Application of Thyroid Imaging Reporting and Data System in the Ultrasound Assessment of Thyroid Nodules According to Physician Experience.
OBJECTIVE
The aim of this study was to investigate and compare the diagnostic performances of the Thyroid Imaging Reporting and Data System (TIRADS) in differentiating benign and malignant thyroid nodules according to the level of physician experience.


METHODS
From March to October 2013, 1102 patients with 1128 thyroid nodules who underwent initial ultrasound-guided fine needle aspiration were included in this study. Thyroid nodules were categorized according to TIRADS. Diagnostic performances of ultrasound were compared according to performer experience using the χ test or Fisher exact test.


RESULTS
Of 1128 thyroid nodules, 281 were malignant, and 847 were benign. The risk of malignancy of each TIRADS category by the experienced and less experienced physicians were as follows: category 3 (0.9% vs 0%), category 4a (3.5% vs 1.3%), category 4b (7.3% vs 12.1%), category 4c (67.5% vs 44.9%), and category 5 (97.7% vs 76.5%). Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 99.1%, 35.9%, 52.5%, 35.5%, and 99.1%, respectively, for experienced physicians and 100%, 20.9%, 37.6%, 35.2%, and 100%, respectively, for less experienced physicians. Specificity, accuracy, and positive predictive value were statistically higher for experienced physicians than those for less experienced physicians (P < 0.001, 0.001, and 0.004). There was a significant difference in areas under the curve between the 2 groups (P < 0.001).


CONCLUSIONS
In conclusion, the diagnostic performance of the stratification of malignancy risk according to TIRADS categories was comparable between the experienced and less experienced physician groups. The application of TIRADS is reproducible, and it was easy to predict the probability of thyroid malignancy in both the experienced and less experienced physician groups.
*Department of Radiology, Jeju National University Hospital, Jeju National School of Medicine, Jeju; and †Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine; and ‡Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea.
Su Yeon
SY
Ko
Eun-Kyung
EK
Kim
Hee Jung
HJ
Moon
Jung Hyun
JH
Yoon
Ha Yan
HY
Kim
Jin Young
JY
Kwak
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011873:Radiology Information Systems; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013961:Thyroid Gland / Q000000981:diagnostic imaging*; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging*; D016606:Thyroid Nodule / Q000000981:diagnostic imaging*; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult