Small Thyroid Research Articles

Management of benign paediatric thyroid nodules: experience from paediatric ENT services of a tertiary care hospital

<p class="abstract">Thyroid nodules are a common occurrence in adults but are rarely seen in children. We present here four cases of paediatric thyroid nodules. Patients were subjected to a thorough clinical evaluation, blood thyroid level testing, ultrasonography (USG) and fine needle aspiration cytology (FNAC). The size of the nodules ranged from 2 cm to 7.5 cm. All four nodules were reported as “benign” on FNAC, of which three under-went total thyroidectomy owing to the bi-laterality and large size of the nodules. None of the cases had post-operative complications of hypocalcemia or recurrent laryngeal nerve paralysis. Of the 3 patients taken up for surgery one patient was found to have papillary thyroid carcinoma. Subsequent radiological investigation showed no residual disease. All three operated cases were followed-up in the ENT outpatient department for at least 2 years and showed no signs of recurrence. One patient with a small thyroid nodule (2 cm) was managed non – surgically and has been kept on follow up since 12 months. In our experience, total thyroidectomy, even in a benign disease, in expert hands, is a safe procedure and the best management option in children with large goiter, to avoid recurrence and thereby a redo surgery. </p>

Hypoglossal nerve palsy after gasless trans-axillary endoscopic thyroidectomy: a case report

BackgroundGasless trans-axillary endoscopic thyroidectomy (GTAET) has satisfactory cosmetic effects for the patients who have benign goiter and small thyroid carcinoma, however the complications of this surgical procedure have not been fully documented. Ipsilateral hypoglossal nerve palsy (IHNP) associated with GTAET has never been reported before.Case presentationA 33-year old male patient presented with a 4 × 5 mm solid thyroid nodule in the right lobe. Papillary thyroid carcinoma was confirmed by the fine needle aspiration. He had strong cosmetic demand, therefore GTAET for right lobectomy and central cervical lymphadenectomy was performed in a supine position with cervical extension. Six hours after the operation, he developed tongue deviation to the right side, speech and swallowing difficulties, indicating IHNP. Head and cervical MRI showed no abnormality. The intravenous steroid was used for three days, and oral vitamin B1 and mecobalamin was prescribed for 1 month. Nine days after surgery, he was discharged. Three months after the operation, all the symptoms were completely resolved.ConclusionsTo the best of the authors’ knowledge, this is the first case of IHNP after GTAET, which will be valuable to add our knowledge to diagnose and treat rare complications of GTAET.

The global epidemic of thyroid cancer overdiagnosis illustrated using 18 months of consecutive nodule biopsy correlating clinical priority, ACR‐TIRADS and Bethesda scoring

Low thyroid cancer mortality worldwide has not been altered by decades of increasing radiological, pathological and surgical intervention for thyroid nodules. Ultrasound-based risk stratification of thyroid nodules, such as TIRADS, has been introduced to reduce intervention for the 'global epidemic' of thyroid cancer 'overdiagnosis'. This article illustrates the use of TIRADS at a New Zealand tertiary centre, during its introduction, with all nodules undergoing fine-needle aspiration biopsy (FNAB) correlated with clinical referral priority and cytological Bethesda score. The correlation between TIRADS and Bethesda score was not significant but cytology had a strong association with clinical priority. Accuracy of TIRADS was poor though the risk of malignancy for TIRADS 5 nodules was 5.1 times those rated as TIRADS 3. After TIRADS was introduced, there was no significant trend in the proportion of malignant nodules diagnosed by FNAB. Despite an incomplete TIRADS programme, the ACR targets of malignancy rates were achieved. The number of patients, as well as the number of nodules per patient, referred for FNAB continues to rise. Changing papillary thyroid cancer nomenclature and other control measures by health policymakers, such as adjustments to payment systems, may be justified. Radiologists are wasting precious health resources that can be better deployed. The use of TIRADS is expensive and a symptom of health policy failure. Clear recommendations from professional societies to not report incidental small thyroid nodules may be a useful start. Whether TIRADS merits continuing use and promotion should be further investigated.

