Interobserver variability in sonographic evaluation of thyroid nodules with ACR-TI-RADS, EU-TI-RADS and KTA/KSThR-TIRADS

doi:10.3877/cma.j.issn.1672-6448.2020.07.018

Abstract

Abstract:

Objective

To retrospectively evaluate interobserver variability in sonographic evaluation of thyroid nodules with three different thyroid imaging reporting and data systems (TI-RADS).

Methods

This retrospective study included 257 thyroid nodules of 168 patients confirmed by pathology at Civil Aviation General Hospital between January to December 2017. All nodules were categorized according to the ACR-TIRADS, EU-TIRADS, and KTA/KSThR-TIRADS. Interobserver variability for the three different TI-RADS was determined using weighted Kappa statistics. Interobserver variability for the classification level of different TI-RADS and ultrasonic characteristics evaluation was also determined.

Results

The Kappa values for ACR-TI-RADS, EU-TI-RADS, and KTA/KSThR-TI-RADS were 0.62, 0.45, and 0.64 respectively. For ACR-TI-RADS 5, EU-TI-RADS high risk, and KTA/KSThR-TI-RADS high suspicion level, the Kappa values were 0.726, 0.686, and 0.721, respectively. For US assessment of the cystic, oval shape, and taller-than-wide signs, the Kappa value were 0.733, 0.700, and 0.738, respectively.

Conclusion

Interobserver agreement is good for diagnosing thyroid nodules with ACR-TIRADS and KTA/KSThR-TIRADS. There is good interobserver agreement on high risk level among the three different TIRADS, which providing better clinical practicability.

Key words: Ultrasonography, Thyroid nodule, Thyroid imaging reporting and data system, Ultrasound-based risk stratification

Qiang Fu, Ying Xiong, Kexin Song, Yan Yan, Hao Liu. Interobserver variability in sonographic evaluation of thyroid nodules with ACR-TI-RADS, EU-TI-RADS and KTA/KSThR-TIRADS[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(07): 684-690.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2020.07.018

https://chaosheng.cma-cmc.com.cn/EN/Y2020/V17/I07/684

Figures/Tables 10

References 14

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ACR-TIRADS	EU-TIRADS	KTA/KSThR-TIRADS
1类：0分，良性结节（恶性风险≤2%）	1正常甲状腺无结节	1无结节
2类：2分，无可疑恶性征象（恶性风险≤2%）	2良性：纯囊性或完全海绵样结节（恶性风险几乎为0％）	2良性：海绵样结节、纯囊肿或部分囊性结节伴彗星尾征（恶性风险<3%）
3类：3分，轻度可疑恶性结节（恶性风险<5%）	3低危：卵圆形、边缘光滑的等回声或高回声结节不含高度可疑恶性征象（恶性风险2%~4%）	3低度可疑：部分囊性或等/高冋声结节，无可疑恶性征象（恶性风险3%~15%）
4类：4~6分，中度可疑恶性结节恶性风险（5%~20%）	4中危：卵圆形、边缘光滑的低回声结节不含高度可疑恶性征象（恶性风险6%~17%）	4中度可疑：实性低回声结节且无可疑超声征象，或部分囊性或等/高回声结节，具备一个或多个可疑恶性征象（恶性风险15%~50%）
5类：≥7分，高度可疑恶性结节（恶性风险>20%）	5高危：至少含有以下1种高度可疑恶性征象：形状不规则（直立生长）、边缘不规则（微分叶/针刺样边缘）、微钙化、显著低回声（恶性风险26%~87%）	5高度可疑：实性、低回声结节，具备一个或多个可疑恶性征象：微钙化、直立生长、微分叶/针刺样边缘（恶性风险>60%）

