Korean J Radiol.  2016 Jun;17(3):370-395. 10.3348/kjr.2016.17.3.370.

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

Affiliations
  • 1Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
  • 2Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea.
  • 3Department of Radiology, Ewha Womans University School of Medicine, Seoul 07985, Korea.
  • 4Department of Radiology, Ajou University School of Medicine, Suwon 16499, Korea.
  • 5Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea.
  • 6Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan 15355, Korea.
  • 7Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea.
  • 8Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea.
  • 9Department of Radiology, Human Medical Imaging and Intervention Center, Seoul 06524, Korea. nndgna@gmail.com
  • 10Department of Radiology, Hanyang University College of Medicine, Hanyang University Hospital, Seoul 04763, Korea.
  • 11Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea.
  • 12Department of Radiology, Wonkwang University Hospital, Iksan 54538, Korea.
  • 13Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
  • 14Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan 47392, Korea.
  • 15Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 03722, Korea.
  • 16Department of Radiology, Research Institute and Hospital, National Cancer Center, Goyang 10408, Korea.
  • 17Department of Radiology, Kyungpook National University Hospital, Daegu 41944, Korea.
  • 18Department of Radiology, Dong-A University Medical Center, Busan 49201, Korea.
  • 19Department of Radiology, Newwoori Namsan Hospital, Busan 46224, Korea.
  • 20Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Korea.
  • 21Department of Radiology and Thyroid Center, Daerim St. Mary's Hospital, Seoul 07442, Korea.

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.

Keyword

Thyroid nodule; Thyroid neoplasm; Lymph nodes; Ultrasonography; Multidetector computed tomography; Ablation techniques

MeSH Terms

Elasticity Imaging Techniques
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Humans
Image Processing, Computer-Assisted
Lymph Nodes/diagnostic imaging
Multidetector Computed Tomography
Practice Guidelines as Topic
Societies, Medical
Thyroid Neoplasms/*diagnosis/diagnostic imaging/pathology
Thyroid Nodule/*diagnosis/diagnostic imaging/pathology
Ultrasonography

Figure

  • Fig. 1 Algorithm of K-TIRADS for malignancy risk stratification based on solidity and echogenicity of thyroid nodules. Modified from Na et al. Thyroid 2016;26:562-572 (25). *Microcalcification, nonparallel orientation, spiculated/microlobulated margin. K-TIRADS = Korean Thyroid Imaging Reporting and Data System, US = ultrasonography

  • Fig. 2 Korean Thyroid Imaging Reporting and Data System 5 (high suspicion). A. Solid hypoechoic nodule with microcalcifications. B. Solid hypoechoic nodule with multiple microcalcifications and macrocalcifications. C. Solid hypoechoic nodule with non-parallel orientation. D. Solid hypoechoic nodule with spiculated/microlobulated margin. Diagnosis: papillary carcinoma (A-D).

  • Fig. 3 Korean Thyroid Imaging Reporting and Data System 4 (intermediate suspicion). A. Solid hypoechoic nodule without suspicious US features. Diagnosis: benign follicular nodule. B. Solid isoechoic (predominantly isoechoic) nodule with microcalcification. Diagnosis: benign follicular nodule. C. Predominantly solid hypoechoic nodule with multiple microcalcifications. Diagnosis: papillary carcinoma. D. Predominantly cystic hypoechoic nodule with microcalcification (arrow). Diagnosis: papillary carcinoma. US = ultrasonography

  • Fig. 4 Korean Thyroid Imaging Reporting and Data System 3 (low suspicion). None of nodules have any suspicious US features such as microcalcification, non-parallel orientation, and spiculated/microlobulated margins. A. Solid isoechoic nodule. Diagnosis: follicular variant papillary carcinoma. B. Predominantly solid and isoechoic nodule. Diagnosis: benign follicular nodule. C. Predominantly solid and hypoechoic nodule. Diagnosis: benign follicular nodule. D. Predominantly cystic and isoechoic nodule. Diagnosis: benign follicular nodule. US = ultrasonography

  • Fig. 5 Korean Thyroid Imaging Reporting and Data System 2 (benign). A. Spongiform nodule. Diagnosis: benign (FNA not performed). B. Spongiform nodule with tiny microcystic changes. Diagnosis: benign follicular nodule. C. Predominantly cystic nodule with multiple comet tail artifacts. Diagnosis: benign follicular nodule with colloid. D. Cyst with comet-tail artifact. Diagnosis: benign (colloid cyst, FNA not performed). FNA = fine-needle aspiration

  • Fig. 6 Suspicious lymph nodes (ultrasonography features). A. Large cystic nodal mass. B. Small focal cystic change and hyperechogenicity in lymph node. C. Hyperechogenicity and macrocalcifications in lymph node. D. Multifocal hyperechogenicity (black arrows) and microcalcification (white arrow) in lymph node. E. Hyperechogenicity, microcalcification, and abnormal hypervascularity in lymph node. Diagnosis: metastatic papillary carcinoma (A-E).

  • Fig. 7 Suspicious lymph nodes (CT features). A. Large nonenhancing cystic nodal mass. B. Small focal cystic change and strong enhancement in lymph node. C. Diffuse, strong enhancement in lymph node. D. Heterogeneous mild enhancement in lymph node (arrow). E, F. Multiple variable-sized nodal calcifications and tiny nodal calcification (F, arrow) on unenhanced CT image. Diagnosis: metastatic papillary carcinoma (A-F).

  • Fig. 8 Indeterminate lymph nodes. A, B. US features of indeterminate lymph nodes. US images shows ovoid and elongated lymph nodes which show loss of central echogenic hilum and central hilar vascularity. Note absence of any suspicious US feature in these nodes. Diagnosis: probable benign lymph node (FNA not performed). C, D. CT features of indeterminate lymph nodes. CT images show lymph nodes that do not have central fat hilum and central hilar vessel enhancement. Note absence of any suspicious CT feature in these nodes. Diagnosis: probably benign lymph node (arrow) (C, FNA not performed), metastatic papillary carcinoma (arrow) (D). FNA = fine-needle aspiration, US = ultrasonography

  • Fig. 9 Benign lymph nodes. A, B. US features of benign lymph nodes. US image shows elongated lymph node with prominent central echogenic hilum and central hilar vascularity (A). US image shows ovoid lymph node with small deformed echogenic hilum (arrow), however, color-Doppler US shows prominent typical central hilar vascularity (B). C, D. CT features of benign lymph nodes. CT image shows lymph node with central hilar fat (C, arrows) and enhanced lymph node with central hilar vessel enhancement (D, arrow). Diagnosis: benign lymph node (A-D, FNA not performed). FNA = fine-needle aspiration, US = ultrasonography


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