Ultrasonography Diagnosis and Imaging-Based Management of Thyroid Nodules: Revised Korean Society of Thyroid Radiology Consensus Statement and Recommendations

Abstract

The rate of detection of thyroid nodules and carcinomas has increased with the widespread use of ultrasonography (US), which is the mainstay for the detection and risk stratification of thyroid nodules as well as for providing guidance for their biopsy and nonsurgical treatment. The Korean Society of Thyroid Radiology (KSThR) published their first recommendations for the US-based diagnosis and management of thyroid nodules in 2011. These recommendations have been used as the standard guidelines for the past several years in Korea. Lately, the application of US has been further emphasized for the personalized management of patients with thyroid nodules. The Task Force on Thyroid Nodules of the KSThR has revised the recommendations for the ultrasound diagnosis and imaging-based management of thyroid nodules. The review and recommendations in this report have been based on a comprehensive analysis of the current literature and the consensus of experts.

Likelihood of malignancy in thyroid nodules according to a proposed Thyroid Imaging Reporting and Data System (TI-RADS) classification merging suspicious and benign ultrasound features

“…According to recent guidelines and recommendations reported by different scientific societies (3)(4)(5)(6), ultrasound remains the most important tool in the initial evaluation of thyroid nodules since it has the ability to detect and diagnose potentially malignant thyroid nodules.…”

“…The first step of the committee was to create the Thyroid Ultrasound Reporting Lexicon to describe ultrasound characteristics of thyroid nodules, providing concise written definitions and illustrations to guide practitioners (22). Also recently, the Korean Society of Thyroid Radiology proposed a modification to the TI-RADS system (K-TIRADS) using a flowchart-guided classification according to the presence or absence of different ultrasound features found in thyroid nodules (6).…”

Comparison of Fine Needle Aspiration Cytology and Ultrasonography in Solitary Thyroid Nodule

“…The correlation between the nodule size and the risk for malignancy remains controversial. Although a recent systemic review suggested that the larger nodules present a higher pretest probability of malignancy 18 , whether the malignancy risk is higher in the larger nodules and whether the nodule size could be a predictor for malignancy are still controversial [19][20][21] .…”

Microcalcificaciones y focos ecogénicos puntiformes, ¿qué tan bien sabemos lo que estamos viendo?

“…No hay consenso en la literatura con respecto a la nomenclatura de los distintos focos ecogénicos, ni a la definición pictográfica precisa de cada uno de ellos [6][7][8][9][10][11] . Recientemente, un estudio publicado por un grupo con vasta experiencia en patología tiroidea 5 , planteó por primera vez un nuevo enfoque para resolver algunas de las interrogantes en torno al tema, evaluando el grado de asociación entre cinco distintos tipos de focos ecogénicos propuestos y el riesgo de malignidad 5 .…”