Diagnostic performance of 2015 American Thyroid Association guidelines and inter-observer variability in assigning risk category

Abstract

Objective: To determine the interobserver variability of the 2015 American Thyroid Association (ATA) thyroid guidelines and to evaluate the diagnostic accuracy of the guidelines in detecting thyroid cancer. Materials and methods: Sonographic patterns of 189 thyroid lesions were retrospectively analyzed by two radiologists according to the 2015 guidelines. The risk of malignancy was calculated for each pattern and compared with the published expected risk of malignancy. Results: The observed risk of malignancy for very low suspicion, low suspicion, intermediate suspicion and high suspicion patterns were 2%, 12.7%, 26.3% and 29.8% respectively. Interobserver agreement for final category assignment was moderate (κ 0.518). Conclusion: The estimated risk of malignancy in the high suspicion pattern of the 2015 ATA thyroid biopsy guidelines appears to be less than stated. However, this needs further validation in a larger cohort study. Keywords: ATA guidelines, Interobserver agreement, Interobserver variability, Thyroid ultrasound, Fine needle aspiration biopsy