Observer variability and the performance between faculties and residents: US criteria for benign and malignant thyroid nodules

Korean J Radiol. 2010 Mar-Apr;11(2):149-55. doi: 10.3348/kjr.2010.11.2.149. Epub 2010 Feb 22.

Abstract

Objective: To evaluate the interobserver variability and performance in the interpretation of ultrasonographic (US) findings of thyroid nodules.

Materials and methods: 72 malignant nodules and 61 benign nodules were enrolled as part of this study. Five faculty radiologists and four residents independently performed a retrospective analysis of the US images. The observers received one training session after the first interpretation and then performed a secondary interpretation. Agreement was analyzed by Cohen's kappa statistic. Degree of performance was analyzed using receiver operating characteristic (ROC) curves.

Results: Agreement between the faculties was fair-to-good for all criteria; however, between residents, agreement was poor-to-fair. The area under the ROC curves was 0.72, 0.62, and 0.60 for the faculties, senior residents, and junior residents, respectively. There was a significant difference in performance between the faculties and the residents (p < 0.05). There was a significant increase in the agreement for some criteria in the faculties and the senior residents after the training session, but no significant increase in the junior residents.

Conclusion: Independent reporting of thyroid US performed by residents is undesirable. A continuous and specialized resident training is essential to enhance the degree of agreement and performance.

Keywords: Faculty; Internship and Residency; Observer variation; Thyroid Nodule; Ultrasonography.

MeSH terms

  • Adult
  • Aged
  • Clinical Competence / statistics & numerical data*
  • Diagnosis, Differential
  • Faculty, Medical / statistics & numerical data*
  • Female
  • Humans
  • Internship and Residency / statistics & numerical data*
  • Male
  • Middle Aged
  • Observer Variation
  • ROC Curve
  • Radiology / education
  • Retrospective Studies
  • Sensitivity and Specificity
  • Thyroid Gland / diagnostic imaging
  • Thyroid Neoplasms / diagnostic imaging*
  • Ultrasonography