Inter- and Intraobserver Agreement in the Assessment of Thyroid Nodule Ultrasound Features and Classification Systems: A Blinded Multicenter Study

Persichetti, Agnese; Stasio, Enrico Di; Coccaro, Carmela; Graziano, Filomena; Bianchini, A.; Donna, Vincenzo Di; Corsello, Salvatore Maria; Valle, D.; Bizzarri, Giancarlo; Frasoldati, Andrea; Pontecorvi, Alfredo; Papini, Enrico; Guglielmi, Rinaldo

doi:10.1089/thy.2019.0360

Cited by 73 publications

(65 citation statements)

References 24 publications

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“…Thus, objective US findings need to be critically processed by the operator, who can re-weight the risk with respect to what is established by the classification system alone. Thus, in the clinical daily life thyroid US remains a subjective imaging tool that holds the operator expertise as an intrinsic characteristic of this instrument (24,25). From a practical point of view, nodules considered as suspect or very suspect (MUT class 4 or 5) by the US operator need to undergo FNA, since the malignancy risk is of 63 and 90%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Sometimes the clinician struggles to enter the lesion in a class rather than another, because of intermediate or ambiguous situations ( 14 , 18 , 19 , 25 ). Moreover, interobserver agreement has recently been questioned in a multicenter study, resulting lower than that suggested by single center studies ( 24 ). Finally, it is possible that a nodule is classified in a category that does not match the one in which the clinician would have classified it according to his/her experienced-based perception.…”

Section: Discussionmentioning

confidence: 99%

“…Specifications of each of the five categories were defined according to the knowledge present in the literature, leaving the US operator the possibility to rule on the nodule category risk based on his ultrasound-clinical experience. Starting from the concept that there is inter-observer and intra-observer variability in interpreting US characteristics and that available US classifications do not cover all US characteristics (24,25), the operator was asked to downgrade or upgrade the class of risk in presence of its judgment based also on clinical (not US) data available and on his advisory opinion arising from his/her US series of experience.…”

Section: Us Classificationsmentioning

confidence: 99%

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The Added Value of Operator's Judgement in Thyroid Nodule Ultrasound Classification Arising From Histologically Based Comparison of Different Risk Stratification Systems

et al. 2020

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Objective: Several ultrasound classifications for thyroid nodules were proposed but their accuracy is still debated, since mainly estimated on cytology and not on histology. The aim of this study was to test the diagnostic accuracy and the inter-classification agreement of AACE/ACE-AME, American Thyroid Association (ATA), British Thyroid Association (BTA), and Modena Ultrasound Thyroid Classification (MUT) that stratifies malignancy risk considering also the clinician subjective impression. Methods: A prospective study collecting thyroid nodule features at ultrasound and histological diagnosis was conducted. Ultrasound features were collected following a preformed checklist in candidates for surgery because of indeterminate, suspicious, or malignant cytology. All the nodules, besides the cytologically suspicious one, were blinded analyzed. MUT score was applied prospectively, and the others retrospectively. Sensitivity, specificity, diagnostic cutoff value, and accuracy of each classification were calculated. The overall agreement between classifications was tested by Bland-Altman, and agreement between single nodule analysis by different classifications by Weighted Cohen's Kappa. Results: In classifying a total of 457 nodules, MUT has the highest accuracy (AUC 0.808) and specificity (89%), followed by ATA and BTA, and finally by AACE/ACE-AME. ATA, BTA, and MUT are highly interchangeable. Considering agreement between single nodule analyses, ATA and BTA had the best (κ = 0.723); AACE/ACE-AME showed slight agreement with BTA (κ = 0.177) and MUT (κ = 0.183), and fair agreement with ATA (κ = 0.282); MUT had fair agreement with both ATA (κ = 0.291) and BTA (κ = 0.271). Conclusion: Classifications have an acceptable overall diagnostic accuracy, improved using a less rigid system that takes into consideration operator subjective impression.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Us Classificationsmentioning

confidence: 99%

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The Added Value of Operator's Judgement in Thyroid Nodule Ultrasound Classification Arising From Histologically Based Comparison of Different Risk Stratification Systems

et al. 2020

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“…It is easy to perform on archived cytological materials and its specificity higher than 98% might be comparable with BRAF 600E testing in cases of suspicion of PTC. In the context of challenges encountered in both ultrasonographic analyses [126][127][128][129][130][131][132][133][134][135] and indeterminate cytomorphology [118][119][120][121][122][123][124] as well as global financial restrictions, we believe our diagnostic assay merits further attention.…”

