Highlights
- •Among radiologists with less interpreting experience, there is fair interobserver agreement for final TI-RADS level scoring, and substantial agreement for biopsy recommendation based on established ACR TI-RADS criteria.
- •Retrospective scoring with established ACR TI-RADS criteria would have substantially reduced the number of biopsies performed.
Abstract
Purpose
To assess diagnostic performance of ACR TI-RADS in thyroid cancer detection and evaluate
interobserver agreement among radiologists with lower interpreting experience.
Methods
Four radiologists retrospectively assessed 295 biopsied thyroid nodules from ultrasound
studies performed between 2009 and 2019, blinded to histopathology. Diagnostic performance
for cancer detection was determined individually, and interobserver agreement among
four readers was evaluated with Fleiss kappa coefficient (ⱪ).
Results
245 (83.1%) benign and 50 (16.9%) malignant nodules were evaluated. Diagnostic performance
based on final TR level was consistent and without significant difference among four
readers, with excellent sensitivity (≥98.0%) and negative predictive value (NPV) [≥94.4%]
for TR levels 3 to 5. Diagnostic performance based on recommendation to biopsy has
moderate sensitivity (≥62%) and high NPV (≥84.7%). Retrospective scoring with established
ACR TI-RADS criteria would have substantially reduced the number of biopsies performed,
with 63.2% of malignancy not biopsied meeting criteria for sonographic surveillance.
Interobserver agreement on TI-RADS scoring for final TR level was fair (ⱪ = 0.39,
95% CI 0.32, 0.47), with substantial agreement for recommendation to biopsy (ⱪ = 0.64,
95% CI 0.58, 0.70).
Conclusions
Substantial reduction in biopsy rate (up to 48%) would have been achieved using the
ACR TI-RADS criteria, with 63% of malignancy not biopsied meeting criteria for sonographic
surveillance. Interobserver agreement was fair for TI-RADS level scoring and substantial
for recommendation to biopsy.
Keywords
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Article info
Publication history
Published online: February 09, 2022
Accepted:
February 3,
2022
Received in revised form:
January 29,
2022
Received:
October 11,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
