Incidental thyroid nodules are commonly detected on ultrasonography (US). This has contributed to the rapidly rising incidence of low-risk papillary thyroid carcinoma over the last 20 years. The appropriate diagnosis and management of these patients is based on the risk factors related to the patients as well as the thyroid nodules. The Korean Society of Thyroid Radiology (KSThR) published consensus recommendations for US-based management of thyroid nodules in 2011 and revised them in 2016. These guidelines have been used as the standard guidelines in Korea. However, recent advances in the diagnosis and management of thyroid nodules have necessitated the revision of the original recommendations. The task force of the KSThR has revised the Korean Thyroid Imaging Reporting and Data System and recommendations for US lexicon, biopsy criteria, US criteria of extrathyroidal extension, optimal thyroid computed tomography protocol, and US follow-up of thyroid nodules before and after biopsy. The biopsy criteria were revised to reduce unnecessary biopsies for benign nodules while maintaining an appropriate sensitivity for the detection of malignant tumors in small (1-2 cm) thyroid nodules. The goal of these recommendations is to provide the optimal scientific evidence and expert opinion consensus regarding US-based diagnosis and management of thyroid nodules.

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2021 Korean Thyroid Imaging Reporting and Data System and Imaging-Based Management of Thyroid Nodules: Korean Society of Thyroid Radiology Consensus Statement and Recommendations

Objectives To investigate the qualitative and quantitative characteristics of contrast-enhanced ultrasound (CEUS) in assessing cervical lymph node metastasis from papillary thyroid carcinoma (PTC) and to evaluate its value in the preoperative diagnosis of cervical lymph node metastasis from PTC. Methods A total of 55 lymph nodes in 46 patients were enrolled retrospectively, including 29 metastases from PTC and 26 normal/reactive ones. All lymph nodes were evaluated by conventional ultrasound (US) and CEUS before biopsy or surgery. A receiver operating characteristic curve analysis was used to analyze the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of US and CEUS features in the diagnosis of lymph node metastasis as well as the overall diagnostic performance of US, CEUS, and a combination of the two. Results Significant differences were found in the enhancement direction, enhancement type, and enhancement range between metastatic and normal/reactive lymph nodes on CEUS (P .05). The combination of US and CEUS had the highest diagnostic accuracy (92.7%) compared with US (80.8%) and CEUS (89.1%) alone in the diagnosis of lymph node metastasis from PTC. Conclusions The characteristics of cervical lymph node metastasis from PTC on CEUS include centripetal perfusion, peripheral or mixed enhancement, and an enlarged range on CEUS compared with US, and the first feature was the most meaningful. The combination of CEUS and US is a promising imaging tool for the preoperative diagnosis of cervical metastatic lymph nodes in patients with PTC.

Value of Qualitative and Quantitative Contrast-Enhanced Ultrasound Analysis in Preoperative Diagnosis of Cervical Lymph Node Metastasis From Papillary Thyroid Carcinoma.

Comparison of Diagnostic Accuracy of Real-Time Elastography and Shear Wave Elastography in Differentiation Malignant From Benign Thyroid Nodules.

Background: Approximately 10-20 million Americans have been clinically diagnosed with thyroid nodules. Shear wave elastography (SWE) and real-time elastography (R

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Comparing the Diagnostic Accuracy of RTE and SWE in Differentiating Malignant Thyroid Nodules from Benign Ones: a Meta-Analysis.

Contrast-enhanced ultrasound (CEUS) is widely used to evaluate tumor microcirculation, which is useful in the differential diagnosis between benignity and malignancy. In the last 10 years, the applicability of CEUS to thyroid nodules has greatly improved due to technological refinements and the development of second-generation contrast agents. In this review, we summarize the applications of CEUS for thyroid nodules, focusing on the imaging findings of malignant and benign nodules in the existing literature and the use of those findings to predict malignancies, with an additional brief description of the utilization of CEUS for other thyroid-related diseases.

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Application of contrast-enhanced ultrasound for evaluation of thyroid nodules

The objective of this study was to prospectively evaluate the diagnostic accuracy of contrast-enhanced ultrasonography (CEUS) in differentiating between benign and metastatic cervical lymph nodes in patients with papillary thyroid cancer (PTC). Three hundred nineteen cervical lymph nodes (162 metastatic from PTC and 157 benign) were evaluated using conventional ultrasonography (US) and CEUS before biopsy or surgery. Metastatic lymph nodes more often manifested centripetal or asynchronous perfusion, hyper-enhancement, heterogeneous enhancement, perfusion defects and ring-enhancing margins than benign lymph nodes at pre-operative CEUS (all p values

Role of Contrast-Enhanced Ultrasound in the Pre-operative Diagnosis of Cervical Lymph Node Metastasis in Patients with Papillary Thyroid Carcinoma

Objective
To explore the values of total ultrasonic scores of conventional ultrasound and ultrasound elastography in the diagnosis of thyroid nodular lesions.


