Ultrasonograhy, it's excellent ability of differentiating cystic from solid lesion and depicting detailedarchitecture, proved itself useful in the diagnosis of thyroid pathologies. Adanced high resolution equipmentsmade hidden small lesion detected and finer structure clearly seen. They seemed to throw light on the histologicaldiagnosis of thyroid diseases, especially differentiation of benignancy and malignancy. Author reviewed picturesof high-resolution ultrasonography of thyroid disease(24 ases0 and correlated them witn proven pathologicalfindings. The results were as follows: 1. Multiplicity of lesion favors benignancy(4 cases). 2. Well definedmargin favors benignancy(14/17), while ill defined margin favors malignancy(3/4), and lesion of no margin favorsthyroiditis(3/3). 3. Surrounding halo favors benignancy(7 cases). 4. Hypoechogenicity were found in most ofmalignancy and thyroiditis. Cystic components in solid nodule were common findings in bening and malignantlesions. Calcification was not found in malignancy.
Diagnosis ; Pathology ; Thyroid Diseases ; Thyroid Gland ; Thyroid Nodule ; Thyroiditis ; Ultrasonography

The detection of thyroid nodules has become more common with the widespread use of ultrasonography (US). US is the mainstay for detecting and making the differential diagnosis of thyroid nodules as well as for providing guidance for a biopsy. The Task Force on Thyroid Nodules of the Korean Society of Thyroid Radiology has developed recommendations for the US diagnosis and US-based management of thyroid nodules. The review and recommendations in this report have been based on a comprehensive analysis of the current literature, the results of multicenter studies and from the consensus of experts.
Biopsy, Fine-Needle ; Diagnosis, Differential ; Humans ; Thyroid Gland/pathology/ultrasonography ; Thyroid Neoplasms/pathology/ultrasonography ; Thyroid Nodule/pathology/*ultrasonography ; Ultrasonography, Interventional

Objective To evaluate extrathyroidal extension (ETE) in papillary thyroid microcarcinoma (PTMC) with three-dimensional tomographic ultrasound imaging (3D-TUI). Methods A total of 97 thyroid nodules of 79 patients with PTMC treated in PUMC Hospital from February 2016 to January 2018 were included in this study.Two ultrasound experts performed independent blinded assessment of the relationship between thyroid nodules and thyroid capsule by two-dimensional ultrasound (2D-US) and 3D-TUI.The results of 2D-US and 3D-TUI in evaluating ETE were compared with intraoperative findings and postoperative histological and pathological results. Results Among the 97 nodules,54 (55.7%) nodules had ETE.The diagnostic sensitivity (68.5% vs.37.0%;χ²=10.737,P=0.002),accuracy (74.5% vs.56.7%;χ²=6.686,P=0.015),and area under the receiver operating characteristic curve[0.761 (95%CI=0.677-0.845) vs.0.592 (95%CI=0.504-0.680);Z=3.500,P<0.001] of 3D-TUI were higher than those of 2D-US.However,3D-TUI and 2D-US showed no significant difference in the specificity (84.1% vs.81.4%;χ²=0.081,P=0.776),negative predictive value (67.9% vs.50.7%;χ²=3.645,P=0.066),or positive predictive value (84.1% vs.71.4%;χ²=1.663,P=0.240). Conclusion Compared with 2D-US,3D-TUI demonstrates increased diagnostic efficiency for ETE of PTMC.
Humans ; Thyroid Nodule ; Thyroid Neoplasms/diagnosis* ; Carcinoma, Papillary/pathology* ; Ultrasonography/methods* ; Retrospective Studies

We evaluated the malignancy and nondiagnostic rates using fine needle aspiration cytology (FNAC) results in thyroid nodules smaller than 1 cm according to the subdivided size. We retrospectively reviewed the medical records of all subjects underwent FNAC from 2003 to 2009 in our hospital, and 2,756 patients of subcentimeter thyroid nodules with one or more suspicious sonographic features and 7,105 with nodule sized 1 cm or more were included. The malignancy rate was higher in those subcentimeter nodules with suspicious sonographic findings than the nodule sized 1cm or more (19.7% vs 7.8%, P < 0.001). We grouped the nodules based on size with mm interval and observed that the malignancy rate did not decrease but the nondiagnostic results increased its size decrement. When we divided the subjects arbitrarily into a 5 mm or smaller and a 6-9 mm sized group, nondiagnostic cytology findings were reported more frequently in the smaller group (24.3% vs 18.1%, P = 0.001), while the rate of "malignant" was similar (18.3% vs 15.5%, P = 0.123) and the rate of "suspicious for malignancy" was higher (6.8% vs 2.9%, P < 0.001). Therefore when we decide to perform FNAC or not in subcentimeter-sized nodules, we should consider sonographic findings and other clinical risk factors but not the nodular size itself.
Adult ; Biopsy, Fine-Needle ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Thyroid Gland/pathology/ultrasonography ; Thyroid Neoplasms/diagnosis/*pathology/*ultrasonography ; Thyroid Nodule/diagnosis/*pathology/*ultrasonography

