Classification schemes for reporting thyroid cytology of fine needle aspiration (FNA) of thyroid nodules are largely used in clinical practice, but the level of inter-observer agreement among cytopathologists is poorly acknowledged. The present study aimed to explore the inter-observer agreement among the experienced authors of the 2014 Italian Consensus for Classification and Reporting of Thyroid Cytology (ICCRTC). A stratified randomization was performed in order to obtain a sample homogeneously distributed and representative of all ICCRTC classes. Four high-experience raters were randomly selected among the extensors of the Italian consensus. They independently reviewed 60 FNA samples blindly of the initial cytological report and clinical features. Their overall agreement was evaluated according to Fleiss’ kappa. The overall inter-observer agreement was moderate (κ 0.46). Specifically, a good agreement was found when the samples were consistent for malignancy (TIR5) or were not adequate for diagnosis (TIR1) (κ 0.67 and κ 0.73, respectively). A moderate agreement was present for suspicious-for-malignant category (TIR4), and a fair agreement was recorded in the two intermediate ones (TIR3A and TIR3B) (κ 0.36 and κ 0.35, respectively). For clinical purposes, the agreement was good (κ 0.74) in differentiating cases with surgical indication (TIR4/TIR5) from those in which surgery is not essential or requires limited extension (TIR3B/TIR3A/TIR2). In conclusion, the present study confirms the reliability of ICCRTC. These data represent a reference for cytopathologists using this system and are useful for the practice of clinicians and surgeons.

中文翻译：

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探索意大利共识成员之间关于甲状腺细胞学分类和报告的观察员间协议。

报告甲状腺结节细针穿刺（FNA）甲状腺细胞学的分类方案在临床实践中被广泛使用，但是细胞病理学家之间的观察员之间的共识水平尚未得到公认。本研究旨在探讨2014年《意大利甲状腺细胞学分类和报告共识》（ICCRTC）的有经验的作者之间的观察员共识。为了获得均匀分布并代表所有ICCRTC类的样本，进行了分层随机化。从意大利共识的延伸者中随机选择了四个经验丰富的评估者。他们对最初的细胞学报告和临床特征盲目地独立审查了60个FNA样品。他们的总体协议根据Fleiss的kappa进行了评估。κ0.46）。具体而言，一个好的协议被发现时，样品（分别为恶性肿瘤（TIR5）一致或不够充分诊断（TIR1）κ 0.67和κ分别为0.73）。适度的协议是本可疑换恶性类别（TIR4），和（a公平协议记录在两个中间者（TIR3A和TIR3B）κ 0.36和κ分别为0.35）。出于临床目的，协议很好（κ0.74），将具有手术适应症（TIR4 / TIR5）的病例与那些不是必须进行手术或需要有限扩展的病例（TIR3B / TIR3A / TIR2）区别开来。总之，本研究证实了ICCRTC的可靠性。这些数据为使用该系统的细胞病理学家提供了参考，对于临床医生和外科医生的实践很有用。