Korean J Radiol.  2018 Aug;19(4):623-631. 10.3348/kjr.2018.19.4.623.

Primary Imaging Test and Appropriate Biopsy Methods for Thyroid Nodules: Guidelines by Korean Society of Radiology and National Evidence-Based Healthcare Collaborating Agency

• Ha EJ
• Lim HK
• Yoon JH
• Baek JH
• Do KH
• Choi M
• Choi JA
• Lee M
• Na DG
• The Korean Society of Thyroid Radiology (KSThR) and Korean Society of Radiology

• KMID: 2413692
• DOI: http://doi.org/10.3348/kjr.2018.19.4.623

Abstract

The Korean Society of Radiology and the National Evidence-based Healthcare Collaborating Agency developed guidelines for primary imaging tests and appropriate biopsy methods for thyroid nodules. These guidelines were developed using an adaptation process by collaboration between the development committee and the working group. The development committee, composed of research methodology experts, established the overall plan and provided support about methodological strategies. The working group, composed of radiologist experts in thyroid imaging, wrote the proposals. The guidelines recommend neck ultrasound (US) as a first-line imaging modality for the diagnosis of thyroid nodules in patients with suspected nodules, and US-guided fine-needle aspiration as a primary method for histologic examination of thyroid nodules.

Keyword

Thyroid nodule; Ultrasound; Guideline; Fine-needle aspiration; Diagnosis; Recommendation

MeSH Terms

Biopsy*
Biopsy, Fine-Needle
Cooperative Behavior
Diagnosis
Evidence-Based Practice*
Humans
Methods*
Neck
Research Design
Thyroid Gland*
Thyroid Nodule*
Ultrasonography

Figure

• 

  Fig. 1 Flow diagram of guideline selection (Key Question 1).

• 

  Fig. 2 Flow diagram of guideline selection (Key Question 2).

Reference

1. Vander JB, Gaston EA, Dawber TR. The significance of nontoxic thyroid nodules. Final report of a 15-year study of the incidence of thyroid malignancy. Ann Intern Med. 1968; 69:537–540. PMID: 5673172.

2. Tunbridge WM, Evered DC, Hall R, Appleton D, Brewis M, Clark F, et al. The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol (Oxf). 1977; 7:481–493. PMID: 598014.

3. Mandel SJ. A 64-year-old woman with a thyroid nodule. JAMA. 2004; 292:2632–2642. PMID: 15572721.

4. Mortensen JD, Woolner LB, Bennett WA. Gross and microscopic findings in clinically normal thyroid glands. J Clin Endocrinol Metab. 1955; 15:1270–1280. PMID: 13263417.

5. Guth S, Theune U, Aberle J, Galach A, Bamberger CM. Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur J Clin Invest. 2009; 39:699–706. PMID: 19601965.

6. Tan GH, Gharib H. Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med. 1997; 126:226–231. PMID: 9027275.

7. Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab. 2002; 87:1941–1946. PMID: 11994321.

8. Nam-Goong IS, Kim HY, Gong G, Lee HK, Hong SJ, Kim WB, et al. Ultrasonography-guided fine-needle aspiration of thyroid incidentaloma: correlation with pathological findings. Clin Endocrinol (Oxf). 2004; 60:21–28. PMID: 14678283.

9. Korean Statistical Information Service. Web site. 2015. Accessed August 25, 2017. http://kosis.kr/statisticsList/statisticsList_01List.jsp?vwcd=MT_ZTITLE&parmTabId=M_01_01#SubCont.

10. Na DG, Baek JH, Jung SL, Kim JH, Sung JY, Kim KS, et al. Korean Society of Thyroid Radiology (KSThR) and Korean Society of Radiology. Core needle biopsy of the thyroid: 2016 consensus statement and recommendations from Korean Society of Thyroid Radiology. Korean J Radiol. 2017; 18:217–237. PMID: 28096731.

11. Shin JH, Baek JH, Chung J, Ha EJ, Kim JH, Lee YH, et al. Korean Society of Thyroid Radiology (KSThR) and Korean Society of Radiology. Ultrasonography diagnosis and imaging-based management of thyroid nodules: revised Korean Society of Thyroid Radiology consensus statement and recommendations. Korean J Radiol. 2016; 17:370–395. PMID: 27134526.

12. Choi SJ, Jeong WK, Jo AJ, Choi JA, Kim MJ, Lee M, et al. Methodology for developing evidence-based clinical imaging guidelines: joint recommendations by Korean Society of Radiology and National Evidence-Based Healthcare Collaborating Agency. Korean J Radiol. 2017; 18:208–216. PMID: 28096730.

13. Moon WJ, Baek JH, Jung SL, Kim DW, Kim EK, Kim JY, et al. Korean Society of Thyroid Radiology (KSThR). Korean Society of Radiology. Ultrasonography and the ultrasound-based management of thyroid nodules: consensus statement and recommendations. Korean J Radiol. 2011; 12:1–14. PMID: 21228935.

