Jarløv A E, Gjørup T, Hegedüs L, Hvid-Jacobsen K, Marving J, Hansen J M
Department of Internal Medicine and Endocrinology, Herlev Hospital, Denmark.
Clin Endocrinol (Oxf). 1990 Jul;33(1):1-11. doi: 10.1111/j.1365-2265.1990.tb00459.x.
In order to evaluate the reproducibility of the diagnosis of solitary cold thyroid lesions, two specialists in nuclear medicine and two specialists in endocrinology independently twice read 240 thyroid 99mTc pertechnetate scintigrams. No significant difference or interaction between the results obtained from the right and the left lobe was found. A solitary cold lesion was diagnosed in 100 of the 480 lobes; however, in only 30 did all four observers agree upon the diagnosis. Interobserver variation was determined by pairwise comparison of observers. The observed agreement was between 0.91 and 0.94. After adjusting for expected chance agreement, kappa values between 0.57 and 0.70 were found. Intraobserver variation was smaller than interobserver variation, revealing agreement rates of 0.93-0.96 and kappa values between 0.71 and 0.77. Agreement was related to large lesions, lesions located centrally in the lobe, and ovoid-shaped lesions. Clinicians should be aware to what extent they can rely on the information they use in their decisions. The considerable inconsistency in the evaluation of cold lesions on thyroid scintigrams should be taken into consideration, and calls in question the value of using thyroid scintigrams for deciding whether a patient should be referred for operation or biopsy.
为了评估孤立性冷甲状腺病变诊断的可重复性，两名核医学专家和两名内分泌专家对240例甲状腺高锝酸盐99mTc闪烁扫描图进行了两次独立阅片。未发现左右叶所得结果之间存在显著差异或相互作用。在480个叶中，有100个叶诊断为孤立性冷病变；然而，只有30个叶的所有四名观察者对诊断达成一致。观察者间的差异通过观察者之间的成对比较来确定。观察到的一致性在0.91至0.94之间。在调整预期的偶然一致性后，发现kappa值在0.57至0.70之间。观察者内差异小于观察者间差异，显示一致性率为0.93 - 0.96，kappa值在0.71至0.77之间。一致性与大病变、位于叶中央的病变以及椭圆形病变有关。临床医生应意识到他们在决策中所依赖的信息在多大程度上是可靠的。应考虑到甲状腺闪烁扫描图上冷病变评估中存在的相当大的不一致性，这使人对使用甲状腺闪烁扫描图来决定患者是否应转诊进行手术或活检的价值产生质疑。
