Department of Radiology, NYU Langone Health, 660 First Ave, New York, NY 10016.
Present address: Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD.
AJR Am J Roentgenol. 2020 May;214(5):1152-1157. doi: 10.2214/AJR.19.21913. Epub 2020 Feb 25.
The objective of this article is to assess radiologist concordance in characterizing thyroid nodules using the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS), focusing on the effect of radiologist experience on reader concordance. Three experienced and three less experienced radiologists assessed 150 thyroid nodules using the TI-RADS lexicon. Percent concordance was determined for various endpoints. Interreader concordance for the five TI-RADS categories was 87.2% for shape, 81.2% for composition, 76.1% for echogenicity, 72.9% for margins, and 69.8% for echogenic foci. Concordance for individual features was 96.3% for rim calcifications, 90.8% for macrocalcifications, 90.1% for spongiform, 83.5% for comet tail artifact, and 77.7% for punctate echogenic foci. Concordance for the TI-RADS level and recommendation for fine-needle aspiration (FNA) were 50.4% and 78.9%, respectively. Concordance was significantly ( < 0.05) higher for less experienced readers in identifying margins (84.3% vs 67.4%), echogenic foci (76.9% vs 69.3%), comet tail artifact (89.6% vs 79.2%), and punctate echogenic foci (85.3% vs 75.5%), and lower for peripheral rim calcifications (95.0% vs 97.8 %), but was not different ( > 0.05) for the remaining categories and features. A range of TI-RADS categories, features, and recommendations for FNA had generally moderate interreader agreement among six radiologists. Our results show that concordance for numerous characteristics was significantly higher for the less experienced versus the more experienced readers. These results suggest that less experienced readers relied more on the explicit TI-RADS criteria, whereas the experienced radiologists partially relied on their accumulated experience when forming impressions. However, the overall TI-RADS level and recommendation for FNA were unaffected, supporting the robustness of the TI-RADS lexicon and its continued use in practice.
本文旨在评估放射科医生使用美国放射学院甲状腺成像报告和数据系统 (TI-RADS) 对甲状腺结节进行特征描述的一致性，重点关注放射科医生经验对读者一致性的影响。三位经验丰富的放射科医生和三位经验较少的放射科医生使用 TI-RADS 词汇表评估了 150 个甲状腺结节。确定了各种终点的百分比一致性。五位 TI-RADS 类别的读者间一致性为：形状 87.2%，成分 81.2%，回声 76.1%，边缘 72.9%，回声焦点 69.8%。个别特征的一致性为：边缘钙化 96.3%，大钙化 90.8%，海绵状 90.1%，彗尾伪影 83.5%，点状回声焦点 77.7%。TI-RADS 级别和细针抽吸 (FNA) 推荐的一致性分别为 50.4%和 78.9%。在识别边缘（84.3%比 67.4%）、回声焦点（76.9%比 69.3%）、彗尾伪影（89.6%比 79.2%）和点状回声焦点（85.3%比 75.5%）方面，经验较少的读者明显更高（<0.05），而在边缘周围边缘钙化（95.0%比 97.8%）方面则较低，但在其余类别和特征方面无差异（>0.05）。六位放射科医生对 TI-RADS 类别、特征和 FNA 推荐的一系列范围具有中等的读者间一致性。我们的结果表明，对于许多特征，经验较少的读者的一致性明显高于经验丰富的读者。这些结果表明，经验较少的读者更依赖于明确的 TI-RADS 标准，而经验丰富的放射科医生在形成印象时部分依赖于他们积累的经验。然而，总体 TI-RADS 级别和 FNA 的推荐不受影响，支持 TI-RADS 词汇的稳健性及其在实践中的持续使用。
