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Comparison of the diagnostic performance of the 2017 ACR TI-RADS guideline to the Kwak guideline in children with thyroid nodules

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Abstract

Background

The Kwak Thyroid Imaging Reporting and Data System (Kwak-TI-RADS) guideline (2011) and American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) guideline (2017) were developed as ultrasound (US) risk stratification tools for detecting thyroid malignancy in adults.

Objective

The purpose of this study was to investigate the inter-rater reliability and diagnostic performance of the ACR TI-RADS guideline in the pediatric population and compare it to the Kwak guideline.

Materials and methods

This retrospective study comprised 75 children who underwent thyroid US at a tertiary-level pediatric hospital. Three pediatric radiologists and one pediatric radiology fellow graded the US findings using the Kwak-TI-RADS and ACR TI-RADS guidelines. We assessed reliability of radiologists’ ratings using percentage inter-rater agreement, and intra-class correlation coefficients (ICC2,1). We assessed area-under-the-receiver-operating-characteristic curve (AUROCC) to compare the discriminative diagnostic ability of the Kwak-TI-RADS and ACR TI-RADS scoring systems against histopathology/cytology, or stability on US over a 2-year follow-up period for cases without tissue diagnosis.

Results

The inter-rater agreement was significantly better for the ACR TI-RADS level compared to the Kwak-TI-RADS level (P<0.001) using the percentage pairwise agreement. The ROC curves for assessing the diagnostic performance of the two methods showed no significant difference between the methods. The AUROCCs for the Kwak-TI-RADS and ACR TI-RADS levels were 0.74 (95% confidence interval [CI] 0.67–0.82) and 0.72 (95% CI 0.61–0.82), respectively.

Conclusion

Both the Kwak-TI-RADS and ACR TI-RADS guidelines provide moderate malignancy risk stratification for thyroid nodules in the pediatric population, with better inter-rater agreement for the ACR TI-RADS guideline. Further work to adjust the recommendations for pediatric patients is necessary.

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Authors and Affiliations

  1. Department of Medical Imaging, CHEO, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada

    Gali Shapira-Zaltsberg, Elka Miller, Claudia Martinez-Rios & Kerri Highmore

  2. University of Ottawa, Ottawa, ON, Canada

    Gali Shapira-Zaltsberg, Elka Miller, Claudia Martinez-Rios, Juan Bass, Ellen B. Goldbloom, Ken Tang, Lamia Hayawi & Kerri Highmore

  3. Department of General Surgery, CHEO, Ottawa, ON, Canada

    Juan Bass

  4. Department of Endocrinology, CHEO, Ottawa, ON, Canada

    Ellen B. Goldbloom

  5. Research Institute, CHEO, Ottawa, ON, Canada

    Ken Tang & Lamia Hayawi

Authors
  1. Gali Shapira-Zaltsberg
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  2. Elka Miller
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  3. Claudia Martinez-Rios
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  4. Juan Bass
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  6. Ken Tang
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  7. Lamia Hayawi
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  8. Kerri Highmore
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Correspondence to Gali Shapira-Zaltsberg.

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Shapira-Zaltsberg, G., Miller, E., Martinez-Rios, C. et al. Comparison of the diagnostic performance of the 2017 ACR TI-RADS guideline to the Kwak guideline in children with thyroid nodules. Pediatr Radiol 49, 862–868 (2019). https://doi.org/10.1007/s00247-019-04385-6

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  • DOI: https://doi.org/10.1007/s00247-019-04385-6

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