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Comparative Study
. 2013 Oct 24;8(10):e77927.
doi: 10.1371/journal.pone.0077927. eCollection 2013.

Interobserver agreement of Thyroid Imaging Reporting and Data System (TIRADS) and strain elastography for the assessment of thyroid nodules

Mireen Friedrich-Rust  1 , Gesine Meyer, Nina Dauth, Christian Berner, Dimitra Bogdanou, Eva Herrmann, Stefan Zeuzem, Joerg Bojunga
Affiliations
Comparative Study

Interobserver agreement of Thyroid Imaging Reporting and Data System (TIRADS) and strain elastography for the assessment of thyroid nodules

Mireen Friedrich-Rust et al. PLoS One. .

Abstract

Background: 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.

Methods: 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).

Results: 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.

Conclusions: 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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Example of TIRADS and SE of thyroid adenoma: 10 mm nodule in the right thyroid gland classified as TIRADS 4 (consistent with malignancy) in the left image and SE 2 (predominantly green  =  soft; consistent with benign nodule) in the right image.
Histology revealed a benign follicular thyroid adenoma.
Figure 2
Figure 2. Example of TIRADS and SE of papillary carcinoma: 10 mm nodule in the right thyroid gland classified as TIRADS 4 (consistent with malignancy) in the left image and SE 3 (predominantly blue  =  hard; consistent with malignancy) in the right image.
Histology revealed a papillary T2 carcinoma.
See this image and copyright information in PMC

Comment on

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