Implementation of evidence-based guidelines for thyroid nodule biopsy: A model for establishment of practice standards Journal Article


Authors: Hambly, N. M.; Gonen, M.; Gerst, S. R.; Li, D.; Jia, X.; Mironov, S.; Sarasohn, D.; Fleming, S. E.; Hann, L. E.
Article Title: Implementation of evidence-based guidelines for thyroid nodule biopsy: A model for establishment of practice standards
Abstract: 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 (κ, 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. © American Roentgen Ray Society.
Keywords: adult; aged; aged, 80 and over; middle aged; major clinical study; area under the curve; outcome assessment; diagnostic accuracy; sensitivity and specificity; evidence-based medicine; diagnosis, differential; observer variation; evidence based practice; practice guideline; tumor biopsy; biopsy; echography; practice guidelines as topic; rating scale; aspiration biopsy; thyroid nodule; guideline adherence; roc curve; diagnostic test accuracy study; fine-needle aspiration; malignancy rating scale; thyroid malignancy; thyroid nodules
Journal Title: American Journal of Roentgenology
Volume: 196
Issue: 3
ISSN: 0361-803X
Publisher: American Roentgen Ray Society  
Date Published: 2011-03-01
Start Page: 655
End Page: 660
Language: English
DOI: 10.2214/ajr.10.4577
PUBMED: 21343510
PROVIDER: scopus
DOI/URL:
Notes: --- - "Export Date: 23 June 2011" - "CODEN: AJROA" - "Source: Scopus"
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MSK Authors
  1. Stephen E Fleming
    11 Fleming
  2. Mithat Gonen
    1031 Gonen
  3. Xiaoyu Jia
    46 Jia
  4. Niamh Maire Hambly
    2 Hambly
  5. Svetlana Mironov
    37 Mironov
  6. Duan Li
    20 Li
  7. Scott R Gerst
    48 Gerst
  8. Lucy E Hann
    69 Hann