The Usefulness of Contrast-Enhanced Ultrasound to Evaluate Small Solid Thyroid Nodules Compared to TI-RADS

Clinical ThyroidologyVol. 33, No. 3 Thyroid NodulesThe Usefulness of Contrast-Enhanced Ultrasound to Evaluate Small Solid Thyroid Nodules Compared to TI-RADSErivelto VolpiErivelto VolpiDepartment of Head and Neck Surgery, Oncology Center, Oswaldo Cruz German Hospital, CETRUS Medical School, São Paulo, BrazilSearch for more papers by this authorPublished Online:8 Mar 2021https://doi.org/10.1089/ct.2021;33.114-116AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetails Volume 33Issue 3Mar 2021 InformationCopyright 2021 American Thyroid Association, Inc.To cite this article:Erivelto Volpi.The Usefulness of Contrast-Enhanced Ultrasound to Evaluate Small Solid Thyroid Nodules Compared to TI-RADS.Clinical Thyroidology.Mar 2021.114-116.http://doi.org/10.1089/ct.2021;33.114-116Published in Volume: 33 Issue 3: March 8, 2021PDF download

Active Surveillance for Papillary Thyroid Microcarcinoma in a Population with Restrictive Diagnostic Workup Strategies.

Background: The worldwide incidence of papillary thyroid carcinoma (PTC) has increased. Efforts to reduce overtreatment follow two approaches: limiting diagnostic workup of low-risk thyroid nodules and pursuing active surveillance (AS) after diagnosis of microscopic PTC (mPTC). However, most studies on AS have been performed in countries with a relatively high proportion of overdiagnosis and thus incidental mPTC. The role of AS in a population with a restrictive diagnostic workup protocol for imaging and fine-needle aspiration remains unknown. Therefore, the aim of this study was to describe the proportion and characteristics of patients with mPTC in the Netherlands and to describe the potential candidates for AS in a situation with restrictive diagnostic protocols since 2007. Methods: All operated patients with an mPTC in the Netherlands between 2005 and 2015 were identified from the Netherlands Cancer Registry database. Three groups were defined: (Group 1) mPTC with preoperative distant or lymph node metastases, (Group 2) mPTC in pathology report after thyroid surgery for another indication, and (Group 3) patients with a preoperative high suspicious thyroid nodule or proven mPTC (Bethesda 5 or 6). Only patients in Group 3 were considered potential candidates for AS. Results: A total of 1018 mPTC patients were identified. Group 1 consisted of 152 patients with preoperatively discovered metastases. Group 2 consisted of 667 patients, of whom 16 (2.4%) had lymph node metastases. There were 199 patients in Group 3, of whom 27 (13.6%) had lymph node metastases. After initial treatment in Group 3, 3.5% (7/199) of the patients had recurrence. Conclusions: Restrictive diagnostic workup strategies of patients with small thyroid nodules lead to limited patients eligible for AS and a higher incidence of lymph node metastases. We believe that there is limited additive value for AS in countries with restrictive diagnostic workup guidelines such as in the Netherlands. However, if an mPTC is encountered, AS can be offered on an individual basis.

Triggers of thyroid cancer diagnosis: a systematic review and meta-analysis.