We reviewed the current status of thyroid fine-needle aspiration cytology (FNAC) in Korea. Thyroid aspiration biopsy was first introduced in Korea in 1977. Currently, radiologists aspirate the thyroid nodule under the guidance of ultrasonography, and cytologic interpretation is only legally approved when a cytopathologist makes the diagnosis. In 2008, eight thyroid-related societies came together to form the Korean Thyroid Association. The Korean Society for Cytopathology and the endocrine pathology study group of the Korean Society for Pathologists have been updating the cytologic diagnostic guidelines. The Bethesda System for Reporting Thyroid Cytopathology was first introduced in 2009, and has been used by up to 94% of institutions by 2016. The average diagnosis rates are as follows for each category: I (12.4%), II (57.9%), III (10.4%), IV (2.9%), V (3.7%), and VI (12.7%). The malignancy rates in surgical cases are as follows for each category: I (28.7%), II (27.8%), III (50.6%), IV (52.3%), V (90.7%), and VI (100.0%). Liquid-based cytology has been used since 2010, and it was utilized by 68% of institutions in 2016. The categorization of thyroid lesions into “atypia of undetermined significance” or “follicular lesion of undetermined significance” is necessary to draw consensus in our society. Immunocytochemistry for galectin-3 and BRAF is used. Additionally, a molecular test for BRAF in thyroid FNACs is actively used. Core biopsies were performed in only 44% of institutions. Even the institutions that perform core biopsies only perform them for less than 3% of all FNACs. However, only 5% of institutions performed core biopsies up to three times more than FNAC.
Biopsy ; Biopsy, Fine-Needle* ; Biopsy, Needle ; Consensus ; Diagnosis ; Galectin 3 ; Immunohistochemistry ; Korea* ; Pathology ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule ; Ultrasonography

OBJECTIVETo screen out the sonogram features for the differential diagnosis of benign and malignant thyroid small nodules (≤ 1.0 cm) by Logistics regression analysis, to establish the binary Logistic regression model of sonogram features as independent variable and investigate the value of wall configuration of ultrasonogrophic nodules in the differential diagnosis of benign and malignant thyroid small nodules.

METHODSA total of 208 thyroid nodules ≤ 1.0 cm in diameter in 190 patients were evaluated. With postoperative pathological examination or fine needle aspiration biopsy, 106 nodules were confirmed as benign and 102 as malignant. Ultrasonic features of thyroid nodules were evaluated for the differential diagnosis of benign and malignant small thyroid nodules based on pathological diagnosis as a gold standard, a Logistic model was obtained, and the odds ratio of variables were compared. The margin of thyroid nodule was divided into regular or irregular margin, and the latter was divided further into four subtypes: strip, triangular, antler and papillary. The border was divided into clear, fuzzy or both. The periphery was divided into those with normal and abnormal echo;. The calcification included no calcification, microcalcification and non-microcalcification.

RESULTSFour statistically significant features were obtained finally by Logistics regression analysis, including margin, border, periphery and calcification. A formula was constructed by two-variables logistic regression analysis and probability of malignancy = 1/(1 + e - z), in which z = 5.026 × margin + 4.218 × border + 4.024 × periphery + 3.892 × calcification - 15.247. The odds ratio of margin was higher than the other independent variables.

CONCLUSIONSLogistics regression analysis indicates that the calcification, border, periphery, and especially margin of thyroid nodules are significant features for differentiating benign and malignant thyroid nodules. The margin score was more intuitionistic for the differentialtion of benign and malignant thyroid nodules.

Duplex Doppler US may be useful for the detection of thyroid malignancies that show either anarchic winding or penetrating "sword like" neoangiogenic vessels. It may be helpful in selecting nodules that should undergo fine needle aspiration biopsy.
Biopsy, Fine-Needle ; Diagnosis, Differential ; Humans ; Thyroid Neoplasms/blood supply/pathology/*ultrasonography ; Thyroid Nodule/blood supply/pathology/*ultrasonography ; *Ultrasonography, Doppler, Duplex ; Ultrasonography, Interventional

