I learned it the hard way, that they often ARE off, and that checking it by hand results in a higher degree of confidence in the outcome.
I, and some of the guys I used to work with, put a LOT of hours into a truck trying to solve a seemingly unsolveable problem, until we invented a procedure for checking TDC and the pin position. Sadly, I would say that at least 1/3 of the engines people have complaints about (and at least some of the ones nobody complains about) are off enough to make a measurable, and some, a serious difference.
Yes, I know a LOT of shops know nothing about it, and would never question the pin position... But they don't read TDR, either. That puts you ahead of them. Too bad they wouldn't listen... they could learn from our mistakes and our efforts.
Heck, I know someone who has been to reputable TDR advertiser's shops who didn't get an inaccurate pin detected, and fixing that made a very noticeable improvement in performance, not to mention reduced smoke.
It IS real, it IS important, and it DOES happen way too often.