Understanding the method of thyroid cancer detection has potential implications on interpreting incidence rates, the diagnosis and management of thyroid cancer. We conducted a systematic review of studies reporting methods of thyroid cancer detection to estimate the frequency of incidentally found cancers and classify triggers of incidental thyroid cancer diagnosis. We searched multiple bibliographic databases from inception to June 2020. A pair of reviewers, working independently and in duplicate selected studies for inclusion, extracted data, and evaluated each trial's risk of bias. Studies enrolling patients older than 18 years with thyroid cancer confirmed histologically were included. In total, 17 cohorts and 1 cross-sectional study, conducted between 1991 and 2018, enrolling 4668 patients with thyroid cancer were included: 88% had papillary thyroid cancer and 23% had papillary thyroid microcarcinoma. The proportion of patients with non-incidental and incidental thyroid cancer was similar: 49% [95% confidence interval (CI): 40-58%]. Subgroup analysis showed that most patients with incidental thyroid cancers had tumor size <10 mm (76%; 95% CI: 56-92%), age >45 (61%; 95% CI: 56-67%), and were detected through imaging (35%; 95% CI: 26-45%), of which ultrasound was the most common modality (27%; 95% CI: 14-43%). The heterogeneity for all the effect sizes was large and significant. About half of thyroid cancers were found incidentally through the use of imaging studies, in particular neck ultrasound. These incidentally found cancers were mostly small papillary thyroid cancer. These results highlight opportunities for interventions aimed at reducing drivers of overdiagnosis.

Active surveillance in small cytological indeterminate thyroid nodules: a call to common sense?

To describe the clinical characteristics and outcomes of patients with cytologically Bethesda IV category (B IV) thyroid nodules who opted for active surveillance. We prospectively evaluated 155 patients with a single thyroid nodule classified as B IV. Immediate molecular testing and/or thyroid surgery was offered, except when the patient (i) could not afford molecular testing/rejected the surgery, (ii) had a high surgical risk, (iii) had other disorders/comorbidities which needed to be addressed with higher priority, and (iv) had undetectable serum calcitonin levels, in whom active surveillance (AS) was performed. From 155 patients, only two patients could afford molecular testing; 84% (n = 130) underwent immediate thyroid surgery: lobectomy was performed in only 8% (n = 10). AS was the initial management for 15% (n = 23) of the patients. The frequency of tumor enlargement was 14% (n = 3), after a median of 42 months (range, 7-72) of follow-up, without any evidence of lymph node or clinical distant metastases development. Deferred surgery was performed in 4 patients (17%) after a median of 24 months (range, 12-48) of AS. Follicular adenoma was diagnosed in three and a follicular variant of papillary thyroid carcinoma in one patient, all of them without evidence of disease after 12 months of follow-up. Despite current guidelines does not support AS for indeterminate Bethesda IV nodules, our findings showed that most of these patients had excellent outcomes, in a setting where lobectomy was not the preference and the access to molecular testing was limited. Probably AS could be a valid alternative in these low-risk tumors in selected patients.

Terminology Change for Small Low-Risk Papillary Thyroid Cancer As a Response to Overtreatment: Results from Three Australian Community Juries.

Background: The majority of small papillary thyroid cancers (sPTCs) are treated surgically, rather than by active surveillance. Patient and clinician preference for surgery may be partially driven by the use of cancer terminology. Some experts propose that changing terminology would better communicate the indolent nature of sPTCs and improve uptake of active surveillance. Others argue that terminology that includes "cancer" correctly reflects the biological nature of these tumors. The views of informed lay publics can provide value-based perspectives on complex issues and guide policy discussions. Methods: We recruited 40 people for three community juries, held in Sydney, Wodonga, and Cairns, Australia. Participants were of diverse backgrounds and ages, recruited through random digit dialing and a topic-blinded social media strategy. Juries were informed about thyroid cancer, overdiagnosis, and overtreatment, and heard arguments for and against terminology change before deliberation. The deliberative process in Jury 1 led to a refinement of jury charge, the updated version that was then used in Juries 2 and 3. Results: Jury 1 favored no terminology change, and Juries 2 and 3 were divided on the topic. Key reasons for opposing terminology change included a strong desire to retain terminology that aligns with the pathological definition of cancer, and to avoid even a minimal risk of harm that could arise if patients became complacent in follow-up. Key reasons to support terminology change included a desire to reduce psychological distress, stigma, and discrimination associated with a cancer diagnosis, and an argument that terminology change may be a more effective trigger for health system reform compared with other options. The juries unanimously recommended community education and health system reforms to reduce harms of overtreatment, and expressed an expectation that clinicians and researchers reach agreement on clinical guidelines to promote better uptake of active surveillance. Conclusions: The conceptual tension between a pathological and an outcome-based understanding of cancer was apparent in deliberation. This highlights an ongoing challenge for those advocating changing disease terminology. Regardless of action on terminology, jurors shared a strong expectation that practical changes would be made to respond to the harms of overtreatment.

