目的:超声评估甲状腺结节是首选技术,但这取决于操作员的解释,导致观察者之间的可变性。本研究旨在确定医师之间关于结节特征的共识,分类系统中的风险分类,以及需要细针抽吸穿刺。
方法:来自同一中心的4位内分泌科医生对来自100位不同患者的甲状腺结节的100张超声图像进行了盲目评估。评估了以下超声特征:成分,回声,边距,钙化,和微钙化。结节也根据ATA分类,EU-TIRADS,K-TIRADS,和ACR-TIRADS分类。Krippendorff的α检验用于评估观察者之间的一致性。
结果:观察者对超声特征的共识是:组合物的Krippendorff系数0.80(0.71-0.89),0.59(0.47-0.72)的回声,利润率为0.73(0.57-0.88),钙化0.55(0.40-0.69),微钙化为0.50(0.34-0.67)。ATA分类系统的一致性为0.7(0.61-0.80),0.63(0.54-0.73)适用于EU-TIRADS,K-TRADS为0.64(0.55-0.73),K-TIRADS为0.68(0.60-0.77)。细针抽吸穿刺(FNA)适应症的一致性为0.86(0.71-1),0.80(0.71-0.88),0.770.67-0.87),和0.73(0.64-0.83)分别用于先前描述的系统。
结论:对于需要使用各种分类系统进行细胞学研究的结节的鉴定,观察者之间的共识是可以接受的。然而,在结节的危险分层和许多超声特征中观察到有限的一致性.
OBJECTIVE: Ultrasound evaluation of thyroid nodules is the preferred technique, but it is dependent on operator interpretation, leading to inter-observer variability. The current study aimed to determine the inter-physician consensus on nodular characteristics, risk categorization in the classification systems, and the need for fine needle aspiration puncture.
METHODS: Four endocrinologists from the same center blindly evaluated 100 ultrasound images of thyroid nodules from 100 different patients. The following ultrasound features were evaluated: composition, echogenicity, margins, calcifications, and microcalcifications. Nodules were also classified according to ATA, EU-TIRADS, K-TIRADS, and ACR-TIRADS classifications. Krippendorff\'s alpha test was used to assess interobserver agreement.
RESULTS: The interobserver agreement for ultrasound features was: Krippendorff\'s coefficient 0.80 (0.71-0.89) for composition, 0.59 (0.47-0.72) for echogenicity, 0.73 (0.57-0.88) for margins, 0.55 (0.40-0.69) for calcifications, and 0.50 (0.34-0.67) for microcalcifications. The concordance for the classification systems was 0.7 (0.61-0.80) for ATA, 0.63 (0.54-0.73) for EU-TIRADS, 0.64 (0.55-0.73) for K-TIRADS, and 0.68 (0.60-0.77) for K-TIRADS. The concordance in the indication of fine needle aspiration puncture (FNA) was 0.86 (0.71-1), 0.80 (0.71-0.88), 0.77 0.67-0.87), and 0.73 (0.64-0.83) for systems previously described respectively.
CONCLUSIONS: Interobserver agreement was acceptable for the identification of nodules requiring cytologic study using various classification systems. However, limited concordance was observed in risk stratification and many ultrasonographic characteristics of the nodules.