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Ultrasound grading of thyroid nodules using the BTA U-scoring guidelines – Is there evidence of intra-and interobserver variability?

Ultrasound grading of thyroid nodules using the BTA U-scoring guidelines – Is there evidence of intra-and interobserver variability?
Ultrasound grading of thyroid nodules using the BTA U-scoring guidelines – Is there evidence of intra-and interobserver variability?
Introduction U-score ultrasound classification (graded U1-U5) is widely used to grade thyroid nodules based on benign and malignant sonographic features. It is well established that ultrasound is an operator-dependent imaging modality and thus more susceptible to subjective variances between operators when using imaging-based scoring systems. We aimed to assess whether there is any intra- or interobserver variability when U-scoring thyroid nodules and whether previous thyroid ultrasound experience has an effect on this variability. Methods A total of 14 ultrasound operators were identified (five experienced thyroid operators, five with intermediate experience and four with no experience) and were asked to U-score images from 20 thyroid cases shown as a single projection, with and without Doppler flow. The cases were subsequently rescored by the 14 operators after six weeks. The first and second round U-scores for the three operator groups were then analysed using Fleiss’ kappa to assess interobserver variability and Cochran’s Q test to determine any intraobserver variability. Results We found no significant interobserver variability on combined assessment of all operators with fair agreement in round 1 (Fleiss’ kappa = 0.30, p <0.0001) and slight agreement in round 2 (Fleiss’ kappa = 0.19, p < 0.0001). Cochran’s Q test revealed no significant intraobserver variability in all 14 operators between round 1 and round 2 (all p>0.05). Conclusions We found no statistically significant inter- or intraobserver variability in the U-scoring of thyroid nodules between all participants reinforcing the validity of this scoring method in clinical practice, allaying concerns regarding potential subjective biases in reporting.
Thyroid ultrasound, U-score, grading, observer variability, thyroid nodules
1742-271X
100-105
Couzins, Mike
be410352-29de-43a3-808d-6cdcd09d0ecb
Forbes, Stuart
87891041-4ab1-4c68-a389-42ead87a7a22
Vigneswaran, Ganesh
4e3865ad-1a15-4a27-b810-55348e7baceb
Mitra, Indu
1e261053-08a1-42a3-b4e8-7685be5a7145
Rutherford, Elizabeth
f619b2cb-a503-4f3d-aabb-1d26a306bdab
Couzins, Mike
be410352-29de-43a3-808d-6cdcd09d0ecb
Forbes, Stuart
87891041-4ab1-4c68-a389-42ead87a7a22
Vigneswaran, Ganesh
4e3865ad-1a15-4a27-b810-55348e7baceb
Mitra, Indu
1e261053-08a1-42a3-b4e8-7685be5a7145
Rutherford, Elizabeth
f619b2cb-a503-4f3d-aabb-1d26a306bdab

Couzins, Mike, Forbes, Stuart, Vigneswaran, Ganesh, Mitra, Indu and Rutherford, Elizabeth (2021) Ultrasound grading of thyroid nodules using the BTA U-scoring guidelines – Is there evidence of intra-and interobserver variability? Ultrasound, 29 (2), 100-105. (doi:10.1177/1742271X20971323).

Record type: Article

Abstract

Introduction U-score ultrasound classification (graded U1-U5) is widely used to grade thyroid nodules based on benign and malignant sonographic features. It is well established that ultrasound is an operator-dependent imaging modality and thus more susceptible to subjective variances between operators when using imaging-based scoring systems. We aimed to assess whether there is any intra- or interobserver variability when U-scoring thyroid nodules and whether previous thyroid ultrasound experience has an effect on this variability. Methods A total of 14 ultrasound operators were identified (five experienced thyroid operators, five with intermediate experience and four with no experience) and were asked to U-score images from 20 thyroid cases shown as a single projection, with and without Doppler flow. The cases were subsequently rescored by the 14 operators after six weeks. The first and second round U-scores for the three operator groups were then analysed using Fleiss’ kappa to assess interobserver variability and Cochran’s Q test to determine any intraobserver variability. Results We found no significant interobserver variability on combined assessment of all operators with fair agreement in round 1 (Fleiss’ kappa = 0.30, p <0.0001) and slight agreement in round 2 (Fleiss’ kappa = 0.19, p < 0.0001). Cochran’s Q test revealed no significant intraobserver variability in all 14 operators between round 1 and round 2 (all p>0.05). Conclusions We found no statistically significant inter- or intraobserver variability in the U-scoring of thyroid nodules between all participants reinforcing the validity of this scoring method in clinical practice, allaying concerns regarding potential subjective biases in reporting.

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More information

Accepted/In Press date: 5 October 2020
e-pub ahead of print date: 16 November 2020
Published date: 1 May 2021
Additional Information: © The Author(s) 2020.
Keywords: Thyroid ultrasound, U-score, grading, observer variability, thyroid nodules

Identifiers

Local EPrints ID: 448665
URI: http://eprints.soton.ac.uk/id/eprint/448665
ISSN: 1742-271X
PURE UUID: c0642548-e2ca-40b9-8075-738eecad494a
ORCID for Ganesh Vigneswaran: ORCID iD orcid.org/0000-0002-4115-428X

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Date deposited: 29 Apr 2021 16:32
Last modified: 17 Mar 2024 04:06

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Contributors

Author: Mike Couzins
Author: Stuart Forbes
Author: Indu Mitra
Author: Elizabeth Rutherford

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