World Congress on Thyroid Cancer 4.0
July 29 – August 1, 2021
WCTC3.5 Steering Committee:
Rocco Bellantone, Co-Chair
Celestino Lombardi, Co-Chair
Gregory W. Randolph, MD
Bryan McIver, MD
Jeremy Freeman, MD
Ian J. Witterick, MD
Ashok R. Shaha, MD
Jatin P. Shah, MD
OP46 – Malignancy rate of suspicious thyroid nodules less than 1cm on various TIRADS
Ha, Su Min1; Kim, Jae Kyun1; Baek, Jung Hwan2
1 Department of Radiology and Thyroid Center, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, 06973, Korea
2 Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
Background/Purpose: In patients with active surveillance of papillary thyroid microcarcinoma (PTMC), definitive therapy, usually preceded by definitive diagnostic procedure, is not recommended until there is evidence of disease progression, as stated in American Thyroid Association (ATA) guideline. Because deferring definitive diagnosis and therapy until disease progression has no impact on disease-specific survival.
Objectives: We evaluated the malignancy rate of thyroid nodules, further stratified by size cut off value 1cm, with suspicious finding on ultrasound using various malignant stratification systems.
Methods: The data was retrospectively collected from nine university hospitals between January 2003 and June 2003, previously enrolled in the Korean Society of Thyroid Radiology (KSThR) multicenter study for ultrasound (US) differentiation between benign and malignant thyroid nodules. 829 thyroid nodules in 711 patients (620 women, 91 men, mean age, 48.7 years; range 6-98 years, 351 malignant and 478 benign nodules) were included. We calculated the malignancy rate of thyroid nodules, further stratified by size, according to recommendations, and using four different types of malignant risk stratification systems. We assessed factors that differentiate benign from malignant nodules by ?²test.
Results: In less than 1cm suspicious thyroid nodules on US, the malignancy rates ranged from 77.4% to 82.8%; the lowest was from the KSThR, whereas the highest was by the Web-based system. Therefore, less than 1cm suspicious thyroid nodules on US were actually 17.2%-22.6% benign.
Discussion & Conclusion: Biopsy should be considered before active surveillance to exclude benign nodules having suspicious US features. Biopsy could prevent unnecessary active surveillance and patients’ anxiety.
- Sobin LH. Histological typing of thyroid tumours. Histopathology. 1990;16(5):513.
- Ahn HS, Kim HJ, Welch HG. Korea’s thyroid-cancer “epidemic”–screening and overdiagnosis. The New England journal of medicine. 2014;371(19):1765-7.
- Oda H, Miyauchi A, Ito Y, Yoshioka K, Nakayama A, Sasai H, et al. Incidences of Unfavorable Events in the Management of Low-Risk Papillary Microcarcinoma of the Thyroid by Active Surveillance Versus Immediate Surgery. Thyroid : official journal of the American Thyroid Association. 2016;26(1):150-5.
- Ito Y, Miyauchi A, Kihara M, Higashiyama T, Kobayashi K, Miya A. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid : official journal of the American Thyroid Association. 2014;24(1):27-34.
- Sugitani I, Toda K, Yamada K, Yamamoto N, Ikenaga M, Fujimoto Y. Three distinctly different kinds of papillary thyroid microcarcinoma should be recognized: our treatment strategies and outcomes. World journal of surgery. 2010;34(6):1222-31.
- Ito Y, Miyauchi A, Inoue H, Fukushima M, Kihara M, Higashiyama T, et al. An observational trial for papillary thyroid microcarcinoma in Japanese patients. World journal of surgery. 2010;34(1):28-35.
- Frates MC, Benson CB, Charboneau JW, Cibas ES, Clark OH, Coleman BG, et al. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology. 2005;237(3):794-800.
- Marqusee E, Benson CB, Frates MC, Doubilet PM, Larsen PR, Cibas ES, et al. Usefulness of ultrasonography in the management of nodular thyroid disease. Annals of internal medicine. 2000;133(9):696-700.
- Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid : official journal of the American Thyroid Association. 2016;26(1):1-133.
- Ito Y, Oda H, Miyauchi A. Insights and clinical questions about the active surveillance of low-risk papillary thyroid microcarcinomas [Review]. Endocrine journal. 2016;63(4):323-8.
- Shin JH, Baek JH, Chung J, Ha EJ, Kim JH, Lee YH, et al. Ultrasonography Diagnosis and Imaging-Based Management of Thyroid Nodules: Revised Korean Society of Thyroid Radiology Consensus Statement and Recommendations. Korean journal of radiology. 2016;17(3):370-95.
- Moon WJ, Jung SL, Lee JH, Na DG, Baek JH, Lee YH, et al. Benign and malignant thyroid nodules: US differentiation–multicenter retrospective study. Radiology. 2008;247(3):762-70.
- Moon WJ, Baek JH, Jung SL, Kim DW, Kim EK, Kim JY, et al. Ultrasonography and the ultrasound-based management of thyroid nodules: consensus statement and recommendations. Korean journal of radiology. 2011;12(1):1-14.
- Kwak JY, Jung I, Baek JH, Baek SM, Choi N, Choi YJ, et al. Image reporting and characterization system for ultrasound features of thyroid nodules: multicentric Korean retrospective study. Korean journal of radiology. 2013;14(1):110-7.
- Lee YH, Baek JH, Jung SL, Kwak JY, Kim JH, Shin JH. Ultrasound-guided fine needle aspiration of thyroid nodules: a consensus statement by the korean society of thyroid radiology. Korean journal of radiology. 2015;16(2):391-401.
