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Radiol.
2015
May-Jun;16(3):560-565.
English.
Inter-Observer
Ultrasound
Variation
Measurement
in
of
the
Attribution
Non-Commercial
License
(http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the
original work is properly cited.
Abstract
Objective
Thyroid nodule measurement using ultrasonography (US) is widely performed in
various clinical scenarios. The purpose of this study was to evaluate interobserver variation in US measurement of the volume and maximum diameter of
thyroid nodules.
Materials and Methods
This retrospective study included 73 consecutive patients with 85 well-defined
thyroid nodules greater than 1 cm in their maximum diameter. US examinations
were independently performed by using standardized measurement methods,
conducted by two clinically experienced thyroid radiologists. The maximum
nodule diameter and nodule volume, calculated from nodule diameters using the
ellipsoid formula, were obtained by each reader. Inter-observer variations in
volume and maximum diameter were determined using 95% Bland-Altman limits
of agreement. The degree of inter-observer variations in volumes and the
maximum diameters were compared using the Student's t test, between nodules <
2 cm in maximum diameter and those with 2 cm.
Results
The mean inter-observer difference in measuring the nodule volume was -1.6%,
in terms of percentage of the nodule volume, and the 95% limit of agreement was
13.1%. For maximum nodule diameter, the mean inter-observer difference was
-0.6%, in terms of percentage of the nodule diameter, and the 95% limit of
agreement was 7.3%. Inter-observer variation in volume was greater in nodules
of < 2 cm in maximum diameter, compared to the larger nodules (p = 0.035).
However, no statistically significant difference was noted between the two groups
regarding maximum nodule diameters (p = 0.511).
Conclusion
Any differences smaller than 13.1% and 7.3% in volume and maximum diameter,
respectively, measured by using US for well-defined thyroid nodules of > 1 cm
should not be considered as a real change in size.
calculated using the ellipsoid formula ([length width height] / 6). Before
performing this study, the radiologists discussed about standardizing the
measurement method in order to obtain objective measurements. When measuring
nodule size, we positioned the calipers at the outer margin of the halo of the
nodule (Fig. 1) (14). The maximum transverse diameter was depicted on
transverse US, and the width and height of the thyroid nodule were measured. The
width was measured as the maximum transverse diameter, and the height was
measured as the maximum anteroposterior diameter perpendicular to the width.
The length of the thyroid nodule was measured as the maximum longitudinal
diameter on longitudinal US images. After measuring the width, height, and
length, the greatest value was defined as the maximum diameter.
Fig.
(US)
is
shown.
For each patient, the two radiologists independently measured the diameter and
volume of thyroid nodule on the same day. To evaluate inter-observer variation,
the faculty radiologist waited outside of the room while thyroid US was being
performed by the fellow radiologist. After the fellow radiologist measured the
thyroid nodule and showed the nodule he had measured to the faculty radiologist,
the faculty radiologist then measured it in the same manner without receiving any
Windows, version 19.0, IBM Corp., Armonk, NY, USA; and MedCalc for
Windows, version 13.3.3, MedCalc Software, Ostend, Belgium). In this study, p <
0.05 was considered to indicate a statistical significance.
Go to:
RESULTS
The Bland-Altman plots of measurements, which represent the relationship
between the differences and mean values determined by the two radiologists, are
shown in Figure 2. Regarding volumes, the mean difference and 95% limits of
agreement were -0.06 mL and -0.88 mL to +0.76 mL, respectively; for maximum
diameter, the mean difference and the 95% limits of agreement were -0.01 cm and
-0.20 to +0.17 cm, respectively. Spearman's coefficient of rank correlation
analysis revealed a statistically significant and positive correlation between
absolute difference and mean value of volume and maximum diameter (volume,
0.694, p < 0.001; maximum diameter, 0.424, p < 0.001), thus indicating that the
inter-observer variation increased as the volume and maximum diameter
increased. The 95% limits of agreement between standardized volumes and
maximum diameters measured by the two radiologists (i.e., measurement
differences in percentages) were 13.1% and 7.3%, respectively (Fig. 2).
Fig.
maximum
diameter(C,
D) with
change in size. This work permits reference data for monitoring size change of
thyroid nodule during follow-up US.
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