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Sonographic Features of Benign Thyroid Nodules

Interobserver Reliability and Overlap With Malignancy

Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina USA (J.R.W., W.K.C., J.R.F., C.A.M.); and Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts USA (K.H.Z.).

Address correspondence and reprint requests to Julia R. Fielding, MD, Department of Radiology, University of North Carolina at Chapel Hill, Campus Box 7510, 101 Manning Dr, Chapel Hill, NC 27599 USA. E-mail: julia_fielding{at}med.unc.edu.

Objective. To prospectively determine the sonographic findings of nodular hyperplasia of the thyroid, to compare these with reported findings associated with malignancy, and to assess interobserver reliability. Methods. Seventy thyroid nodules were scanned, and then biopsies of the nodules were performed under sonographic guidance with fine-needle cytologic analysis; in all cases images were reviewed by 2 experienced radiologists without knowledge of clinical outcome. Findings reported associated with malignancy were specifically assessed. Interobserver agreement between the expert and secondary readers for each finding was calculated by the or weighted statistic and the Fisher exact test of independence. Results. There were 68 benign and 2 malignant nodules in a population of 63 female and 7 male patients. The mean benign nodule size was 2.9 cm; 60% were solid; 54% were hypoechoic; 59% were microlobulated or macrolobulated; 47% had central vascularity; 24% contained calcifications; and 82% were elliptical in shape. There was very good interobserver reliability for the presence of calcium ( = 0.91) and good agreement for the presence and location of vascularity ( = 0.75) and the amount of cystic components ( = 0.62; all P < .01). Conclusions. Sixty-nine percent of benign nodules had at least 1 finding reported previously as associated with malignancy. The interobserver reliability of the sonographic findings was good to very good for 3 of the 5 findings assessed.

Key Words: interobserver reliability • thyroid nodules • thyroid sonography

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