Interobserver Agreement of Thyroid Imaging Reporting and Data System (TIRADS) and Strain Elastography for the Assessment of Thyroid Nodules
Open Access
- 24 October 2013
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 8 (10), e77927
- https://doi.org/10.1371/journal.pone.0077927
Abstract
Thyroid Imaging Reporting and Data System (TIRADS) was developed to improve patient management and cost-effectiveness by avoiding unnecessary fine needle aspiration biopsy (FNAB) in patients with thyroid nodules. However, its clinical use is still very limited. Strain elastography (SE) enables the determination of tissue elasticity and has shown promising results for the differentiation of thyroid nodules. The aim of the present study was to evaluate the interobserver agreement (IA) of TIRADS developed by Horvath et al. and SE. Three blinded observers independently scored stored images of TIRADS and SE in 114 thyroid nodules (114 patients). Cytology and/or histology was available for all benign (n = 99) and histology for all malignant nodules (n = 15). The IA between the 3 observers was only fair for TIRADS categories 2–5 (Coheńs kappa = 0.27,p = 0.000001) and TIRADS categories 2/3 versus 4/5 (ck = 0.25,p = 0.0020). The IA was substantial for SE scores 1–4 (ck = 0.66,p<0.000001) and very good for SE scores 1/2 versus 3/4 (ck = 0.81,p<0.000001). 92–100% of patients with TIRADS-2 had benign lesions, while 28–42% with TIRADS-5 had malignant cytology/histology. The negative-predictive-value (NPV) was 92–100% for TIRADS using TIRADS-categories 4&5 and 96–98% for SE using score ES-3&4 for the diagnosis of malignancy, respectively. However, only 11–42% of nodules were in TIRADS-categories 2&3, as compared to 58–60% with ES-1&2. IA of TIRADS developed by Horvath et al. is only fair. TIRADS and SE have high NPV for excluding malignancy in the diagnostic work-up of thyroid nodules.Keywords
This publication has 32 references indexed in Scilit:
- Prospective evaluation of thyroid imaging reporting and data system on 4550 nodules with and without elastographyActa Endocrinologica, 2013
- Elastography: New Developments in Ultrasound for Predicting Malignancy in Thyroid NodulesJournal of Clinical Endocrinology & Metabolism, 2007
- European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epitheliumActa Endocrinologica, 2006
- Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines TaskforceThyroid®, 2006
- Thyroid Gland Tumor Diagnosis at US ElastographyRadiology, 2005
- Prevalence of Thyroid Disorders in the Working Population of Germany: Ultrasonography Screening in 96,278 Unselected EmployeesThyroid®, 2004
- Risk for Malignancy of Thyroid Nodules as Assessed by Sonographic CriteriaJournal of Ultrasound in Medicine, 2004
- The Thyroid NoduleNew England Journal of Medicine, 2004
- Lifetime follow-up care is necessary for all patients with treated thyroid nodulesActa Endocrinologica, 2003
- Evaluation of the fine needle aspiration biopsy in the preoperative selection of cold thyroid nodulesCancer, 1991