Interobserver agreement of thyroid imaging reporting and data system and realtime elastography for the assessment of thyroid nodules

Mireen Friedrich-Rust; Gesine Meyer; Nina Dauth; Christian Berner; Eva Herrmann; Hartmut Schroeter; Katharina Holzer; Lisa Voelkl; Stefan Zeuzem; Joerg Bojunga

doi:10.1530/endoabs.32.P1093

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Endocrine Abstracts (2013) 32 P1093 | DOI: 10.1530/endoabs.32.P1093

ECE2013 Poster Presentations Thyroid cancer (64 abstracts)

Interobserver agreement of thyroid imaging reporting and data system and realtime elastography for the assessment of thyroid nodules

Mireen Friedrich-Rust ¹ , Gesine Meyer ¹ , Nina Dauth ¹ , Christian Berner ¹ , Eva Herrmann ² , Hartmut Schroeter ³ , Katharina Holzer ⁴ , Lisa Voelkl ⁵ , Stefan Zeuzem ¹ & Joerg Bojunga ¹

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¹Department of Internal Medicine 1, J.W. Goethe-University Hospital, Frankfurt, Germany; ²Institute of Biostatistics and Mathematical Modelling, Faculty of Medicine, J.W. Goethe-University, Frankfurt, Germany; ³Praxis-Klinik für Diagnostik (PKD) am Staedel, Frankfurt, Germany; ⁴Department of General and Visceral Surgery, J.W. Goethe-University Hospital, Frankfurt, Germany; ⁵Institute of Pathology, J.W. Goethe-University Hospital, Frankfurt, Germany.

Introduction: Work-up of thyroid nodules remains challenging. Thyroid imaging reporting and data system (TIRADS) has been developed to improve patient management and cost-effectiveness by avoiding unnecessary fine needle aspiration biopsy (FNAB) in patients with thyroid nodules. However, since its publication in JCEM (2009) its clinical use is still very limited and its practicability in clinical practice is questioned. Realtime-elastography (RTE) enables the determination of tissue elasticity and has shown promising results for the differentiation of thyroid nodules.

Methods: The aim of the present study was to evaluate the interobserver agreement of TIRADS and RTE. Three blinded observers independently scored stored images of TIRADS and RTE in 114 nodules of 114 patients. In addition, the diagnostic performance of TIRADS and RTE for the diagnosis of malignant thyroid nodules was calculated. Cytology and/or histology was available for all benign (n=99) and histology for all malignant nodules (n=15).

Results: The interobserver agreement between the three physicians was only weak for TIRADS categories 2–5 (Cohen’s κ=0.27, P=0.000001) and TIRADS categories 2/3 vs 4/5 (ck=0.25, P=0.0020). The interobserver agreement was substantial for RTE scores 1–4 (ck=0.66, P<0.000001) and very good for RTE scores 1/2 vs 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 and 5 and 96–98% for RTE using score 3 and 4 for the diagnosis of malignancy, respectively. However, only 11–42% of nodules were in TIRADS-categories 2 and 3, as compared to 58–60% with RTE-score 1 and 2.

Conclusions: Interobserver agreement of TIRADS is only fair. TIRADS and RTE have high NPV for excluding malignancy in the diagnostic work-up of thyroid nodules. However, only 1/3 of FNABs could be avoided using TIRADS as compared to 60% using RTE. Prospective multicenter studies are needed to further evaluate the clinical utility of both methods.