TY - JOUR
T1 - TIRADS interobserver variability among indeterminate thyroid nodules
T2 - A single-institution study
AU - Sahli, Zeyad T.
AU - Sharma, Ashwyn K.
AU - Canner, Joseph K.
AU - Karipineni, Farah
AU - Ali, Osama
AU - Kawamoto, Satomi
AU - Hang, Jen Fan
AU - Mathur, Aarti
AU - Ali, Syed Z.
AU - Zeiger, Martha A.
AU - Sheth, Sheila
N1 - Publisher Copyright:
© 2018 by the American Institute of Ultrasound in Medicine.
PY - 2019/7
Y1 - 2019/7
N2 - 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 fine-needle 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.
AB - 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 fine-needle 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.
KW - Endocrine surgery
KW - Indeterminate nodules
KW - Interobserver variability
KW - TIRADS
KW - Thyroid
KW - —Afirma
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U2 - 10.1002/jum.14870
DO - 10.1002/jum.14870
M3 - Article
C2 - 30467876
AN - SCOPUS:85067367446
SN - 0278-4297
VL - 38
SP - 1807
EP - 1813
JO - Journal of Ultrasound in Medicine
JF - Journal of Ultrasound in Medicine
IS - 7
ER -