2021 Korean Thyroid Imaging Reporting and Data System and Imaging-Based Management of Thyroid Nodules: Korean Society of Thyroid Radiology Consensus Statement and Recommendations

Incidental thyroid nodules are commonly detected on ultrasonography (US). This has contributed to the rapidly rising incidence of low-risk papillary thyroid carcinoma over the last 20 years. The appropriate diagnosis and management of these patients is based on the risk factors related to the patients as well as the thyroid nodules. The Korean Society of Thyroid Radiology (KSThR) published consensus recommendations for US-based management of thyroid nodules in 2011 and revised them in 2016. These guidelines have been used as the standard guidelines in Korea. However, recent advances in the diagnosis and management of thyroid nodules have necessitated the revision of the original recommendations. The task force of the KSThR has revised the Korean Thyroid Imaging Reporting and Data System and recommendations for US lexicon, biopsy criteria, US criteria of extrathyroidal extension, optimal thyroid computed tomography protocol, and US follow-up of thyroid nodules before and after biopsy. The biopsy criteria were revised to reduce unnecessary biopsies for benign nodules while maintaining an appropriate sensitivity for the detection of malignant tumors in small (1–2 cm) thyroid nodules. The goal of these recommendations is to provide the optimal scientific evidence and expert opinion consensus regarding US-based diagnosis and management of thyroid nodules.

Should Small Low-Risk Papillary Thyroid Cancer Be Called Cancer at All?

Should Small Low-Risk Papillary Thyroid Cancer Be Called Cancer at All?

Research progress of radiation-induced hypothyroidism in head and neck cancer.

This paper reviews the factors related to hypothyroidism after radiotherapy in patients with head and neck cancer to facilitate the prevention of radiation-induced hypothyroidism and reduce its incidence. Hypothyroidism is a common complication after radiotherapy in patients with head and neck cancer, wherein the higher the radiation dose to the thyroid and pituitary gland, the higher the incidence of hypothyroidism. With prolonged follow-up time, the incidence of hypothyroidism gradually increases. Intensity modulated radiotherapy should limit the dose to the thyroid, which would reduce the incidence of hypothyroidism. In addition, the risk factors for hypothyroidism include small thyroid volume size, female sex, and previous neck surgery. The incidence of radiation-induced hypothyroidism in head and neck cancer is related to the radiation dose, radiotherapy technique, thyroid volume, sex, and age. A prospective, large sample and long-term follow-up study should be carried out to establish a model of normal tissue complications that are likely to be related to radiation-induced hypothyroidism.

BRAFV600E mutation is associated with aggressive features in papillary thyroid carcinomas\u2009\u2264\u20091.5\xa0cm

BackgroundWhile some studies suggest that the BRAF V600E mutation correlates with a high-risk phenotype in papillary thyroid microcarcinoma (PTMC), more evidence is necessary before this mutation can be used to help guide decision making in the management of small thyroid nodules. This study investigated whether BRAF V600E mutation is associated with aggressive features in PTMC (≤ 1 cm) and small PTC (1–1.5 cm).MethodsRetrospective chart review was performed on 121 patient cases. Patients who underwent thyroid surgery for PTMC (≤ 1 cm) or small PTC (1–1.5 cm) were included if molecular testing was done for BRAF V600E mutation. Two study groups were created based on tumour size: PTMC (n = 55) and small PTC (n = 66). The groups were analysed for the presence of a BRAF V600E mutation and aggressive features, including macroscopic extrathyroidal extension (ETE), lymph node metastasis (LNM), and high-risk histological features (tall cell, columnar cell, hobnail, solid/trabecular, and diffuse sclerosing). The Fischer exact test was used to calculate statistical significance.ResultsBRAF V600E mutations were detected in 43.6% of PTMC and 42.4% of small PTC. Of the mutated PTMC nodules, 54.1% demonstrated aggressive characteristics as compared to 19.4% of the non-mutated PTMCs (p = 0.010). Of the mutated small PTC tumours, 82.1% had aggressive features. In contrast, 28.9% of the non-mutated small PTCs showed aggressive features (p < 0.001).ConclusionsOur findings demonstrate an association between a BRAF V600E mutation and aggressive features in PTMC (≤ 1 cm) and small PTC (1–1.5 cm). Therefore, determining the molecular status of these thyroid nodules for the presence of BRAF V600E can help guide patient management.Graphical