Methods
A total of 347 thyroid nodules proved by fine-needle aspiration cytology (FNAC) and surgery underwent preoperative conventional ultrasound and ultrasound elastography.The features on gray scale,color Doppler flow imaging (CDFI) and elastogram were documented and total ultrasonic scores recorded.


Results
Among 347 nodules, 184 nodules were benign and 163 malignant.Significant differences of total ultrasonic scores were found between thyroid carcinoma and benign nodular lesions including the parameters of nodular shape, edge, echoes, sound attenuation, psammous calcifications, internal blood flow and ultrasound elastography score.The higher the total ultrasonic scores, the more possibility of thyroid carcinoma was.By the analysis of receiver operating characteristic curve, the sensitivity, specificity and accuracy of distinguishing thyroid carcinoma from benign nodular lesions was 84.0%, 89.6% and 84.9% if the cut-off value of total ultrasonic scores was over 4.


Conclusion
For the differential diagnosis of benign and malignant thyroid lesions, the total ultrasonic scores of conventional ultrasound and ultrasound elastography can offer greater values.


Key words: 
Ultrasonography; Elasticity imaging techniques; Thyroid neoplasms

Ultrasonic scores of conventional ultrasound and ultrasound elastography in the diagnosis of thyroid nodular lesions

Objective
To evaluate the association of the BRAF V600E mutation with sonographic features in patients with papillary thyroid carcinoma.


Methods
A consecutive series of 61 papillary thyroid carcinoma(PTC) was evaluated by US and elastography before US-FNA, BRAF V600E mutation and surgery.The PTCs were categorized into 2 groups according to the results of the BRAF V600E mutation, BRAF-positive and BRAF-negative patients. The sonographic features were compared between BRAF-positive and BRAF-negative patients.


Results
The BRAF V600E mutation was detected in 82% of patients (50 of 61). There were no significant difference between BRAF-positive and BRAF-negative PTC on sonographic features including the nodular size, echogenicity, shape, margin, calcification and the pattern of blood flow.However the prevalence of PTC with a score higher than 4 on the Hong et al score was 72% (36/50) in the BRAF-positive group, significantly higher than 36.4%(4/11) in the BRAF-negative group(P=0.024). A score higher than 4 correlated highly with a BRAF-positive diagnosis (sensitivity 72.0%, specificity 63.6%, positive predictive value 90.0%, negative predictive value 33.3%, accuracy 70.5% and OR 4.5).


Conclusions
The BRAF V600E mutation was significantly associated with elastography classification, a score higher than 4 on the Hong et al score could highly predict the occurrence of BRAF V600E mutation in papillary thyroid cancer.


Key words: 
Ultrasonography; Thyroid neoplasms; Biopsy, fine-needle; BRAF V600E mutation

Associations of the BRAF V600E mutation with sonographic features in patients with papillary thyroid carcinoma

Objective
To evaluate the diagnostic and prognostic value of BRAF V600E mutation screening of ultrasound-guided fine-needle aspiration (FNA) specimens in patients with thyroid nodule.


Methods
The BRAF V600E mutation status were assessed in FNA specimens of 104 patients with thyroid nodules before operations. The BRAF mutation status, clinical, and pathology records of the patients were reviewed and the associations between these characteristics and papillary thyroid cancer(PTC) were analyzed.


Results
Seventy-one PTC and 14 benign thyroid nodules were included in this study. BRAF V600E mutations were found in 57/71(80%) PTC. All benign thyroid nodules had no BRAF V600E mutation. The sensitivity, specificity, positive predictive value and negative predictive value of BRAF V600E mutations in differentiation between PTC and benign thyroid nodules were 80%, 100%, 100% and 50% (P<0.001). In 44 patients with PTC who underwent surgery, the central compartment lymph node metastases and extrathyroidal invasion were not significantly different between BRAF-positive and BRAF-negative PTC(P=0.283 and 0.307).


Conclusions
BRAF V600E mutation may be a potential tool to facilitate ultrasound in diagnosis of PTC. In patients with PTC, the presence of the BRAFV600E mutation was not significantly associated with prognostic factors.


Key words: 
Ultrasonography; Thyroid neoplasms; Biopsy, fine-needle; BRAF mutation

Guoqiang Mo

Papers

Role of Contrast-Enhanced Ultrasound in the Pre-operative Diagnosis of Cervical Lymph Node Metastasis in Patients with Papillary Thyroid Carcinoma

Ultrasonic scores of conventional ultrasound and ultrasound elastography in the diagnosis of thyroid nodular lesions

Associations of the BRAF V600E mutation with sonographic features in patients with papillary thyroid carcinoma

Use of the BRAF V600E mutation in fine-needle aspirations of thyroid nodules