目的:细胞学不确定的比例很高,Afirma基因表达分类器“可疑”甲状腺结节是良性的。甲状腺成像报告和数据系统(TIRADS),由美国放射学会于2017年提出,以标准化的方式帮助根据超声特征对甲状腺结节进行分类,以指导管理.我们的目的是确定TIRADS分类在细胞学不确定和Afirma可疑结节中的观察者间差异。
方法:我们回顾性地查询了2012年2月至2016年9月期间获得的甲状腺细针穿刺标本的细胞病理学档案,这些标本具有(1)不确定的诊断,(2)我们机构的超声成像,(3)确认可疑结果,和(4)我们机构的手术。我们使用组内相关系数比较了3名盲放射科医生的TIRADS变异性。
结果:我们的队列包括127个结节。组内相关系数可以解释为:小于0.4,差;0.4至0.59,一般;0.6至0.74,良好;0.75至1.00,优。原始TIRADS评分和类别变异性的组内相关系数为0.561(95%置信区间[CI]:0.464-0.651)或公平,0.547(95%CI,0.449-0.640)或公平,分别。在分析成分时,回声,形状,margin,和回声病灶,ICC为0.552(95%CI,0.454-0.643),公平;0.533(95%CI,0.432-0.627),公平;0.359(95%CI,0.248-0.469),差;0.192(95%CI,0.084-0.308),差;和0.549(95%CI,0.451-0.641),公平,分别。
结论:我们的结果表明,在细胞学不确定和Afirma可疑结节的子集中,TIRADS观察者间的变异性是公平的。形状和保证金标准是最大的分歧来源。需要进行大型前瞻性研究来评估TIRADS在该甲状腺结节子集中的观察者间变异性。
OBJECTIVE: 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.