title: Interobserver agreement of Thyroid Imaging Reporting and Data System (TIRADS) and strain elastography for the assessment of thyroid nodules.
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.
authors.affiliation: Department of Internal Medicine 1, J.W.Goethe-University Hospital, Frankfurt, Germany.
authors.forename: Mireen
authors.initials: M
authors.lastname: Friedrich-Rust
authors.forename: Gesine
authors.initials: G
authors.lastname: Meyer
authors.forename: Nina
authors.initials: N
authors.lastname: Dauth
authors.forename: Christian
authors.initials: C
authors.lastname: Berner
authors.forename: Dimitra
authors.initials: D
authors.lastname: Bogdanou
authors.forename: Eva
authors.initials: E
authors.lastname: Herrmann
authors.forename: Stefan
authors.initials: S
authors.lastname: Zeuzem
authors.forename: Joerg
authors.initials: J
authors.lastname: Bojunga
mesh_terms: D006801:Humans; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging*; D016606:Thyroid Nodule / Q000000981:diagnostic imaging*; D014463:Ultrasonography