超声特征在甲状腺结节不典型细胞病理诊断中的应用：观察者间的一致性以及联合基于形态和评分的分类方法对风险分层的影响。
Ultrasound characterization for thyroid nodules with indeterminate cytology: inter-observer agreement and impact of combining pattern-based and scoring-based classifications in risk stratification.
机构信息
Department of Diagnostic Imaging, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
出版信息
Endocrine. 2019 Nov;66(2):278-287. doi: 10.1007/s12020-019-02000-0. Epub 2019 Jul 12.
BACKGROUND
The American Thyroid Association (ATA) sonographic patterns stratify the risk of malignancy of cytologically indeterminate thyroid nodules (ITNs). This study aimed to (1) assess inter-observer agreement for sonographic features and patterns; (2) identify potential sources of disagreement; and (3) evaluate whether the number of suspicious features risk-stratifies non-ATA and high-suspicion patterns.
METHODS
Three observers independently reviewed the ultrasound images of 463 ITNs with histological follow-up consecutively evaluated between October 2008 and June 2015 at an academic cancer center. Each observer evaluated individual sonographic features. ATA sonographic patterns were derived from the interpretation of sonographic features. Nodules not fitting into any of the proposed patterns were clustered into a non-ATA pattern.
RESULTS
The inter-observer agreement for ATA sonographic patterns and echogenicity was fair, moderate for margins, good for composition and echogenic foci, and very good for extrathyroidal extension and lymph node metastasis. The interpretation of each sonographic feature was significantly different between observers, and there was complete disagreement in at least one of the features in 104 (22%) nodules. A total of 169 nodules (37%) were classified into the non-ATA pattern. The number of suspicious features allowed risk stratifying nodules with non-ATA and high-suspicion sonographic patterns. Most Non-invasive Follicular Thyroid Neoplasms with Papillary-like Nuclear Features had 0-1 suspicious features and none had >2.
CONCLUSIONS
Echogenicity interpretation was the greatest source of disagreement. The number of suspicious features risk-stratifies ITNs with non-ATA or high-suspicion patterns. Future studies attempting to objectivize the interpretation of echogenicity and heterogeneity are needed.
背景
美国甲状腺协会（ATA）的超声模式将细胞学不确定的甲状腺结节（ITN）的恶性风险分层。本研究旨在：（1）评估超声特征和模式的观察者间一致性；（2）确定意见分歧的潜在来源；（3）评估可疑特征的数量是否对非 ATA 和高度可疑模式进行风险分层。
方法
三位观察者独立回顾了 2008 年 10 月至 2015 年 6 月在一家学术癌症中心连续评估的 463 个 ITN 的超声图像。每位观察者评估了个别超声特征。ATA 超声模式源自对超声特征的解读。不符合任何拟议模式的结节被归类为非 ATA 模式。
结果
ATA 超声模式和回声强度的观察者间一致性为中等，边界为中度，成分和回声焦点为好，甲状腺外延伸和淋巴结转移为极好。观察者之间对每个超声特征的解读有显著差异，至少有一个特征在 104 个（22%）结节中完全不一致。共有 169 个（37%）结节被归类为非 ATA 模式。可疑特征的数量允许对具有非 ATA 和高度可疑超声模式的结节进行风险分层。大多数具有乳头状核特征的非侵袭性滤泡性甲状腺肿瘤有 0-1 个可疑特征，没有>2 个。
结论
回声强度的解读是意见分歧最大的来源。可疑特征的数量对具有非 ATA 或高度可疑模式的 ITN 进行风险分层。需要进一步研究尝试客观化回声和异质性的解读。
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