Comments: Effect of the location and size of thyroid nodules on the diagnostic performance of ultrasound elastography: A retrospective analysis

We read with great interest the research article entitled “Effect of the location and size of thyroid nodules on the diagnostic performance of ultrasound elastography: A retrospective analysis” by Xie and Yu (). The authors claimed that the results of strain ultrasound elastography should be carefully evaluated when small thyroid nodules are close to the carotid artery. They indicated that the use of cytology to determine nodule parameters is effective in determining the diagnostic ability of strain ultrasound elastography. However, [...]

Prevalence and risk factors for thyroid cancer in patients with multinodular goitre

BackgroundRates of thyroid cancer in patients with multinodular goitre (MNG) vary widely, from 3 per cent in older studies to 35 per cent in more recent studies. The purpose of the present study was to evaluate the prevalence of thyroid cancer in patients operated on for MNG, and to determine risk factors for incidental thyroid malignancy.MethodsA prospectively developed database of all patients who underwent thyroidectomy for a benign MNG at the high-volume endocrine surgery unit of a tertiary referral university hospital was interrogated.ResultsA total of 3233 patients were analysed, separated into three groups according to their functional thyroid status (hypothyroid, hyperthyroid or euthyroid). There were 2788 women (86.2 per cent); the mean patient age was 56.4 years and mean preoperative disease duration was 106.2 months. Incidental thyroid cancer was identified in 1026 patients (31.7 per cent), of which 917 (89.4 per cent) were papillary cancers. Multivariable regression analysis identified functional thyroid status, younger age, male sex, smaller adenoma size, smaller thyroid glands, Hashimoto’s thyroiditis and chronic non-specific thyroiditis as independent risk factors for thyroid cancer.ConclusionMNG was associated with a considerable rate of incidental thyroid cancer, which has been underestimated. A variety of factors should be taken into account when considering the malignant potential of a presumed benign MNG.

Cervical extradural metastasis from follicular carcinoma thyroid after 14 years post-thyroidectomy with Elsberg phenomenon

Background. Follicular carcinoma thyroid usually metastasises to bone. Common sites of bone metastasis include skull and spine. Spinal metastasis are more common in the cervical region followed by dorsolumbar spine. Cervical extradural lesions present with progressive quadriparesis, sensory loss, dysautonomia, and respiratory distress. Typical Elsberg phenomenon in a cervical extradural lesion is rare. Elsberg phenomenon involves the involvement of ipsilateral upper limb, ipsilateral lower limb followed by contralateral lower limb and contralateral upper limb. Case presentation. We are reporting a case of 47-year-old lady presented with progressive quadriparesis of 1-month duration. Her weakness started in left upper limb followed by left lower limb, right lower limb and right upper limb weakness. She also had sensory loss below the level of C7. She had undergone near-total thyroidectomy for solitary thyroid nodule 14 years back and was on thyroid supplementation since then. Histopathology at that time was reported as follicular adenoma with Hashimoto thyroiditis. Her right upper limb power was grade 4- Left upper limb grade 1 right lower limb Grade 3, left lower limb grade 2 with hypertonia of both upper and lower limbs. She was evaluated with MRI Spine which showed a dumb bell-shaped extramedullary lesion involving the C5-C6 vertebra with significant cord compression and encasement of the left vertebral artery. USG neck showed left supraclavicular lymph node enlargement and small residual thyroid tissue in the left side of the thyroid. USG guided FNAC from the thyroid tissue and neck nodes were inconclusive. The patient underwent C4 and C5 laminectomy and subtotal excision from the cervical lesion. Histopathology was reported as metastasis from follicular carcinoma thyroid. Postoperatively patient limb power improved to grade 3 left upper and lower limbs and was discharged and later referred for radioiodine ablation Conclusion. Cervical extradural metastasis from follicular carcinoma thyroid can present with Elsberg syndrome even without any neck swelling even after decades of post thyroidectomy status for a benign aetiology. Laminectomy and decompression may lead to clinical improvement.

