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

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

doi:10.1007/s00247-019-04385-6

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

Pediatr Radiol. 2019 Jun;49(7):862-868. doi: 10.1007/s00247-019-04385-6. Epub 2019 Jun 1.

Authors

Gali Shapira-Zaltsberg^{1

2}, Elka Miller^{3

4}, Claudia Martinez-Rios^{3

4}, Juan Bass^{4

5}, Ellen B Goldbloom^{4

6}, Ken Tang^{4

7}, Lamia Hayawi^{4

7}, Kerri Highmore^{3

4}

Affiliations

¹ Department of Medical Imaging, CHEO, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada. Shapira.gali1979@gmail.com.
² University of Ottawa, Ottawa, ON, Canada. Shapira.gali1979@gmail.com.
³ Department of Medical Imaging, CHEO, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
⁴ University of Ottawa, Ottawa, ON, Canada.
⁵ Department of General Surgery, CHEO, Ottawa, ON, Canada.
⁶ Department of Endocrinology, CHEO, Ottawa, ON, Canada.
⁷ Research Institute, CHEO, Ottawa, ON, Canada.

PMID: 31154502
DOI: 10.1007/s00247-019-04385-6

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 (ICC_2,1). 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.

Keywords: Carcinoma; Children; Nodules; Thyroid; Thyroid Imaging Reporting and Data System; Ultrasound.

Publication types

Comparative Study
Practice Guideline

MeSH terms

Adolescent
Child
Child, Preschool
Female
Humans
Male
Ontario
Reproducibility of Results
Retrospective Studies
Thyroid Nodule / diagnostic imaging*
Ultrasonography / methods*