THE SONOGRAPHIC PATTERNS PROPOSED IN THE PROVISIONAL 2014 ATA GUIDELINES FOR THE MANAGEMENT OF THYROID NODULES PERFORMS WELL IN MEDULLARY THYROID CARCINOMA AND AGREEMENT IS GOOD AMONG DIFFERENT OBSERVERS
AACE ePoster Library. Valderrabano P. 05/13/15; 97813; 1004
Pablo Valderrabano
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Abstract
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Objective: The 2014 provisional ATA guidelines for the management of thyroid nodules provide a classification based on the sonographic pattern. Each pattern is associated with an estimated risk of malignancy and a size threshold for biopsy. These were developed based on the appearance of papillary and follicular thyroid carcinoma, but the performance on medullary thyroid carcinoma (MTC) is unknown. This study aims to evaluate how MTC would be classified by this system and to measure the agreement between different observers.
Methods: In this IRB-approved retrospective study, we included all patients with MTC evaluated at our institution between 1998 and 2014 whose ultrasound images were available for review. Five independent reviewers with expertise in ultrasound (4 endocrinologists and 1 radiologist) reviewed the images. Each investigator assessed information regarding echogenicity, margins, calcifications, extrathyroidal extension and presence of suspicious lymph nodes. The shape “taller than wider” in the transverse view was considered positive when there was a difference ≥2mm in the measurements given to identify the nodule (common to all observers). Hetero-echogenic nodules in the absence of other suspicious features were considered “Low-suspicion”. Iso-, hyper- or hetero-echogenic nodules with at least one suspicious feature were considered “High-suspicion”. For all other situations, the suspicion pattern was specified by the ATA classification and was followed. Percentage of overall agreement and free marginal kappa were calculated using an online kappa calculator (http://justus.randolph.name/kappa).
Results: Images were available for review in 30 MTC and 90-100% were classified as “Intermediate” or “High-suspicion” by all raters. The percentage of overall agreement for all categories was 77% with a Kappa coefficient of 0.72 (good agreement). The agreement was moderate for the individual features and the kappa coefficient ranged from 0.44 for irregular margins to 0.56 for extrathyroidal extension and presence of suspicious lymph nodes. Six of the 30 nodules evaluated were classified as “Low-suspicion” by at least one of the observers. However, biopsy would have been warranted in 5 due to size >1.5 cm (n=3) or clinical history (known MEN2 and elevated plasma calcitonin, n=2). Biopsy could have been delayed in one nodule (1.3 cm) by one of the observers.
Discussion: Most MTC have an “Intermediate” or “High-suspicion” sonographic pattern and therefore are unlikely to be missed by the new classification.
Conclusion: The new sonographic patterns proposed in the provisional 2014 ATA guidelines perform well for MTC and interobserver agreement is good overall.
Methods: In this IRB-approved retrospective study, we included all patients with MTC evaluated at our institution between 1998 and 2014 whose ultrasound images were available for review. Five independent reviewers with expertise in ultrasound (4 endocrinologists and 1 radiologist) reviewed the images. Each investigator assessed information regarding echogenicity, margins, calcifications, extrathyroidal extension and presence of suspicious lymph nodes. The shape “taller than wider” in the transverse view was considered positive when there was a difference ≥2mm in the measurements given to identify the nodule (common to all observers). Hetero-echogenic nodules in the absence of other suspicious features were considered “Low-suspicion”. Iso-, hyper- or hetero-echogenic nodules with at least one suspicious feature were considered “High-suspicion”. For all other situations, the suspicion pattern was specified by the ATA classification and was followed. Percentage of overall agreement and free marginal kappa were calculated using an online kappa calculator (http://justus.randolph.name/kappa).
Results: Images were available for review in 30 MTC and 90-100% were classified as “Intermediate” or “High-suspicion” by all raters. The percentage of overall agreement for all categories was 77% with a Kappa coefficient of 0.72 (good agreement). The agreement was moderate for the individual features and the kappa coefficient ranged from 0.44 for irregular margins to 0.56 for extrathyroidal extension and presence of suspicious lymph nodes. Six of the 30 nodules evaluated were classified as “Low-suspicion” by at least one of the observers. However, biopsy would have been warranted in 5 due to size >1.5 cm (n=3) or clinical history (known MEN2 and elevated plasma calcitonin, n=2). Biopsy could have been delayed in one nodule (1.3 cm) by one of the observers.
