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Prospective analysis of inter-observer and intra-observer variability in multi ultrasound descriptor assessment of thyroid nodules

Katarzyna Dobruch-Sobczak
Katarzyna Dobruch-Sobczak
, 
Bartosz Migda
Bartosz Migda
, 
Agnieszka Krauze
Agnieszka Krauze
, 
Krzysztof Mlosek
Krzysztof Mlosek
, 
Rafał Z. Słapa
Rafał Z. Słapa
, 
Paweł Wareluk
Paweł Wareluk
, 
Elwira Bakuła-Zalewska
Elwira Bakuła-Zalewska
, 
Zbigniew Adamczewski
Zbigniew Adamczewski
, 
Andrzej Lewiński
Andrzej Lewiński
, 
Wiesław Jakubowski
Wiesław Jakubowski
 et 
Marek Dedecjus
Marek Dedecjus
   | 30 sept. 2019
Journal of Ultrasonography's Cover Image
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Article Category: research-article
Publié en ligne: 30 sept. 2019
Pages: 198 - 206
Reçu: 20 janv. 2019
Accepté: 29 mars 2019
DOI: https://doi.org/10.15557/jou.2019.0030
Mots clés
© 2019 Katarzyna Dobruch-Sobczak et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1.

Chart flow
Chart flow

Fig. 2.

B-mode US image of solid, inhomogeneous hypoechoic lesion with lobular margins and a size of 21 × 17 × 28.5 mm (depth × width × length). During assessment of microcalcifications, there was disagreement between observers, three were negative, and two of were positive for this feature. In histology, the lesion was proved to be follicular thyroid cancer
B-mode US image of solid, inhomogeneous hypoechoic lesion with lobular margins and a size of 21 × 17 × 28.5 mm (depth × width × length). During assessment of microcalcifications, there was disagreement between observers, three were negative, and two of were positive for this feature. In histology, the lesion was proved to be follicular thyroid cancer

Fig. 3.

A. B-mode image of solid, hypoechoic lesion with macrocalcifications in the central part and a size of 17.5 × 19 × 22.5 mm (depth × width × length). There was a disagreement during the assessment of the nodule margin and thyroid capsule: three observers considered it as only modeling of thyroid capsule, but two of them considered it as infiltration of thyroid capsule. B. Sonoelastogram of hypoechoic lesion with central macrocalcification. There was a disagreement in the Asteria scale assessment, with one observer categorizing this nodule as Asteria II, one observer as Asteria III, and the last three as Asteria IV. In histology, the lesion proved to be medullar thyroid cancer
A. B-mode image of solid, hypoechoic lesion with macrocalcifications in the central part and a size of 17.5 × 19 × 22.5 mm (depth × width × length). There was a disagreement during the assessment of the nodule margin and thyroid capsule: three observers considered it as only modeling of thyroid capsule, but two of them considered it as infiltration of thyroid capsule. B. Sonoelastogram of hypoechoic lesion with central macrocalcification. There was a disagreement in the Asteria scale assessment, with one observer categorizing this nodule as Asteria II, one observer as Asteria III, and the last three as Asteria IV. In histology, the lesion proved to be medullar thyroid cancer

List of ultrasound descriptors for thyroid nodules

US features Abbreviations Characteristics
Composition Composition CysticSpongiformMixed cystic (≥50% cystic volume)Mixed solid (≥50% solid volume)Almost completely solidSolidCannot determine
Echo pattern (in comparison to thyroid parenchyma) Echo-Pa IsoechoicMixedHypoechoic
Dominating echo pattern (in comparison to thyroid parenchyma) Echo-Pb HyperechoicIsoechoicHypoechoic
Echo pattern (in comparison to muscles) Echo-M HyperechoicIsoechoicHypoechoic
Margins Margins Well-definedIll-defined
“Halo” pattern “Halo” CompletePartialAbsent
Extrathyroidal extension Capsule Models thyroid shape and capsuleInvasion beyond the thyroidcapsuleAbsent
Macrocalcifications (>1 mm) Macro PresentAbsent
Microcalcifications (≤1 mm) Micro PresentAbsent
Vascularity Vascularity PeripheralCentralCombined (central and peripheral)Absent
Elasticity score (Asteria Scale) Asteria Scale 1 – Elasticity in the whole examined area2 – Elasticity in a large portion of the examined area3 – No elasticity in a large portion of the examined area4 – No elasticity in the whole examined area
Remaining thyroid parenchyma Parenchyma HomogeneousHeterogeneous
Autoimmune thyroiditis AT PresentAbsent
Parenchyma vascularity Parenchyma vascularity NormalDecreasedIncreased

