Considerable interobserver variation calls for unambiguous definitions of thyroid nodule ultrasound characteristics

Author:

Solymosi Tamas12,Hegedűs Laszlo3,Bonnema Steen J3,Frasoldati Andrea4,Jambor Laszlo5,Karanyi Zsolt2,Kovacs Gabor L6,Papini Enrico7,Rucz Karoly8,Russ Gilles9,Nagy Endre V2ORCID

Affiliation:

1. Endocrinology and Metabolism Clinic, Bugat Hospital, Gyöngyös, Hungary

2. Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

3. Department of Endocrinology, Odense University Hospital, Odense, Denmark

4. Endocrinology Unit of Arcispedale S Maria Nuova, Reggio Emilia, Italy

5. Department of Radiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

6. 1st Department of Medicine, Flohr Ferenc Hospital, Kistarcsa, Hungary

7. Regina Apostolorum Hospital in Albano, Rome, Italy

8. 1st Department of Medicine, University of Pecs, Pecs, Hungary

9. Unité Thyroïde et Tumeurs Endocrines – Pr Leenhardt Hôpital La Pitie Salpetriere, Sorbonne Université, Paris, France

Abstract

Objective Thyroid nodule ultrasound characteristics are used as an indication for fine-needle aspiration cytology, usually as the basis for Thyroid Imaging Reporting and Data System (TIRADS) score calculation. Few studies on interobserver variation are available, all of which are based on analysis of preselected still ultrasound images and often lack surgical confirmation. Methods After the blinded online evaluation of video recordings of the ultrasound examinations of 47 consecutive malignant and 76 consecutive benign thyroid lesions, 7 experts from 7 thyroid centers answered 17 TIRADS-related questions. Surgical histology was the reference standard. Interobserver variations of each ultrasound characteristic were compared using Gwet’s AC1 inter-rater coefficients; higher values mean better concordance, the maximum being 1.0. Results On a scale from 0.0 to 1.0, the Gwet’s AC1 values were 0.34, 0.53, 0.72, and 0.79 for the four most important features in decision-making, i.e. irregular margins, microcalcifications, echogenicity, and extrathyroidal extension, respectively. The concordance in the discrimination between mildly/moderately and very hypoechogenic nodules was 0.17. The smaller the nodule size the better the agreement in echogenicity, and the larger the nodule size the better the agreement on the presence of microcalcifications. Extrathyroidal extension was correctly identified in just 45.8% of the cases. Conclusions Examination of video recordings, closely simulating the real-world situation, revealed substantial interobserver variation in the interpretation of each of the four most important ultrasound characteristics. In view of the importance for the management of thyroid nodules, unambiguous and widely accepted definitions of each nodule characteristic are warranted, although it remains to be investigated whether this diminishes observer variation.

Publisher

Bioscientifica

Subject

Endocrinology, Diabetes and Metabolism

Reference51 articles.

1. Clinical practice. The thyroid nodule;Hegedüs,2004

2. Thyroid nodules;Burman,2016

3. Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules;Todsen,2021

4. 2021 Korean thyroid imaging reporting and data system and imaging-based management of thyroid nodules: Korean Society of Thyroid Radiology consensus statement and recommendations;Ha,2021

5. 2020 Chinese guidelines for ultrasound malignancy risk stratification of thyroid nodules: the C-TIRADS;Zhou,2020

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