Thyroid Nodules With Nondiagnostic Cytologic Results: Follow-Up Management Using Ultrasound Patterns Based on the 2015 American Thyroid Association Guidelines

Abstract

OBJECTIVE: The purpose of this study was to evaluate the malignancy rate of nodules with nondiagnostic cytologic results based on the American Thyroid Association (ATA) ultrasound (US) patterns and to suggest management guidelines for these nodules. MATERIALS AND METHODS: From January 2013 to December 2014, 441 nodules (>/= 1 cm) were found in 437 patients with nondiagnostic results of ultrasound (US)-guided fine-needle aspiration biopsy (nondiagnostic nodules). A total of 191 nodules that were cytopathologically confirmed or were smaller (> 3 mm) at follow-up US were enrolled. The US findings of each nodule were reviewed. One radiologist classified the nodules into the following five categories according to the 2015 ATA guidelines: high, intermediate, low, and very low suspicion for malignancy and benign. The reference standard was histopathologic confirmation. Nodules that were smaller at follow-up US were considered benign. The malignancy rate of each category was calculated. RESULTS: Among a total 191 nodules, 20 (10.5%) were malignant. Solid composition, marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, and taller-than-wide shape were more frequently seen in malignant nodules (all p < 0.001). The malignancy rate of nodules with very low suspicion of malignancy was 0% (0/58); low, 0% (0/45); intermediate, 10.3% (6/58); and high, 46.7% (14/30) (p < 0.001). CONCLUSION: When US findings of thyroid nodules are assessed according to the 2015 ATA guidelines, nondiagnostic thyroid nodules with very-low- or low-suspicion US patterns can be followed up with US. Nondiagnostic nodules with intermediate or highly suspicious US patterns should be evaluated with repeat US-guided fine-needle aspiration biopsy.