ACR-TIRADS	EU-TIRADS	KTA/KSThR-TIRADS
1类：0分，良性结节（恶性风险≤2%）	1正常甲状腺无结节	1无结节
2类：2分，无可疑恶性征象（恶性风险≤2%）	2良性：纯囊性或完全海绵样结节（恶性风险几乎为0％）	2良性：海绵样结节、纯囊肿或部分囊性结节伴彗星尾征（恶性风险<3%）
3类：3分，轻度可疑恶性结节（恶性风险<5%）	3低危：卵圆形、边缘光滑的等回声或高回声结节不含高度可疑恶性征象（恶性风险2%~4%）	3低度可疑：部分囊性或等/高冋声结节，无可疑恶性征象（恶性风险3%~15%）
4类：4~6分，中度可疑恶性结节恶性风险（5%~20%）	4中危：卵圆形、边缘光滑的低回声结节不含高度可疑恶性征象（恶性风险6%~17%）	4中度可疑：实性低回声结节且无可疑超声征象，或部分囊性或等/高回声结节，具备一个或多个可疑恶性征象（恶性风险15%~50%）
5类：≥7分，高度可疑恶性结节（恶性风险>20%）	5高危：至少含有以下1种高度可疑恶性征象：形状不规则（直立生长）、边缘不规则（微分叶/针刺样边缘）、微钙化、显著低回声（恶性风险26%~87%）	5高度可疑：实性、低回声结节，具备一个或多个可疑恶性征象：微钙化、直立生长、微分叶/针刺样边缘（恶性风险>60%）

?	ACR-TIRADS	EU-TIRADS	KTA/KSThR-TIRADS
风险分层分类	1类、2类、3类、4类、5类	无结节/良性/低危/中危/高危	无结节/良性/低度可疑/中度可疑/高度可疑
海绵样结节定义	微囊结构>50%（不考虑回声或其他征象）	被细小分隔分隔开的完全微囊结构（不考虑回声或其他征象）	微囊结构>50%的等回声结节且不伴有其他可疑恶性征象
回声类型	极低回声、低回声、等回声、高回声、无回声	显著低回声、低/中低回声、等回声、高回声、无回声	低回声、等回声、无回声
混合回声结节类型判断	根据实性部分的主要回声特点判断	实性部分中若出现低回声则判断为低/中低回声	根据实性部分的主要回声特点判断
孤立性钙化危险分类	4类	低危	中度可疑
可疑恶性征象	极低回声、纵横比>1、甲状腺外扩散、微钙化	纵横比>1、不规则边缘（针刺/微分叶边缘）、微钙化、显著低回声	微钙化、纵横比>1、微分叶/针刺样边缘

?	ACR-TIRADS	EU-TIRADS	KTA/KSThR-TIRADS
风险分层分类	1类、2类、3类、4类、5类	无结节/良性/低危/中危/高危	无结节/良性/低度可疑/中度可疑/高度可疑
海绵样结节定义	微囊结构>50%（不考虑回声或其他征象）	被细小分隔分隔开的完全微囊结构（不考虑回声或其他征象）	微囊结构>50%的等回声结节且不伴有其他可疑恶性征象
回声类型	极低回声、低回声、等回声、高回声、无回声	显著低回声、低/中低回声、等回声、高回声、无回声	低回声、等回声、无回声
混合回声结节类型判断	根据实性部分的主要回声特点判断	实性部分中若出现低回声则判断为低/中低回声	根据实性部分的主要回声特点判断
孤立性钙化危险分类	4类	低危	中度可疑
可疑恶性征象	极低回声、纵横比>1、甲状腺外扩散、微钙化	纵横比>1、不规则边缘（针刺/微分叶边缘）、微钙化、显著低回声	微钙化、纵横比>1、微分叶/针刺样边缘

风险分层分类	ACR-TIRADS					EU-TIRADS				KTA/KSThR-TIRADS
风险分层分类	1	2	3	4	5	2	3	4	5	2	3	4	5
读片者1、2评估纳入各分层亚类结节例数	30/50	48/24	43/58	62/50	74/75	27/49	75/53	60/45	88/84	30/48	94/85	62/48	71/74
读片者1、2各分层亚类评估一致例数	23	20	30	30	60	21	35	16	68	23	66	30	58
Kappa值	0.502	0.492	0.497	0.408	0.726	0.483	0.402	0.131	0.686	0.521	0.598	0.424	0.721
P值	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	0.033	<0.001	<0.001	<0.001	<0.001	<0.001

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