidelines. The risk of malignancy was estimated for Bethesda, TI-RADS scores, ATA US patterns and their combination. Results Of the 140 indeterminate thyroid nodules examined, 74 (52.9%) were histologically benign. A different rate of malignancy (p < 0.001) among Bethesda III, IV and V was observed. The rate of malignancy increased according to the US suspicion categories (p < 0.001) in both US classifications (TI-RADS and ATA). Thyroid nodules classified as Bethesda III and the lowest risk US categories (very low, low and intermediate suspicion by ATA and 2, 3 and 4a by TI-RADS) displayed a sensitivity of 95.3% for both classifications and a negative predictive value of 94.3 and 94.1%, respectively. The highest risk US categories (high suspicion by ATA and 4b,4c and 5 by TI-RADS) were significantly associated with cancer (odds ratios [ORs] 14.7 and 9.8, respectively). Conclusions Ultrasound classifications, ACR TI-RADS and ATA guidelines, may help guide the management of indeterminate thyroid nodules, suggesting a conservative approach to nodules with low-risk US suspicion and Bethesda III, while molecular testing and surgery should be considered for nodules with high-risk US suspicion and Bethesda IV or V.

scholarly journals Taller-Than-Wide Shape: A New Definition Improves the Specificity of TIRADS Systems

2019 ◽  
Vol 9 (2) ◽  
pp. 85-91 ◽  
Author(s):  
Giorgio Grani ◽  
Livia Lamartina ◽  
Valeria Ramundo ◽  
Rosa Falcone ◽  
Cristiano Lomonaco ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Diagnostic Performance ◽  
Thyroid Nodules ◽  
Negative Impact ◽  
Lower Sensitivity ◽  
Intraobserver Variability ◽  
Transverse Diameter ◽  
American Thyroid Association ◽  
Alternative Definition ◽  
The Impact

Introduction: A taller-than-wide (TTW) shape is a suspicious feature of thyroid nodules commonly defined as an anteroposterior/transverse diameter (AP/T) ratio >1. An intraobserver variability of up to 18% in AP diameter evaluations has been described, which may lead to overreporting of this feature. To potentially improve the reliability of the TTW definition, we propose an arbitrary ratio of ≥1.2. Objective: The aim of this study was to estimate the impact of this definition on diagnostic performance. Methods: We prospectively analyzed 553 thyroid nodules referred for cytology evaluation at an academic center. Before fine-needle aspiration, two examiners jointly defined all sonographic features considered in risk stratification systems developed by the American Thyroid Association (ATA), the American Association of Clinical Endocrinologists (AACE), the American College of Radiology (ACR TIRADS), the European Thyroid Association (EU-TIRADS), and the Korean Society of Thyroid Radiology (K-TIRADS). TTW was defined according to the current definition (AP/T diameter ratio >1) and an arbitrary alternative definition (AP/T ratio >1.2). Results: The alternative definition classified fewer nodules as TTW (28, 5.1% vs. 94, 17%). The current and proposed definitions have a sensitivity of 26.2 and 11.9% (p = 0.03) and a specificity of 83.8 and 95.5% (p < 0.001). Thus, as a single feature, the arbitrary definition has a lower sensitivity and a higher specificity. When applied to sonographic risk stratification systems, however, the proposed definition would increase the number of avoided biopsies (up to 58.2% for ACR TIRADS) and the specificity of all systems, without negative impact on sensitivity or diagnostic odds ratio. Conclusions: Re-defining TTW nodules as those with an AP/T ratio ≥1.2 improves this marker’s specificity for malignancy. Using this definition in risk stratification systems will increase their specificity, reducing the number of suggested biopsies without significantly diminishing their overall diagnostic performance.

scholarly journals Comparison of Four Ultrasonography-Based Risk Stratification Systems in Thyroid Nodules with Nondiagnostic/Unsatisfactory Cytology: A Real-World Study

Cancers ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1948
Author(s):  
You-Bin Lee ◽  
Young-Lyun Oh ◽  
Jung-Hee Shin ◽  
Sun-Wook Kim ◽  
Jae-Hoon Chung ◽  
...  
Keyword(s):  
Roc Curve ◽  
Thyroid Nodules ◽  
Positive Likelihood Ratio ◽  
Roc Curves ◽  
The Other ◽  
American Thyroid Association ◽  
Data Systems ◽  
Malignancy Rate ◽  
Line P ◽  
The Eu

