Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
AJR Am J Roentgenol. 2011 Mar;196(3):655-60. doi: 10.2214/AJR.10.4577.
Multiple studies have defined criteria for the selection of thyroid nodules for biopsy. No set of criteria is sufficiently sensitive and specific. The aim of this study is to develop a method for assessing consistency of practice in an ultrasound group and to determine whether a 5-point malignancy rating scale can be used to select patients for biopsy.
One hundred one nodules (50 benign and 51 malignant) were selected from a thyroid biopsy database. Seven radiologists were educated on evidence-based criteria used to select nodules for biopsy. Using this information, readers graded the likelihood of malignancy using a 5-point malignancy rating scale, where 1 equals the lowest probability of malignancy and 5 equals the highest probability of malignancy, on the basis of overall impression of sonographic findings. Interobserver agreement on biopsy recommendation, reader sensitivity, specificity, and accuracy were determined.
The sensitivity and specificity of biopsy recommendation were 96.1% and 52%, respectively. The misclassification rate was 25.7%, and accuracy was 74.3%. Interobserver agreement on biopsy recommendation was fair to substantial (κ, 0.38-0.69). The proportion of agreement was excellent for malignant nodules (0.88-1.0). The risk of malignancy increased with increasing malignancy rating: 4.3% of nodules with a malignancy rating of 1 were malignant versus 93.4% of those assigned a rating of 5.
Our study illustrates a method to evaluate the standard of practice for thyroid nodule assessment among radiologists within an ultrasound group. Application of a 5-point malignancy rating scale to select nodules for biopsy is feasible and shows good diagnostic accuracy.
多项研究已经定义了选择甲状腺结节进行活检的标准。没有一套标准是足够敏感和特异的。本研究的目的是开发一种方法来评估超声组实践的一致性，并确定是否可以使用 5 分恶性评分量表来选择活检患者。
从甲状腺活检数据库中选择了 101 个结节（50 个良性和 51 个恶性）。对 7 名放射科医生进行了基于证据的选择结节进行活检的标准的教育。使用这些信息，读者根据超声检查结果的总体印象，使用 5 分恶性评分量表对恶性肿瘤的可能性进行评分，其中 1 表示恶性肿瘤的可能性最低，5 表示恶性肿瘤的可能性最高。确定活检推荐的观察者间一致性、读者敏感性、特异性和准确性。
活检推荐的敏感性和特异性分别为 96.1%和 52%。错误分类率为 25.7%，准确性为 74.3%。活检推荐的观察者间一致性为中等至良好（κ，0.38-0.69）。恶性结节的一致性比例极好（0.88-1.0）。恶性评分越高，恶性肿瘤的风险越大：恶性评分 1 的结节中恶性肿瘤的比例为 4.3%，而恶性评分 5 的结节中恶性肿瘤的比例为 93.4%。
我们的研究说明了一种在超声组内评估放射科医生甲状腺结节评估标准的方法。应用 5 分恶性评分量表选择活检结节是可行的，并且具有良好的诊断准确性。
