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Interobserver Agreement Among Thyroid Ultrasound Operators in Defining Thyroid Nodules as Subcapsular.

Pierpaolo Trimboli1,2, Enrico Papini3, Jörg Bojunga4

  • 1Thyroid Unit, Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland.

Thyroid : Official Journal of the American Thyroid Association
|August 25, 2025
PubMed
Summary

Interobserver agreement for classifying subcapsular thyroid nodules (TNs) using ultrasound was unsatisfactory. Standardized definitions are needed to improve consistency in assessing these nodules for cancer risk and guiding treatment decisions.

Keywords:
FNACTIRADSsubcapsularthyroidultrasound

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Area of Science:

  • Radiology
  • Endocrinology
  • Oncology

Background:

  • Ultrasound (US) is crucial for assessing thyroid nodules (TNs) and guiding fine needle aspiration cytology (FNAC).
  • Subcapsular TN location may influence the decision for FNAC, potentially favoring surgery over surveillance if malignancy is suspected.
  • A clear definition of subcapsular TNs is currently lacking, leading to diagnostic ambiguity.

Purpose of the Study:

  • To evaluate the interobserver agreement (IOA) among experienced thyroid US experts in classifying TNs as subcapsular or not.
  • To identify US features that may influence variability in the assessment of subcapsular TNs.

Main Methods:

  • Twelve experienced US raters assessed 60 static US images of TNs for subcapsular location.
  • Interobserver agreement was calculated using Fleiss' kappa, with analyses of TN features influencing variability.
  • Cases were derived from surgically resected and histologically diagnosed TNs.

Main Results:

  • The overall IOA for subcapsular TN classification was fair (κ = 0.34).
  • Higher IOA was observed among raters with greater experience (κ = 0.39) and for medium-sized TNs (κ = 0.38).
  • The highest IOA (κ = 0.46) was found for TNs categorized as EU-TIRADS 5 and smaller than 2 cm.

Conclusions:

  • The current IOA among US experts for assessing subcapsular TNs is unsatisfactory.
  • A standardized definition of subcapsular TN location is essential for improving clinical decision-making.
  • Future guidelines should address the consistent assessment and management of subcapsular TNs.