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Malignancy risk stratification in thyroid nodules with nondiagnostic results at cytologic examination: combination of thyroid imaging reporting and data system and the Bethesda System

Authors
 Hee Jung Moon  ;  Eun-Kyung Kim  ;  Jung Hyun Yoon  ;  Jin Young Kwak 
Citation
 RADIOLOGY, Vol.274(1) : 287-295, 2015 
Journal Title
RADIOLOGY
ISSN
 0033-8419 
Issue Date
2015
MeSH
Adenocarcinoma, Follicular/classification ; Adenocarcinoma, Follicular/diagnostic imaging ; Adenocarcinoma, Follicular/pathology* ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biopsy, Fine-Needle ; Carcinoma, Medullary/classification ; Carcinoma, Medullary/diagnostic imaging ; Carcinoma, Medullary/pathology* ; Carcinoma, Papillary/classification ; Carcinoma, Papillary/diagnostic imaging ; Carcinoma, Papillary/pathology* ; Female ; Humans ; Image-Guided Biopsy ; Male ; Middle Aged ; Registries ; Retrospective Studies ; Risk Assessment ; Thyroid Neoplasms/classification ; Thyroid Neoplasms/diagnostic imaging ; Thyroid Neoplasms/pathology* ; Thyroid Nodule/classification ; Thyroid Nodule/diagnostic imaging ; Thyroid Nodule/pathology* ; Tumor Burden ; Ultrasonography
Abstract
PURPOSE: To evaluate the malignancy risks of thyroid nodules with nondiagnostic results at ultrasonography (US)-guided fine-needle aspiration biopsy ( FNAB fine-needle aspiration biopsy ) and the criteria for selecting those for repeat US-guided FNAB fine-needle aspiration biopsy according to the thyroid imaging reporting and data system ( TIRADS thyroid imaging reporting and data system ).

MATERIALS AND METHODS: This retrospective study was approved by the institutional review board, and the requirement to obtain informed consent was waived. Five hundred forty-eight nondiagnostic nodules were included. US features of internal composition, echogenicity, margin, calcifications, shape, and vascularity were evaluated, and thyroid nodules were classified according to TIRADS thyroid imaging reporting and data system . TIRADS thyroid imaging reporting and data system category 3 included nodules without any suspicious features of solidity, hypoechogenicity or marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, and taller-than-wide shape. Categories 4a, 4b, 4c, and 5 included nodules with one, two, three or four, or five suspicious US features. The malignancy risk was calculated.

RESULTS: Of the 548 nodules, 40 (7.3%) were malignant and 508 (92.7%) were benign. The malignancy risks of categories 3 and 4a nodules were 0.8% and 1.8%, respectively, whereas the malignancy risks of categories 4b, 4c, and 5 nodules were 6.1%, 14.4%, and 31%. In the 294 nodules larger than 10 mm, the malignancy risks of categories 3, 4a, 4b, 4c, and 5 nodules were 0.9%, 1.3%, 0%, 15%, and 33%, respectively. In the 254 nodules measuring 10 mm or smaller, the malignancy risks of categories 3, 4a 4b, 4c, and 5 nodules were 0%, 2.7%, 14%, 14.3%, and 31%.

CONCLUSION: Nondiagnostic thyroid nodules without suspicious US features and those with one suspicious feature can be followed up with US, but nondiagnostic nodules with two or more suspicious features should undergo repeat US-guided FNAB fine-needle aspiration biopsy.
Full Text
http://pubs.rsna.org/doi/abs/10.1148/radiol.14140359
DOI
10.1148/radiol.14140359
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Jin Young(곽진영) ORCID logo https://orcid.org/0000-0002-6212-1495
Kim, Eun-Kyung(김은경) ORCID logo https://orcid.org/0000-0002-3368-5013
Moon, Hee Jung(문희정) ORCID logo https://orcid.org/0000-0002-5643-5885
Yoon, Jung Hyun(윤정현) ORCID logo https://orcid.org/0000-0002-2100-3513
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/139211
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