14. Lee YH, Baek JH, Jung SL, Kwak JY, Kim JH, Shin JH. Korean Society of Thyroid Radiology (KSThR). Korean Society of Radiology. Ultrasound-guided fine needle aspiration of thyroid nodules: a consensus statement by the korean society of thyroid radiology. Korean J Radiol. 2015; 16:391–401. PMID: 25741201.

15. Na DG, Lee JH, Jung SL, Kim JH, Sung JY, Shin JH, et al. Korean Society of Thyroid Radiology (KSThR). Korean Society of Radiology. Radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: consensus statement and recommendations. Korean J Radiol. 2012; 13:117–125. PMID: 22438678.

16. Gharib H, Papini E, Paschke R, Duick DS, Valcavi R, Hegedüs L, et al. AACE/AME/ETA Task Force on Thyroid Nodules. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and EuropeanThyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract. 2010; 16(Suppl 1):1–43.

17. 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. 2016; 26:1–133. PMID: 26462967.

18. Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G, et al. British Thyroid Association. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf). 2014; 81(Suppl 1):1–122.

19. National Comprehensive Cancer Network. Web site. 2015. Accessed August 14, 2015. https://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf.

20. Frates MC, Benson CB, Charboneau JW, Cibas ES, Clark OH, Coleman BG, et al. Society of Radiologists in Ultrasound. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology. 2005; 237:794–800. PMID: 16304103.

21. Smith-Bindman R, Lebda P, Feldstein VA, Sellami D, Goldstein RB, Brasic N, et al. Risk of thyroid cancer based on thyroid ultrasound imaging characteristics: results of a population-based study. JAMA Intern Med. 2013; 173:1788–1796. PMID: 23978950.

22. Brito JP, Gionfriddo MR, Al Nofal A, Boehmer KR, Leppin AL, Reading C, et al. The accuracy of thyroid nodule ultrasound to predict thyroid cancer: systematic review and meta-analysis. J Clin Endocrinol Metab. 2014; 99:1253–1263. PMID: 24276450.

23. Cesur M, Corapcioglu D, Bulut S, Gursoy A, Yilmaz AE, Erdogan N, et al. Comparison of palpation-guided fine-needle aspiration biopsy to ultrasound-guided fine-needle aspiration biopsy in the evaluation of thyroid nodules. Thyroid. 2006; 16:555–561. PMID: 16839257.

24. Hambly NM, Gonen M, Gerst SR, Li D, Jia X, Mironov S, et al. Implementation of evidence-based guidelines for thyroid nodule biopsy: a model for establishment of practice standards. AJR Am J Roentgenol. 2011; 196:655–660. PMID: 21343510.

25. Solbiati L, Osti V, Cova L, Tonolini M. Ultrasound of thyroid, parathyroid glands and neck lymph nodes. Eur Radiol. 2001; 11:2411–2424. PMID: 11734934.

26. Lee YH, Kim DW, In HS, Park JS, Kim SH, Eom JW, et al. Differentiation between benign and malignant solid thyroid nodules using an US classification system. Korean J Radiol. 2011; 12:559–567. PMID: 21927557.

27. Can AS, Peker K. Comparison of palpation-versus ultrasound-guided fine-needle aspiration biopsies in the evaluation of thyroid nodules. BMC Res Notes. 2008; 1:12. PMID: 18710537.

28. Deandrea M, Mormile A, Veglio M, Motta M, Pellerito R, Gallone G, et al. Fine-needle aspiration biopsy of the thyroid: comparison between thyroid palpation and ultrasonography. Endocr Pract. 2002; 8:282–286. PMID: 12185993.

29. Carmeci C, Jeffrey RB, McDougall IR, Nowels KW, Weigel RJ. Ultrasound-guided fine-needle aspiration biopsy of thyroid masses. Thyroid. 1998; 8:283–289. PMID: 9588492.

30. Danese D, Sciacchitano S, Farsetti A, Andreoli M, Pontecorvi A. Diagnostic accuracy of conventional versus sonography-guided fine-needle aspiration biopsy of thyroid nodules. Thyroid. 1998; 8:15–21. PMID: 9492148.

31. Yang J, Schnadig V, Logrono R, Wasserman PG. Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. Cancer. 2007; 111:306–315. PMID: 17680588.

32. Gharib H, Papini E. Thyroid nodules: clinical importance, assessment, and treatment. Endocrinol Metab Clin North Am. 2007; 36:707–735. viPMID: 17673125.

33. Wu HH, Jones JN, Osman J. Fine-needle aspiration cytology of the thyroid: ten years experience in a community teaching hospital. Diagn Cytopathol. 2006; 34:93–96. PMID: 16514671.

34. Baek JH. Current status of core needle biopsy of the thyroid. Ultrasonography. 2017; 36:83–85. PMID: 28301922.

35. Suh CH, Baek JH, Kim KW, Sung TY, Kim TY, Song DE, et al. The role of core-needle biopsy for thyroid nodules with initially nondiagnostic fine-needle aspiration results: a systematic review and meta-analysis. Endocr Pract. 2016; 22:679–688. PMID: 27176143.