Section: Chromosomementioning

confidence: 99%

DNA FISH Diagnostic Assay on Cytological Samples of Thyroid Follicular Neoplasms

Vielh

Balogh

Suciu

et al. 2020

Cancers

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Although fine-needle aspiration cytology (FNAC) is helpful in determining whether thyroid nodules are benign or malignant, this distinction remains a cytological challenge in follicular neoplasms. Identification of genomic alterations in cytological specimens with direct and routine techniques would therefore have great clinical value. A series of 153 cases consisting of 72 and 81 histopathologically confirmed classic follicular adenomas (cFAs) and classic follicular thyroid carcinomas (cFTCs), respectively, was studied by means of different molecular techniques in three different cohorts of patients (pts). In the first cohort (training set) of 66 pts, three specific alterations characterized by array comparative genomic hybridization (aCGH) were exclusively found in half of cFTCs. These structural abnormalities corresponded to losses of 1p36.33-35.1 and 22q13.2-13.31, and gain of whole chromosome X. The second independent cohort (validation set) of 60 pts confirmed these data on touch preparations of frozen follicular neoplasms by triple DNA fluorescent in situ hybridization using selected commercially available probes. The third cohort, consisting of 27 archived cytological samples from an equal number of pts that had been obtained for preoperative FNAC and morphologically classified as and histologically verified to be follicular neoplasms, confirmed our previous findings and showed the feasibility of the DNA FISH (DNA fluorescent in situ hybridization) assay. All together, these data suggest that our triple DNA FISH diagnostic assay may detect 50% of cFTCs with a specificity higher than 98% and be useful as a low-cost adjunct to cytomorphology to help further classify follicular neoplasms on already routinely stained cytological specimens.

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Thyroid Nodule Margin Assessment Using ACR TI‐RADS: Adding Points for Macrolobulation Impairs Performance

Haug

Young

Patel

2022

J of Ultrasound Medicine

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Objective We evaluated the performance of ACR TI‐RADS when points for lobulated margins are applied only when the margins meet a quantified measure of margin microlobulation and not applied when nodules only demonstrate macrolobulation. Methods We retrospectively reviewed ultrasound and pathology records (May 01, 2018 to July 31, 2020) to find all thyroid nodules at one institution characterized as having lobulated margins using the ACR TI‐RADS lexicon and subsequently undergoing fine needle aspiration (FNA). Nodule margins were evaluated to note the presence or absence of microlobulation, quantitatively defined as a protrusion with a base <2.5 mm in length. The impact to detection of malignant nodules and avoidance of benign FNA when margin points for lobulation were added only when microlobulated was analyzed. Results 58 of 516 thyroid nodules undergoing US‐guided FNA were classified as lobulated, comprising the study population. 21 (36.2%) had microlobulated margins, with 12 of the 21 (57.1%) being malignant. Comparatively, of the 37 nodules showing only macrolobulated margins without microlobulation, only 2 (5.4%) were malignant (P < .0001). For 53 nodules ≥10 mm, 15 (28.3%) benign nodules would not have met size criteria for FNA had points for margins not been applied when only showing macrolobulation, whereas all 10 malignant nodules would still have been sampled. Conclusion Adding two points to the ACR TI‐RADS score for lobulated thyroid nodules should only apply when microlobulations are present.

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Inter- and Intraobserver Agreement in the Assessment of Thyroid Nodule Ultrasound Features and Classification Systems: A Blinded Multicenter Study

Cited by 73 publications

References 24 publications

The Added Value of Operator's Judgement in Thyroid Nodule Ultrasound Classification Arising From Histologically Based Comparison of Different Risk Stratification Systems

The Added Value of Operator's Judgement in Thyroid Nodule Ultrasound Classification Arising From Histologically Based Comparison of Different Risk Stratification Systems

DNA FISH Diagnostic Assay on Cytological Samples of Thyroid Follicular Neoplasms

Thyroid Nodule Margin Assessment Using ACR TI‐RADS: Adding Points for Macrolobulation Impairs Performance

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