BACKGROUND AND OBJECTIVES: With the availability of more sensitive ultrasonography, a larger number of nonpalpable thyroid nodule can be detected. But it is controversial that USG-FNA should be routinely used to incidentally detect nonpalpable thyroid nodule. The purpose of this study is to investigate the clinical significance of thyroid incidentaloma and the usefulness of the USG-FNA in the management of thyroid incidentaloma. SUBJECTS AND METHOD: A retrospective study was performed on 208 patients who underwent USG-FNA for thyroid incidentaloma smaller than 1.5 cm from 2001 to 2005. The cytologic findings were compared with the ultrasonographic findings and the surgical pathology. RESULTS: Suspicious malignant sonographic findings were detected in 48 cases. And in 10 cases, more than two malignant findings were detected. Of the 208 cases, 159 cases were cytologically diagnosed as benign lesion (76.4%), 7 cases as follicular neoplasm (3.3%), 33 cases as malignancy (15.8%), and 9 cases as inadequate specimen (4.4%). Of the 40 cases with follicular neoplasm and malignant cytology, 37 cases underwent surgery and 30 cases were confirmed to malignancy on the postoperative pathologic diagnosis. In the cases diagnosed to malignancy on pathology, extracapsular extension was present in 9 cases (30%), and nodal metastasis in 8 cases (26.7%). The sensitivity, specificity, and accuracy of the USG-FNA for malignancy were 93.3%, 71.4%, and 89.1%, respectively. CONCLUSION: USG-FNA is a useful diagnostic tool in the management of thyroid incidentaloma especially when more than two suspicious malignant sonographic findings need to be detected. The clinical characteristics is not significantly different between palpable and nonpalpable nodules.
Biopsy, Fine-Needle* ; Diagnosis ; Humans ; Neoplasm Metastasis ; Pathology ; Pathology, Surgical ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography

OBJECTIVE: The aim of this study was to determine the efficacy of the use of an ultrasound-guided fine-needle aspiration biopsy (US-FNAB) to diagnose thyroid nodules smaller than 5 mm in the maximum diameter and to evaluate pathological findings of small thyroid malignancies. MATERIALS AND METHODS: From May 2007 to April 2008, we evaluated the findings of US-FNABs of small thyroid nodules less than 5 mm in the maximum diameter. The cytopathological findings were retrospectively reviewed and the diagnostic performance of the use of an US-FNAB was examined in all patients. RESULTS: Of 201 small thyroid nodules in 180 patients, there were 162 adequate specimens (81%). Among 180 patients, 75 patients underwent thyroid surgery and 50 malignant and 33 benign nodules were identified based on a pathological examination. All small malignant thyroid nodules were identified as papillary thyroid microcarcinomas (PTMCs). There were 34 (55%) true positive, 0 (0%) false positive, 23 (37%) true negative and five (8%) false negative results for malignancy after performing a first US-FNAB in 62 surgically confirmed nodules. The sensitivity (87%), specificity (100%), positive predictive value (100%), negative predictive value (82%), accuracy (92%), false positive rate (0%) and false negative rate (8%) for an US-FNAB were determined. In 23 patients with a primary PTMC, capsular invasion (9%, 2 of 23), a perithyroidal lymph node metastasis (30%, 7 of 23), the rate of multifocality (9%, 2 of 23) and bilaterality (4%, 1 of 23) were also determined. CONCLUSION: An US-FNAB of thyroid nodules smaller than 5 mm in the maximum diameter is an effective diagnostic procedure.
Adolescent ; Adult ; Aged ; *Biopsy, Fine-Needle ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Neoplasms/*pathology/ultrasonography ; Thyroid Nodule/*pathology/ultrasonography ; *Ultrasonography, Interventional

PURPOSE: The goal of this study was to evaluate the clinicopathological and imaging features of thyroid nodules surgically diagnosed as hyaline trabecular tumor (HTT), and to assess the role of cytology and frozen sections (FS) in the diagnosis of HTT. METHODS: This study included 21 thyroid nodules in 21 patients treated from August 2005 to March 2015 (mean age, 53.3 years) who were either diagnosed as HTT or had HTT suggested as a possible diagnosis based on cytology, FS, or the final pathology report. Patients' medical records were retrospectively reviewed for cytopathologic results and outcomes during the course of follow-up. Sonograms were reviewed and categorized. RESULTS: Twelve nodules from 12 patients were surgically confirmed as HTT. Ultrasonography (US)-guided fine needle aspiration (FNA) was performed on 11 nodules, of which six (54.5%) were papillary thyroid carcinoma (PTC) or suspicious for PTC and three (27.3%) were HTT or suspicious for HTT. Intraoperative FS suggested the possibility of HTT in seven nodules, of which four (57.1%) were confirmed as HTT. US-FNA suggested the diagnosis of HTT in 10 nodules, of which three (30.0%) were confirmed as HTT. Common US features of the 12 pathologically confirmed cases of HTT were hypoechogenicity or marked hypoechogenicity (83.4%), absence of calcifications (91.7%), parallel shape (100.0%), presence of vascularity (75.0%), and probable benignity (58.3%). CONCLUSION: HTT should be included in the differential diagnosis of solid tumors with hypoechogenicity or marked hypoechogenicity and otherwise benign US features that have been diagnosed as PTC through cytology.
Biopsy, Fine-Needle ; Diagnosis* ; Diagnosis, Differential ; Follow-Up Studies ; Frozen Sections* ; Humans ; Hyalin* ; Medical Records ; Pathology ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule ; Ultrasonography*