title: Variability in Interpretation of Ultrasound Elastography and Gray-Scale Ultrasound in Assessing Thyroid Nodules.
abstract: The aim of this study was to validate inter-observer variability for strain ultrasound elastography (USE) and to compare the diagnostic performance of a combination of gray-scale ultrasound (US) and USE with that of gray-scale US. Three observers from different institutions evaluated gray-scale US images and USE video files of 443 cytopathologically proven benign or malignant thyroid nodules over a 3-mo period. Inter-observer variability did not statistically differ between USE using the Asteria criteria and gray-scale US; however, USE using the Rago criteria had the lowest inter-observer agreement (p < 0.043). For all three observers, sensitivity was increased by adding USE to gray-scale US (81.3%-88.3%, 75.4%-85.4%) compared with gray-scale US (70.4%-80.8%). Specificity was decreased by adding USE to gray-scale US (51.7%-59.1%, 59.1%-73.9%) compared with gray-scale US (69.0%-82.8%). USE and gray-scale US had comparable inter-observer variability. However, on addition of USE to gray-scale US, the additional diagnostic yield was limited compared with that of gray-scale US alone.
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Jieun
authors.initials: J
authors.lastname: Koh
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Hee Jung
authors.initials: HJ
authors.lastname: Moon
authors.affiliation: Department of Radiology, College of Medicine, Hanyang University, Seoul, Korea.
authors.forename: Jeong Seon
authors.initials: JS
authors.lastname: Park
authors.affiliation: Department of Radiology, College of Medicine, Chung-Ang University, Seoul, Korea.
authors.forename: Soo Jin
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Biostatistics Collaboration Unit, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Ha Yan
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Eun-Kyung
authors.initials: EK
authors.lastname: Kim
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, College of Medicine, Yonsei University, Seoul, Korea. Electronic address: docjin@yuhs.ac.
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Kwak
mesh_terms: D003937:Diagnosis, Differential; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012680:Sensitivity and Specificity; D016606:Thyroid Nodule / Q000000981:diagnostic imaging*
keywords: Diagnosis; Elastography; Inter-observer variability; Thyroid nodule; Ultrasound