RESUMO
El Thyroid Imaging Reporting and Data System (TI-RADS) es un sistema de clasificación ultrasonográfico cuyo propósito es estandarizar el reporte de los nódulos tiroideos por categorías de riesgo de cáncer, lo cual disminuye el número global de biopsias. Objetivo: Estimar la concordancia inter- e intraobservador en la aplicación del TI-RADS entre radiólogos de una clínica universitaria colombiana. Métodos: Estudio de concordancia. Se distribuyeron 140 imágenes con códigos aleatorios. Participaron seis evaluadores (dos residentes de primer año, dos radiólogos con doce años de experiencia y dos radiólogos intervencionistas con 22 y 25 años de experiencia, respectivamente). El intervalo de reaplicación fue de 5 a 7 días. El ocultamiento de datos fue revelado después del análisis estadístico mediante el cociente estadístico kappa. Resultados: El kappa global fue de 0,35 (IC 95%: 0,27-0,38), el acuerdo para la categoría 1 fue de k=0,76; para las categorías 3,4B y 5 fue menor a k=0,15. El kappa de concordancia intraobservador fue de 0,21 a 0,61 (p<0,05). La pareja de radiólogos con mayor kappa logró un acuerdo del 0,63 (IC 95%: 0,53-0,72). Conclusiones: La fuerza de la concordancia global del TI-RADS interobservadores fue débil, para las categorías de riesgo bajo fue moderado y para la categoría de mayor riesgo de malignidad fue escaso. La mayor concordancia intraobservador fue obtenida por el radiólogo con más experiencia.
The Thyroid Imaging Reporting and Data System (TI-RADS) is an ultrasound classification system. Its purpose is to standardize the reporting of thyroid nodules in cancer-risk categories, which decreases the global number of biopsies. Objective: The purpose of this study is to estimate the inter-observer and intra-observer concordance in the application of TI-RADS between radiologists of a Colombia university clinic. Methods: Study of concordance. 140 images with random codes were distributed. Six reviewers participated (2 first year residents, 2 radiologists with 12 years of experience and 2 interventional radiologists with 22-25 years of experience, respectively). The time interval between repeated measurements was 5-7 days. Data concealment was revealed after statistical analysis using the kappa statistic ratio. Results: The overall kappa was 0.35 (95% CI: 0.27 to 0.38), the agreement for category 1 was k=0.76, for categories 3, 4B and 5 were lower with a k<0.15. The kappa for intra-observer concordance was 0.21 to 0.61 (p <0.05). The pair of radiologists with the highest kappa achieved a concordance of 0.63 (95% CI: 0.53-0.72). Discussion: The strength of the overall agreement between TI-RADS observers was weak, low risk categories had moderate agreement and the highest risk category of malignancy had the lowest kappa value. The largest intra-observer concordance was obtained by the most experienced radiologist.
Assuntos
Humanos , Nódulo da Glândula Tireoide , Ultrassonografia , ClassificaçãoRESUMO
Deep venous thrombosis (DVT) is a major health problem and is estimated to have an incidence of 600,000 cases per year. Clinical signs and symptoms of DVT are unreliable. If clinical signs alone were used to diagnose DVT, 42% of patients would receive unnecessary anticoagulation therapy. Most patients evaluated with ultrasonography (US) do not have DVT. The key to making a precise diagnosis is recognizing the characteristics of various diseases on US images. The anatomic approach is the most useful strategy for characterizing the spectrum of pathologic conditions seen in patients with symptoms that simulate DVT. The inferior extremity can be divided into four regions-inguinal, thigh, popliteal, and lower leg-with the rough limits defined for each as they are examined at US. The differential diagnoses affecting the lower extremities include infectious, neoplastic, traumatic, inflammatory, vascular, and miscellaneous entities. Some pathologic conditions seen in the inguinal region are adenopathies, lymphangitis, soft-tissue tumors, hematomas, adductor tendonitis, and hernias. In the thigh, cellulitis, myositis, abscess, benign and malignant tumors, and sports-related lesions are seen. In the popliteal region, cellulitis, arthritis, benign and malignant masses, muscle contusions, ruptured popliteal cysts, and thrombophlebitis are seen. And in the lower leg, cellulitis, lipomas, tennis leg, superficial thrombophlebitis, tendonitis, and soft-tissue hydrostatic edema secondary to cardiac and renal failure can simulate DVT.