Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico.
Division of Quantitative Sciences, University of Florida Health Cancer Center, University of Florida, Gainesville, FL, USA.
J Clin Endocrinol Metab. 2022 Jul 14;107(8):e3288-e3294. doi: 10.1210/clinem/dgac279.
Thyroid nodule risk stratification allows clinicians to standardize the evaluation of thyroid cancer risk according to ultrasound features.
To evaluate interrater agreement among clinicians assessing thyroid nodules ultrasound features and thyroid cancer risk categories.
DESIGN, SETTING, AND PARTICIPANTS: We surveyed Endocrine Society and Latin American Thyroid Society members to assess their interpretation of composition, echogenicity, shape, margins, and presence of echogenic foci of 10 thyroid nodule cases. The risk category for thyroid cancer was calculated following the American College of Radiology-Thyroid Imaging Reporting & Data System (ACR-TIRADS) framework from individual responses.
We used descriptive statistics and Gwet's agreement coefficient (AC1) to assess the primary outcome of interrater agreement for ACR-TIRADS risk category. As secondary outcomes, the interrater agreement for individual features and a subgroup analysis of interrater agreement for the ACR-TIRADS category were performed (ultrasound reporting system, type of practice, and number of monthly appraisals).
A total of 144 participants were included, mostly endocrinologists. There was moderate level of agreement for the absence of echogenic foci (AC1 0.53, 95% CI 0.24-0.81) and composition (AC1 0.54, 95% CI 0.36-0.71). The agreement for margins (AC1 0.24, 95% CI 0.15-0.33), echogenicity (AC1 0.34, 95% CI 0.22-0.46), and shape assessment (AC1 0.42, 95% CI 0.13-0.70) was lower. The overall agreement for ACR-TIRADS assessment was AC1 0.29, (95% CI 0.13-0.45). The AC1 of ACR-TIRADS among subgroups was similar.
This study found high variation of judgments about ACR-TIRADS risk category and individual features, which poses a potential challenge for the widescale implementation of thyroid nodule risk stratification.
甲状腺结节风险分层可使临床医生根据超声特征对甲状腺癌风险进行标准化评估。
评估评估甲状腺结节超声特征和甲状腺癌风险类别的临床医生之间的组间一致性。
设计、设置和参与者：我们调查了内分泌学会和拉丁美洲甲状腺学会的成员，以评估他们对 10 例甲状腺结节病例的成分、回声、形状、边缘和回声焦点存在的解释。根据美国放射学院-甲状腺成像报告和数据系统（ACR-TIRADS）框架，从个人反应中计算出甲状腺癌的风险类别。
我们使用描述性统计和 Gwet 一致性系数（AC1）来评估 ACR-TIRADS 风险类别的组间一致性的主要结果。作为次要结果，对个别特征的组间一致性和 ACR-TIRADS 类别的组间一致性进行了亚组分析（超声报告系统、实践类型和每月评估次数）。
共纳入 144 名参与者，主要为内分泌学家。在无回声焦点（AC1 0.53，95%置信区间 0.24-0.81）和成分（AC1 0.54，95%置信区间 0.36-0.71）方面存在中等水平的一致性。在边缘（AC1 0.24，95%置信区间 0.15-0.33）、回声（AC1 0.34，95%置信区间 0.22-0.46）和形状评估（AC1 0.42，95%置信区间 0.13-0.70）方面的一致性较低。ACR-TIRADS 评估的总体一致性为 AC1 0.29（95%置信区间 0.13-0.45）。亚组间 ACR-TIRADS 的 AC1 相似。
本研究发现对 ACR-TIRADS 风险类别和个别特征的判断存在高度差异，这对甲状腺结节风险分层的广泛实施构成了潜在挑战。