Impact of SSKI vs. Corticosteroids on Total Thyroidectomy for Graves Disease: A Retrospective Review

Background: Graves disease is an autoimmune disorder resulting in overproduction of thyroid hormone. While medical management can be used to reestablish euthyroid state, definitive management includes radioactive iodine or total thyroidectomy. For patients undergoing thyroidectomy, SSKI is frequently prescribed preoperatively to decrease thyroid vascularity and intraoperative blood loss. However, corticosteroids is often given when rapid preparation is necessary prior to surgery. This study explores the impact of SSKI compared to corticosteroids and hypothesizes that replacement of SSKI with corticosteroid will improve surgical outcomes. &#x0D; Methods: We performed a retrospective review of 26 Graves patients undergoing total thyroidectomy from 2015-2020. 18 patients received SSKI prior to surgery, 2 received a corticosteroid in addition to SSKI, 1 received a corticosteroid alone, and 5 received neither. Symptomatology, length of stay, intraoperative blood loss, transient hypoparathyroidism, and thyroid weight were compared. &#x0D; Results: Patients receiving corticosteroids experienced shorter stays (1.0 day vs 1.3 days), greater postoperative parathyroid hormone levels (43.0 pg/mL vs 28.9 pg/mL), less intraoperative blood loss (14.4 mL vs 41.4 mL), and presented with smaller thyroid glands (30 g vs 47 g) compared to those who received SSKI. There was a statistically significant difference in estimated blood loss between the groups (p = 0.0348). For some patients, the addition of a steroid to SSKI decreased surgery time (1.98 hours vs 2.32 hours). &#x0D; Conclusion: Despite limitations in sample size and the retrospective nature of this study, results suggest a positive impact of corticosteroid use on surgical and patient outcomes compared to SSKI alone. Future examination may benefit from greater sample size and equal distribution of patients among groups. We propose further exploration with a prospective study to evaluate the impact of SSKI vs. corticosteroids on surgical difficulty and postoperative complications for Graves disease patients.

Role of ultrasound and doppler in characterizing thyroid nodules and differentiating benign and malignant thyroid nodules

One of the consequences of increased use of imaging has been the discovery of incidentalomas, or pseudodiseases, that are common in the general population but have no or minor clinical significance. One such incidentaloma, the thyroid nodule, is extremely common, found in some autopsy series in as much as 50% of the general population. Most thyroid nodules are benign, usually as a part of multinodular changes. Clinical examination is poor at detecting small thyroid nodules, highlighted by the fact that approximately 70% of clinically normal thyroid glands contain nodules of less than 1 cm when examined sonographically. The ultimate aim in the management of a thyroid nodule is to identify the small group of patients in whom the nodule is malignant and would benefit from early aggressive treatment while avoiding unnecessary investigation and surgery in the majority of patients who have a benign nodule. In view of the above said, we conducted this study to evaluate the diagnostic utility of ultrasound and doppler in characterizing thyroid nodules and differentiating benign and malignant thyroid nodules and correlation of this with the results of FNAC and or histopathology. A prospective study comparing FNAC and HPE on 110 patients was performed. Majority of our patients were in the age group of 40-49 years, predominant in females. Conclusion: FNAC sampling is a simple technique, which is easier to perform by the personnel and has better patient acceptability. FNA of thyroid is basically a technique that helps in differentiating lesions that require surgery from those can be managed conservatively. It can be used as initial modality in the evaluation of palpable thyroid nodules. But imaging also yields accuate results comapable to FNA. Keywords: Ultrasound , Doppler, Thyroid, FNAC, Benign and malignant.

