Zeyad T. Sahli1,2, Ashwyn K. Sharma2, Joseph K. Canner2, Arjun Sabharwal2, Omar H Ali3, Satomi Kawamoto3, Jen‐Fan Hang4,5, Aarti Mathur2, Syed Z. Ali5,3, Martha A. Zeiger1, Sheila Sheth5
1Department of Surgery, The University of Virginia School of Medicine, Charlottesville, VA
2Endocrine Surgery, Department of Surgery, Baltimore, Maryland
3Department of Radiology, Baltimore, Maryland
4Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
5Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Tóm tắt
ObjectivesA high proportion of cytologically indeterminate, Afirma Gene Expression Classifier “suspicious” thyroid nodules are benign. The Thyroid Imaging Reporting and Data System (TIRADS), was proposed by the American College of Radiology in 2017 to help classify thyroid nodules based on ultrasound characteristics in a standardized fashion to guide management. We aim to determine the interobserver variability of TIRADS classification among cytologically indeterminate and Afirma suspicious nodules.MethodsWe retrospectively queried cytopathology archives for thyroid fine‐needle aspiration specimens obtained between February 2012 and September 2016 with associated (1) indeterminate diagnosis, (2) ultrasound imaging at our institution, (3) Afirma suspicious result, and (4) surgery at our institution. We compared the TIRADS variability of the 3 blinded radiologists using intraclass correlation coefficients.ResultsOur cohort consisted of 127 nodules. Intraclass correlation coefficients can be interpreted as follows: less than 0.4, poor; 0.4 to 0.59, fair; 0.6 to 0.74, good; 0.75 to 1.00, excellent. The intraclass correlation coefficients of the raw TIRADS score and category variability was 0.561 (95% confidence interval [CI]: 0.464–0.651) or fair and 0.547 (95% CI, 0.449–0.640) or fair, respectively. When analyzing composition, echogenicity, shape, margin, and echogenic foci, the ICCs were 0.552 (95% CI, 0.454–0.643), fair; 0.533 (95% CI, 0.432–0.627), fair; 0.359 (95% CI, 0.248–0.469), poor; 0.192 (95% CI, 0.084–0.308), poor; and 0.549 (95% CI, 0.451– 0.641), fair, respectively.ConclusionsOur results show that among the subset of cytologically indeterminate and Afirma suspicious nodules, TIRADS interobserver variability was fair. Shape and margin criteria were the biggest sources of disagreement. Large prospective studies are needed to evaluate the interobserver variability of TIRADS in this subset of thyroid nodules.
