Implementation of Evidence-Based Guidelines for Thyroid Nodule Biopsy: A Model for Establishment of Practice Standards
Implementation of Evidence-Based Guidelines for Thyroid Nodule Biopsy: A Model for Establishment of Practice Standards
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DOI：
10.2214/ajr.10.4577
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发表时间：
2011-03-01
影响因子：
5
通讯作者：
Hann, Lucy E.
中科院分区：
文献类型：
--
作者：
Hambly, Niamh M.;Gonen, Mithat;Hann, Lucy E.
OBJECTIVE.多项研究已经确定了选择甲状腺结节进行活检的标准。没有一套标准是足够敏感和具体的。本研究的目的是开发一种方法来评估超声组的实践一致性，并确定是否可以使用5分恶性肿瘤评级量表来选择患者进行活检。从甲状腺活检数据库中选择了101个结节（50个良性和51个恶性）。7名放射科医生接受了用于选择结节进行活检的循证标准的教育。利用这些信息，读者根据超声检查结果的总体印象，使用5分恶性肿瘤评级量表对恶性肿瘤的可能性进行评级，其中1等于恶性肿瘤的最低可能性，5等于恶性肿瘤的最高可能性。确定观察者之间对活检建议的一致性、阅片者的敏感性、特异性和准确性。建议活检的敏感性和特异性分别为96.1%和52%。错分率为25.7%，准确率为74.3%。观察者之间对活检建议的一致性为一般至实质性（kappa，0.38-0.69）。恶性结节的符合率极好（0.88-1.0）。随着恶性程度的增加，恶性风险也增加：恶性程度为1的结节中，4.3%为恶性，而恶性程度为5的结节中，93.4%为恶性。我们的研究说明了一种方法，以评估标准的实践中的甲状腺结节评估放射科医生在超声组。应用5分恶性程度分级表选择结节进行活检是可行的，并显示出良好的诊断准确性。
OBJECTIVE. Multiple studies have defined criteria for the selection of thyroid nodules for biopsy. No set of criteria is sufficiently sensitive and specific. The aim of this study is to develop a method for assessing consistency of practice in an ultrasound group and to determine whether a 5-point malignancy rating scale can be used to select patients for biopsy.MATERIALS AND METHODS. One hundred one nodules (50 benign and 51 malignant) were selected from a thyroid biopsy database. Seven radiologists were educated on evidence-based criteria used to select nodules for biopsy. Using this information, readers graded the likelihood of malignancy using a 5-point malignancy rating scale, where 1 equals the lowest probability of malignancy and 5 equals the highest probability of malignancy, on the basis of overall impression of sonographic findings. Interobserver agreement on biopsy recommendation, reader sensitivity, specificity, and accuracy were determined.RESULTS. The sensitivity and specificity of biopsy recommendation were 96.1% and 52%, respectively. The misclassification rate was 25.7%, and accuracy was 74.3%. Interobserver agreement on biopsy recommendation was fair to substantial (kappa, 0.38-0.69). The proportion of agreement was excellent for malignant nodules (0.88-1.0). The risk of malignancy increased with increasing malignancy rating: 4.3% of nodules with a malignancy rating of 1 were malignant versus 93.4% of those assigned a rating of 5.CONCLUSION. Our study illustrates a method to evaluate the standard of practice for thyroid nodule assessment among radiologists within an ultrasound group. Application of a 5-point malignancy rating scale to select nodules for biopsy is feasible and shows good diagnostic accuracy.