Ultrasonography-guided radiofrequency ablation vs. surgery for the treatment of solitary T1bN0M0 papillary thyroid carcinoma: A comparative study.

Ultrasonography-guided radiofrequency ablation (RFA) has been used to treat low-risk small papillary thyroid carcinoma (PTC) and yielded promising results. However, little research has been conducted on the application of RFA for the management of T1bN0M0 PTC. Therefore, this study was to compare the midterm outcome of RFA with that of surgery for the treatment of clinical solitary T1bN0M0 PTC. This is a retrospective study. In total, 182 patients with solitary T1bN0M0 PTC between April 2014 and May 2019 were treated with RFA or surgery (n=91/group). The primary end points were local tumour progression and complication rates. Local tumour progression were defined as: (a) new or persistent PTC confirmed by core needle biopsy; (b) cervical lymph node metastasis (LNM) confirmed by core needle biopsy or surgery; (c) ablation zone increased in the RFA group. In the RFA group, local tumour progression was seen in four patients (4.4%, three persistent PTC and one LNM). In the surgery group, two patients (2.2%) developed LNM; no new or persistent PTC was confirmed. There was no significant difference between the two groups in local tumour progression. Permanent hypoparathyroidism was observed in four patients (4.4%) in the surgery group, while no major or minor complications were observed in the RFA group. Ultrasonography-guided RFA is feasible and safe for treating solitary T1bN0M0 PTC, so it may be considered an alternative to surgery in select patients, especially those who are ineligible for or refusal of surgery.

Diagnostic performance of the modified Korean Thyroid Imaging Reporting and Data System for thyroid malignancy according to nodule size: a comparison with five society guidelines

PurposeThe aim of this study was to evaluate the diagnostic performance of the modified Korean Thyroid Imaging Reporting and Data System (K-TIRADS) compared with five society risk stratification systems (RSSs) according to nodule size.MethodsIn total, 3,826 consecutive thyroid nodules (≥1 cm) with final diagnoses in 3,088 patients were classified according to five RSSs. The K-TIRADS was modified by raising the biopsy size threshold for low-suspicion nodules and subcategorizing intermediate-suspicion nodules. We assessed the performance of the RSSs as triage tests and their diagnostic accuracy according to nodule size (with a threshold of 2 cm).ResultsOf all nodules, 3,277 (85.7%) were benign and 549 (14.3%) were malignant. In small thyroid nodules (≤2 cm), the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) had the highest reduction rate of unnecessary biopsies (76.3%) and the lowest sensitivity (76.1%). The modified K-TIRADS had the second highest reduction rate of unnecessary biopsies (67.6%) and sensitivity (86.6%). The modified K-TIRADS and ACR TI-RADS had the highest diagnostic odds ratios (P=0.165) and the highest areas under the curve (P=0.315). In large nodules (>2 cm), the sensitivity of the ACR TI-RADS for malignancy was significantly lower (88.8%) than the sensitivities of the modified K-TIRADS and other RSSs, which were very high (98.7%-99.3%) (P<0.001).ConclusionThe modified K-TIRADS allows a large proportion of unnecessary biopsies to be avoided, while maintaining high sensitivity and diagnostic accuracy for small malignant tumors and very high sensitivity for large malignant tumors.

Moving from Evidence to Implementation of Active Surveillance for Small Papillary Thyroid Cancers

Moving from Evidence to Implementation of Active Surveillance for Small Papillary Thyroid Cancers