We compared American Thyroid Association (ATA) guidelines, Korean (K)-Thyroid Imaging, Reporting and Data Systems (TIRADS), EU-TIRADS, and American College of Radiology (ACR) TIRADS in diagnosing malignancy for thyroid nodules with nondiagnostic/unsatisfactory cytology. Among 1143 nondiagnostic/unsatisfactory aspirations from April 2011 to March 2016, malignancy was detected in 39 of 89 excised nodules. The minimum malignancy rate was 7.82% in EU-TIRADS 5 and 1.87–3.00% in EU-TIRADS 3–4. In the other systems, the minimum malignancy rate was 14.29–16.19% in category 5 and ≤3% in the remaining categories. Although the EU-TIRADS category ≥ 5 exhibited the highest positive likelihood ratio (LR) of only 2.214, category ≥ 5 in the other systems yielded the highest positive LR of >5. Receiver operating characteristic (ROC) curves of all systems to predict malignancy were located statistically above the diagonal nondiscrimination line (P for ROC curve: EU-TIRADS, 0.0022; all others, 0.0001). The areas under the ROC curve (AUCs) were not significantly different among the four systems. The ATA guidelines, K-TIRADS, and ACR TIRADS may be useful to guide management for nondiagnostic/unsatisfactory nodules. The EU-TIRADS, although also useful, exhibited inferior performance in predicting malignancy for nondiagnostic/unsatisfactory nodules in Korea, an iodine-sufficient area.

scholarly journals Systematic differences between ultrasound and pathological evaluation of thyroid nodules: a method comparison study

2017 ◽  
Vol 88 (5) ◽  
pp. 464-467
Author(s):  
Carolyn R. Chew ◽  
Tracey Lam ◽  
Steven T. F. Chan ◽  
Laura Chin-Lenn
Keyword(s):  
Thyroid Nodules ◽  
Method Comparison ◽  
Comparison Study ◽  
Pathological Evaluation ◽  
Method Comparison Study

scholarly journals Managing Thyroid Nodules in Qatar During the COVID19 Pandemic

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A841-A842
Author(s):  
Zaina Alamer ◽  
Gowri Karuppasamy ◽  
Arwa Alsaud ◽  
Tania Jaber ◽  
Hanan Farghaly ◽  
...  
Keyword(s):  
High Risk ◽  
Early Detection ◽  
Fine Needle Aspiration ◽  
Medical Staff ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Morbidity And Mortality ◽  
American Thyroid Association ◽  
Fine Needle ◽  
Thyroid Fine Needle Aspiration

Abstract Background: The Coronavirus disease 2019 (COVID-19) pandemic impacted health care systems in all countries, including Qatar. Hamad Medical Corporation (HMC); In compliance with recommendations, suspended all non-urgent procedures, including thyroid fine needle aspiration biopsies (FNAB). Thyroid nodules are second most common cause of referral to HMC endocrine clinic. FNABs are gold standard to differentiate benign from malignant nodules.1- 2 Methods: Our approach includes a teleconsultation to obtain patient’s history and risk factors. Reviewing neck ultrasound (US), obtaining a calcitonin level if indicated, considering comorbidities associated with a high risk of COVID-19 morbidity and mortality.3 Results: We developed a pathway triaging thyroid (FNAB) to:1-Urgent: patients at higher risk of aggressive thyroid malignancy. Benefits of early detection and treatment outweigh the risk of COVID-19 exposure.4 FNAB should not be delayed.2-Semi-urgent: patients at low risk for COVID-19 and high suspicion thyroid nodules, but no evidence that early detection improves survival2, FNAB may be delayed up to 12 months.3-Non-urgent: patients with asymptomatic nodules that have low or intermediate suspicion US pattern.2 Also, includes nodules with ATA high suspicion US pattern in pregnant women and patients at high risk for COVID-19. The risks outweigh the benefits. FNAB should be delayed until outbreak is controlled.4 When urgent FNAB is indicated, safety of patients and medical staff needs to be addressed.5 We recommend testing patient for COVID-19 before FNAB, utilizing US guidance with rapid on-site adequacy evaluation in all cases. Cervical lymph node FNAB with TG washout should be done if indicated. The patient should wear a mask. All medical staff involved should wear personal protective equipment (PPE). The operator should wear N95 mask and face shield. The patient should be informed about cytopathology results via telemedicine. Conclusion: Triaging thyroid (FNAB) during the COVID-19 pandemic should be based on nodule characteristics and risk of COVID-19 morbidity and mortality. Our group recommends deferring FNAB for asymptomatic patients.4FNAB should not be delayed in selected patients who benefit from early detection and intervention. Table1: Triage of Thyroid fine needle aspiration biopsies (FNAB). ATA: American thyroid association. US: ultrasound.

Sign in / Sign up

Export Citation Format

Share Document