Discussion: Most MTC have an “Intermediate” or “High-suspicion” sonographic pattern and therefore are unlikely to be missed by the new classification.
Conclusion: The new sonographic patterns proposed in the provisional 2014 ATA guidelines perform well for MTC and interobserver agreement is good overall.
Objective: The 2014 provisional ATA guidelines for the management of thyroid nodules provide a classification based on the sonographic pattern. Each pattern is associated with an estimated risk of malignancy and a size threshold for biopsy. These were developed based on the appearance of papillary and follicular thyroid carcinoma, but the performance on medullary thyroid carcinoma (MTC) is unknown. This study aims to evaluate how MTC would be classified by this system and to measure the agreement between different observers.
Methods: In this IRB-approved retrospective study, we included all patients with MTC evaluated at our institution between 1998 and 2014 whose ultrasound images were available for review. Five independent reviewers with expertise in ultrasound (4 endocrinologists and 1 radiologist) reviewed the images. Each investigator assessed information regarding echogenicity, margins, calcifications, extrathyroidal extension and presence of suspicious lymph nodes. The shape “taller than wider” in the transverse view was considered positive when there was a difference ≥2mm in the measurements given to identify the nodule (common to all observers). Hetero-echogenic nodules in the absence of other suspicious features were considered “Low-suspicion”. Iso-, hyper- or hetero-echogenic nodules with at least one suspicious feature were considered “High-suspicion”. For all other situations, the suspicion pattern was specified by the ATA classification and was followed. Percentage of overall agreement and free marginal kappa were calculated using an online kappa calculator (http://justus.randolph.name/kappa).
Results: Images were available for review in 30 MTC and 90-100% were classified as “Intermediate” or “High-suspicion” by all raters. The percentage of overall agreement for all categories was 77% with a Kappa coefficient of 0.72 (good agreement). The agreement was moderate for the individual features and the kappa coefficient ranged from 0.44 for irregular margins to 0.56 for extrathyroidal extension and presence of suspicious lymph nodes. Six of the 30 nodules evaluated were classified as “Low-suspicion” by at least one of the observers. However, biopsy would have been warranted in 5 due to size >1.5 cm (n=3) or clinical history (known MEN2 and elevated plasma calcitonin, n=2). Biopsy could have been delayed in one nodule (1.3 cm) by one of the observers.
Discussion: Most MTC have an “Intermediate” or “High-suspicion” sonographic pattern and therefore are unlikely to be missed by the new classification.
Conclusion: The new sonographic patterns proposed in the provisional 2014 ATA guidelines perform well for MTC and interobserver agreement is good overall.
Methods: In this IRB-approved retrospective study, we included all patients with MTC evaluated at our institution between 1998 and 2014 whose ultrasound images were available for review. Five independent reviewers with expertise in ultrasound (4 endocrinologists and 1 radiologist) reviewed the images. Each investigator assessed information regarding echogenicity, margins, calcifications, extrathyroidal extension and presence of suspicious lymph nodes. The shape “taller than wider” in the transverse view was considered positive when there was a difference ≥2mm in the measurements given to identify the nodule (common to all observers). Hetero-echogenic nodules in the absence of other suspicious features were considered “Low-suspicion”. Iso-, hyper- or hetero-echogenic nodules with at least one suspicious feature were considered “High-suspicion”. For all other situations, the suspicion pattern was specified by the ATA classification and was followed. Percentage of overall agreement and free marginal kappa were calculated using an online kappa calculator (http://justus.randolph.name/kappa).
Results: Images were available for review in 30 MTC and 90-100% were classified as “Intermediate” or “High-suspicion” by all raters. The percentage of overall agreement for all categories was 77% with a Kappa coefficient of 0.72 (good agreement). The agreement was moderate for the individual features and the kappa coefficient ranged from 0.44 for irregular margins to 0.56 for extrathyroidal extension and presence of suspicious lymph nodes. Six of the 30 nodules evaluated were classified as “Low-suspicion” by at least one of the observers. However, biopsy would have been warranted in 5 due to size >1.5 cm (n=3) or clinical history (known MEN2 and elevated plasma calcitonin, n=2). Biopsy could have been delayed in one nodule (1.3 cm) by one of the observers.
Discussion: Most MTC have an “Intermediate” or “High-suspicion” sonographic pattern and therefore are unlikely to be missed by the new classification.
Conclusion: The new sonographic patterns proposed in the provisional 2014 ATA guidelines perform well for MTC and interobserver agreement is good overall.
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