- Kim EK, Park CS, Chung WY, Oh KK, Kim DI, Lee JT, et al. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR American journal of roentgenology. 2002;178(3):687-91.
- Choi YJ, Baek JH, Baek SH, Shim WH, Lee KD, Lee HS, et al. Web-Based Malignancy Risk Estimation for Thyroid Nodules Using Ultrasonography Characteristics: Development and Validation of a Predictive Model. Thyroid : official journal of the American Thyroid Association. 2015;25(12):1306-12.
- Russ G. Risk stratification of thyroid nodules on ultrasonography with the French TI-RADS: description and reflections. Ultrasonography (Seoul, Korea). 2016;35(1):25-38.
- Ko MS, Jeong KS, Shong YK, Gong GY, Baek JH, Lee JH. Collapsing benign cystic nodules of the thyroid gland: sonographic differentiation from papillary thyroid carcinoma. AJNR American journal of neuroradiology. 2012;33(1):124-7.
- Lang W, Borrusch H, Bauer L. Occult carcinomas of the thyroid. Evaluation of 1,020 sequential autopsies. Am J Clin Pathol. 1988;90(1):72-6.
- Koo JH, Shin JH, Han BK, Ko EY, Kang SS. Cystic thyroid nodules after aspiration mimicking malignancy: sonographic characteristics. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. 2010;29(10):1415-21.
- Park NH, Kim DW, Park HJ, Lee EJ, Park JS, Park SI, et al. Thyroid cysts treated with ethanol ablation can mimic malignancy during sonographic follow-up. Journal of clinical ultrasound : JCU. 2011;39(8):441-6.
- Ito Y, Amino N, Hirokawa M, Kobayashi K, Miya A, Miyauchi A. A solid thyroid benign nodule that showed a significant decrease in size and ultrasonographic findings mimicking papillary carcinoma during 16-year follow-up. Endocrine journal. 2011;58(1):19-22.
- Sohn YM, Kwak JY, Kim EK, Moon HJ, Kim SJ, Kim MJ. Diagnostic approach for evaluation of lymph node metastasis from thyroid cancer using ultrasound and fine-needle aspiration biopsy. AJR American journal of roentgenology. 2010;194(1):38-43.
- Lacout A, Chevenet C, Marcy PY. Mummified Thyroid Syndrome. AJR American journal of roentgenology. 2016;206(4):837-45.
- Lee HY, Baek JH, Ha EJ, Park JW, Lee JH, Song DE, et al. Malignant-looking thyroid nodules with size reduction: core needle biopsy results. Ultrasonography (Seoul, Korea). 2016;35(4):327-34.
- Yoon JH, Kim EK, Kwak JY, Moon HJ, Kim GR. Sonographic features and ultrasonography-guided fine-needle aspiration of metastases to the thyroid gland. Ultrasonography (Seoul, Korea). 2014;33(1):40-8.
- Hawk WA, Hazard JB. The many appearances of papillary carcinoma of the thyroid. Cleveland Clinic quarterly. 1976;43(4):207-15.
- Leung AK, Chow SM, Law SC. Clinical features and outcome of the tall cell variant of papillary thyroid carcinoma. The Laryngoscope. 2008;118(1):32-8.
- Ostrowski ML, Merino MJ. Tall cell variant of papillary thyroid carcinoma: a reassessment and immunohistochemical study with comparison to the usual type of papillary carcinoma of the thyroid. The American journal of surgical pathology. 1996;20(8):964-74.
- Chen JH, Faquin WC, Lloyd RV, Nose V. Clinicopathological and molecular characterization of nine cases of columnar cell variant of papillary thyroid carcinoma. Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc. 2011;24(5):739-49.
- Asioli S, Erickson LA, Sebo TJ, Zhang J, Jin L, Thompson GB, et al. Papillary thyroid carcinoma with prominent hobnail features: a new aggressive variant of moderately differentiated papillary carcinoma. A clinicopathologic, immunohistochemical, and molecular study of eight cases. The American journal of surgical pathology. 2010;34(1):44-52.
- Liu X, Bishop J, Shan Y, Pai S, Liu D, Murugan AK, et al. Highly prevalent TERT promoter mutations in aggressive thyroid cancers. Endocrine-related cancer. 2013;20(4):603-10.
- Sun J, Liu X, Zhang Q, Hong Y, Song B, Teng X, et al. Papillary Thyroid Carcinoma Treated with Radiofrequency Ablation in a Patient with Hypertrophic Cardiomyopathy: A Case Report. Korean journal of radiology. 2016;17(4):558-61.
- Papini E, Guglielmi R, Gharib H, Misischi I, Graziano F, Chianelli M, et al. Ultrasound-guided laser ablation of incidental papillary thyroid microcarcinoma: a potential therapeutic approach in patients at surgical risk. Thyroid : official journal of the American Thyroid Association. 2011;21(8):917-20.
- Valcavi R, Piana S, Bortolan GS, Lai R, Barbieri V, Negro R. Ultrasound-guided percutaneous laser ablation of papillary thyroid microcarcinoma: a feasibility study on three cases with pathological and immunohistochemical evaluation. Thyroid : official journal of the American Thyroid Association. 2013;23(12):1578-82.
- Yue W, Wang S, Yu S, Wang B. Ultrasound-guided percutaneous microwave ablation of solitary T1N0M0 papillary thyroid microcarcinoma: initial experience. International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group. 2014;30(2):150-7.
- Kim JH, Baek JH, Sung JY, Min HS, Kim KW, Hah JH, et al. Radiofrequency ablation of low-risk small papillary thyroidcarcinoma: preliminary results for patients ineligible for surgery. International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group. 2016:1-11.