AJR: Radiologists should adopt ACR guidelines to standardize thyroid biopsy recommendations
The American College of Radiology Thyroid Imaging and Reporting Data System (ACR TI-RADS) outlines risk stratification and management of thyroid nodules based on ultrasound features, but biopsy recommendations remain variable between radiologists.
According to a study published in the American Journal of Roentgenology, the recommendations rely heavily on accurate assignment of these features.
"Ideally, this process should have low interobserver variability to ensure consistency in recommending biopsy,” wrote corresponding author Jenny K. Hoang, with Duke University Medical Center, and colleagues.
In this study, 100 nodules from 92 patients underwent fine-needle aspiration or diagnostic lobectomy. Eight radiologists evaluated the nodules using five feature categories that constitute the ACR TI-RADS.
Results showed interobserver agreement on biopsy recommendations was “fair,” based on radiologists’ current practice, but applying the ACR-RADS resulted in improved “moderate” agreement.
Additionally, agreement in interpretation was fair to moderate for all features except shape and macrocalcifications, which achieved “substantial” agreement. Margin and echogenic foci achieved the poorest agreement.
“Despite the variability in assigning features, adoption of ACR TI-RADS improves agreement for recommending biopsy,” authors wrote.
“This is one of the core aims of ACR TI-RADS: to provide standardized recommendations despite the expertise of the reader,” wrote Hoang et al. “This agreement on biopsy will likely further improve with targeted education about sonographic findings, particularly margin and echogenic foci.”
The authors noted a few limitations of the study, including the lack of academic radiologist representation. They wrote even though the proportion in this study closely reflected expertise in thyroid ultrasounds in the community, “having only two academic radiologists with very different work practices accounted for poor agreement in recommending biopsy.”
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.