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Background: Atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) show variable malignancy risk. We validated the web‐based predictive models and the scoring system by the American College of Radiology (ACR) for AUS/FLUS nodules to stratify the malignancy risk. Methods: From January 2011 to November 2014, 275 consecutive nodules diagnosed as AUS/FLUS were enrolled. The discrimination and calibration ability of a web‐based scoring with inclusion of biopsy result and sonographic features, old web‐based scoring model without biopsy result, and ACR models were assessed. Results: The areas under the receiver operating characteristic curve of the validation set were 0.670 for the new web‐based model, 0.710 for the old web‐based model, and 0.732 for the ACR scoring risk‐stratification model. All models were well calibrated. Conclusion: The web‐based scoring risk‐stratification model using the combined information of ultrasonography features and biopsy result for AUS/FLUS nodules to stratify malignancy risk presents an acceptable predictive accuracy. [ABSTRACT FROM AUTHOR]

Objectives: To compare the diagnostic efficacy, complication rate, and core needle biopsy (CNB) specimen yield in 18‐ versus 20‐gauge ultrasound (US)‐guided CNB for diagnosis of thyroid nodules. Methods: We included 81 consecutive thyroid nodules with US‐guided biopsy by a 20‐gauge core needle and 86 consecutive thyroid nodules with US‐guided biopsy by an 18‐gauge core needle during 2 years. The rate of inconclusive results, including nondiagnostic or atypia/follicular lesion of undetermined significance, was compared. The diagnostic performance for malignancy was assessed in nodules with a final diagnosis. The complication rate and CNB specimen yield were also compared. Results: Eighteen‐gauge CNB showed a lower rate of nondiagnostic results (1.2% versus 8.6%; P = .024) than 20‐gauge CNB; however, the rates of atypia/follicular lesion of undetermined significance and inconclusive results were not significantly different between the groups (P > .05). In addition, 18‐gauge CNB showed higher sensitivity (75.0% versus 66.7%), a higher negative predictive value (83.9% versus 75.9%), and higher accuracy (78.3% versus 74.4%) for detecting malignancy than 20‐gauge CNB, although the results did not achieve statistical significance. No major complications occurred in either of the CNB groups. The 18‐gauge needle group had significantly fewer CNBs and larger specimen diameters (P < .001). Conclusions: Core needle biopsy with an 18‐gauge needle could be more effective for the diagnosis of thyroid nodules than CNB with a 20‐gauge needle. [ABSTRACT FROM AUTHOR]

Background: To minimize potential harm from overuse of fine-needle aspiration, Thyroid Imaging Reporting and Data Systems (TIRADSs) were developed for thyroid nodule risk stratification. The purpose of this study was to perform validation of three scoring risk-stratification models for thyroid nodules using ultrasonography features, a web-based malignancy risk-stratification system, and a model developed by the Korean Society of Thyroid Radiology and the American College of Radiology. Methods: Using ultrasonography images, radiologists assessed thyroid nodules according to the following criteria: internal content, echogenicity of the solid portion, shape, margin, and calcifications. A total of 954 patients ( Mage = 50.8 years; range 13-86 years) with 1112 nodules were evaluated at the authors' institute from January 2013 to December 2014. The discrimination ability of the three models was assessed by estimating the area under the receiver operating characteristic curve. Additionally, Hosmer-Lemeshow goodness-of-fit statistics (calibration ability) were used to evaluate the agreement between the observed and expected number of nodules that were benign or malignant. Results: Thyroid malignancy was present in 37.2% (414/1112) of nodules. According to the 14-point web-based scoring risk-stratification system, malignancy risk ranged from 4.5% to 100.0% and was positively associated with an increase in risk scores. The areas under the receiver operating characteristic curve of the validation set were 0.884 in the web-based model, 0.891 in the Korean Society of Thyroid Radiology model, and 0.875 in the American College of Radiology model. The Hosmer-Lemeshow goodness-of-fit test indicated that the web-based scoring system showed the best-calibrated result, with a p-value of 0.078. Conclusion: The three scoring risk-stratification models using the ultrasonography features of thyroid nodules to stratify malignancy risk showed acceptable predictive accuracy and similar areas under the curve. The web-based scoring system demonstrated the strongest agreement in calibration ability analysis. The easily accessible automated web-based scoring risk-stratification system may overcome the complexity of the various Thyroid Imaging Reporting and Data System guidelines and provide simplified guidance on personalized and optimal management in real practice. [ABSTRACT FROM AUTHOR]

Background:In thyroid gland, radiofrequency ablation (RFA) has been applied to both recurrent cancers and benign nodules, although, according to the American Thyroid Association (ATA) and the Korean Society of Thyroid Radiology (KSThR) guidelines, surgery is the first-line treatment for follicular neoplasm. However, it has been argued that follicular neoplasm with lower risk of malignancy can be managed by close follow-up. In this study, we evaluated the effectiveness of RFA of small follicular neoplasms, examining reductions in volume and related clinical problems, and making observations over long-term follow-up. Methods:We evaluated 10 follicular neoplasms in 10 patients who were treated with RF ablation between 2009 and 2011. A RF generator and an 18-gauge internally cooled electrode were used to perform complete ablation of the whole nodules. Changes in nodules or ablated zones on follow-up ultrasound, and complications during and after RF ablation were evaluated. Results:The mean follow-up period was 66.4 ± 5.1 months (range: 60–76 months). In eight patients, single session of RF ablation was sufficient, while two patients required two sessions. There was a significant reduction in the mean volume (99.5 ± 1.0%) of lesions, with eight ablated lesions (8/10, 80%) disappearing completely on follow-up. No recurrences were found in any ablated zones at last follow-up. Transient mild neck pain (n = 6) occurred during the procedure without requiring any medication. Conclusion:In addition to active surveillance, RF ablation may be an effective and safe alternative for the management of patients with small (<2 cm) follicular neoplasm suspected on thyroid biopsy and who strongly refuse surgery. [ABSTRACT FROM PUBLISHER]

Background: In patients undergoing active surveillance of papillary thyroid microcarcinoma, definitive therapy-usually preceded by a definitive diagnostic procedure-is not recommended until evidence of disease progression is obtained, as stated in the American Thyroid Association guidelines. This is because the deferring of definitive diagnosis and therapy until disease progression has no impact on the disease-specific survival. This study evaluated the malignancy rate and probability of thyroid nodules, which was further stratified based on the size cutoff value of 1 cm, with suspicious findings on ultrasonography (US), by using various malignant stratification systems. Methods: The data were retrospectively collected between January 2003 and June 2003 from nine university hospitals that had previously participated in the Korean Society of Thyroid Radiology multicenter study on the ultrasonographic differentiation between benign and malignant thyroid nodules. In total, 829 thyroid nodules from 711 patients (620 women, 91 men; Mage = 48.7 years; range 6-98 years; 351 malignant and 478 benign nodules) were included. The probability for malignancy of thyroid nodules was calculated, which was further stratified by size, by using four different types of malignant risk-stratification systems. The factors that could differentiate benign from malignant nodules were assessed using the chi-square test. Results: In the suspicious thyroid nodules <1 cm on US, the malignancy probability ranged from 77.4% to 82.8%; the lowest rate was found in the Korean Society of Thyroid Radiology multicenter study, whereas the highest rate was noted in the Web-based system. Thus, the probability of benign nodules among suspicious thyroid nodules <1 cm on US was 17.2-22.6%. Conclusion: A biopsy should be considered before active surveillance to exclude benign nodules with suspicious US features, and could thus prevent unnecessary active surveillance and patient anxiety. [ABSTRACT FROM AUTHOR]