Assessment of the intra- and inter-observer agreements

Description Intra-observer agreement Inter-observer agreement
Observer 1 Observer 2 Observer 3 Observer 4 Observer 5
Agreement (%) K-value (SE) Agreement (%) K-value (SE) Agreement (%) K-value (SE) Agreement (%) K-value (SE) Agreement (%) K-value (SE) K-value (SE)
Composition 95.0 0.88 (0.12) 100.0 1.00 (0.00) 90.0 0.83 (0.11) 95.0 0.91 (0.09) 90.0 0.75 (0.17) 0.55 (0.04)
Echo-Pa 75.0 0.57 (0.16) 100.0 1.00 (0.00) 90.0 0.83 (0.11) 100.0 1.00 (0.00) 75.0 0.53 (0.17) 0.48 (0.04)
Echo-Pb 85.0 0.69 (0.16) 95.0 0.91 (0.09) 95.0 0.89 (0.11) 100.0 1.00 (0.00) 80.0 0.52 (0.21) 0.50 (0.05)
Echo-M 90.0 0.80 (0.14) 100.0 1.00 (0.00) 100.0 1.00 (0.00) 95.0 0.84 (0.16) 90.0 0.67 (0.18) 0.49 (0.04)
Margins 85.0 0.70 (0.16) 95.0 0.90 (0.10) 95.0 0.88 (0.12) 95.0 0.88 (0.12) 85.0 0.63 (0.20) 0.39 (0.05)
“Halo” 80.0 0.68 (0.13) 85.0 0.76 (0.12) 85.0 0.77 (0.12) 90.0 0.67 (0.19) 75.0 0.62 (0.14) 0.41 (0.04)
Capsule 80.0 0.64 (0.17) 95.0 0.91 (0.09) 85.0 0.72 (0.15) 80.0 0.59 (0.18) 75.0 0.50 (0.19) 0.40 (0.04)
Macro 100.0 1.00 (0.00) 95.0 0.83 (0.17) 95.0 0.64 (0.33) 100.0 1.00 (0.00) 95.0 0.64 (0.33) 0.61 (0.05)
Micro 95.0 0.89 (0.11) 95.0 0.90 (0.10) 90.0 0.77 (0.15) 90.0 0.78 (0.14) 90.0 0.74 (0.17) 0.57 (0.05)
Vascularity 90.0 0.86 (0.10) 90.0 0.74 (0.16) 100.0 1.00 (0.00) 95.0 0.85 (0.13) 95.0 0.87 (0.13) 0.34 (0.03)
Asteria Scale 78.9 0.71 (0.13) 78.9 0.70 (0.13) 94.7 0.92 (0.08) 73.7 0.61 (0.15) 73.7 0.65 (0.13) 0.33 (0.03)
Parenchyma 75.0 0.50 (0.19) 85.0 0.69 (0.16) 100.0 1.00 (0.00) 95.0 0.89 (0.10) 90.0 0.69 (0.20) 0.40 (0.05)
AT 95.0 0.88 (0.12) 80.0 0.47 (0.23) 95.0 * 95.0 0.64 (0.33) 100.0 1.00 (0.00) 0.25 (0.05)
Parenchyma vascularity 80.0 0.64 (0.16) 85.0 0.66 (0.17) 95.0 0.92 (0.08) 85.0 0.71 (0.15) 75.0 0.17 (0.26) 0.18 (0.04)
Average 86.0 0.74 91.4 0.82 93.6 0.86 92.0 0.81 84.9 0.64 0.42

Assessment of intra-observer accuracy

Description Accuracy (%)
Observer 1 Observer 2 Observer 3 Observer 4 Observer 5
Composition 92.5 95.0 77.5 72.5 90.0
Echo-Pa 80.0 80.0 90.0 90.0 82.5
Echo-Pb 92.5 82.5 87.5 95.0 87.5
Echo-M 87.5 95.0 90.0 92.5 97.5
Margins 82.5 87.5 72.5 82.5 92.5
“Halo” 85.0 87.5 82.5 65.0 87.5
Capsule 87.5 85.0 80.0 92.5 92.5
Macro 100.0 92.5 97.5 90.0 97.5
Micro 100.0 92.5 85.0 87.5 95.0
Vascularity 65.0 95.0 85.0 97.5 75.0
Asteria Scale 78.9 86.8 68.4 47.4 73.7
Parenchyma 82.5 82.5 80.0 87.5 65.0
AT 77.5 80.0 92.5 97.5 100.0
Parenchyma vascularity 75.0 87.5 70.0 77.5 85.0
Average 84.7 87.8 82.7 83.9 87.2
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