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Ralf Paschke
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Silvia Cantara
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Anna Crescenzi
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Barbara Jarzab
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Thomas J. Musholt
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Manuel Sobrinho Simoes
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reclassification is unanimously accepted, it will lead to a dramatic reduction of the risk of malignancy for AUS/FLUS, FN/SFN, or indeterminate FNA cytologies [ 14 ] and consequently also a dramatic reduction of the risk of malignancy for associated mutations like

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J L Reverter Endocrinology and Nutrition Service, Germans Trias i Pujol Hospital and Research Institute, Badalona, Spain
Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain

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L Ferrer-Estopiñan Endocrinology and Nutrition Service, Germans Trias i Pujol Hospital and Research Institute, Badalona, Spain
Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain

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F Vázquez Endocrinology and Nutrition Service, Germans Trias i Pujol Hospital and Research Institute, Badalona, Spain
Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain

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S Ballesta Endocrinology and Nutrition Service, Germans Trias i Pujol Hospital and Research Institute, Badalona, Spain
Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain

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S Batule Endocrinology and Nutrition Service, Germans Trias i Pujol Hospital and Research Institute, Badalona, Spain
Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain

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A Perez-Montes de Oca Endocrinology and Nutrition Service, Germans Trias i Pujol Hospital and Research Institute, Badalona, Spain
Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain

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C Puig-Jové Endocrinology and Nutrition Service, Germans Trias i Pujol Hospital and Research Institute, Badalona, Spain
Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain

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M Puig-Domingo Endocrinology and Nutrition Service, Germans Trias i Pujol Hospital and Research Institute, Badalona, Spain
Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain

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nodules has enhanced the need for endocrinologists to be able to define the risk of malignancy as accurately as possible ( 2 ). Ultrasound (US) is the first-line method to identify malignant thyroid nodules with the advantages of accessibility, cost

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Tommaso Piticchio Endocrinology Section, Department of Clinical and Experimental Medicine, Garibaldi Nesima Hospital, University of Catania, Catania, Italy
Servizio di Endocrinologia e Diabetologia, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland

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Gilles Russ Department of Thyroid and Endocrine Tumor Diseases, La Pitie-Salpetriere Hospital, 83 Bd de l’Hopital, Paris, France

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Maija Radzina Riga Stradins University, Radiology Research Laboratory, Riga, Latvia
University of Latvia, Faculty of Medicine, Riga, Latvia

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Francesco Frasca Endocrinology Section, Department of Clinical and Experimental Medicine, Garibaldi Nesima Hospital, University of Catania, Catania, Italy

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Cosimo Durante Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy

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Pierpaolo Trimboli Servizio di Endocrinologia e Diabetologia, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
Facoltà di Scienze Biomediche, Università della Svizzera Italiana (USI), Lugano, Switzerland

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-tiered scoring system (mild, moderate, severe) based on the estimated risk of malignancy. The most renowned TIRADSs from three different continents, specifically ACR-, EU-, and K-TIRADS ( 11 , 12 , 13 ), were evaluated, and their data were directly compared

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Ernesto Maddaloni Endocrinology and Diabetes Unit, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy

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Silvia Irina Briganti Endocrinology and Diabetes Unit, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy

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Anna Crescenzi Pathology Unit, Campus Bio-Medico University of Rome, Rome, Italy

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Giuseppina Beretta Anguissola Endocrinology and Diabetes Unit, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy

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Eleonora Perrella Pathology Unit, Campus Bio-Medico University of Rome, Rome, Italy

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Chiara Taffon Pathology Unit, Campus Bio-Medico University of Rome, Rome, Italy

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Andrea Palermo Endocrinology and Diabetes Unit, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy

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Silvia Manfrini Endocrinology and Diabetes Unit, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy

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Paolo Pozzilli Endocrinology and Diabetes Unit, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy

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Angelo Lauria Pantano Endocrinology and Diabetes Unit, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy

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non-malignant/benign. Cyst fluid may yield only macrophages, but the risk of malignancy is low for these lesions if they are simple and under 3 cm. For this reason, these cases are separated from inadequate specimens obtained from solid lesions and are

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Kanhaiyalal Agrawal Departments of Nuclear Medicine, London, UK

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James Weaver Departments of King's College London, London, UK

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Fahim Ul-Hassan Departments of Nuclear Medicine, London, UK
Departments of Clinical PET Centre, King's College London, London, UK

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Jean-Pierre Jeannon Departments of Otorhinolaryngology Head and Neck Surgery, London, UK

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Ricard Simo Departments of Otorhinolaryngology Head and Neck Surgery, London, UK

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Paul Carroll Departments of Consultant Endocrinologist, London, UK

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Johnathan G. Hubbard Departments of Consultant Endocrine Surgeon, Guy's and St Thomas' NHS Foundation Trust, London, UK

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Ashish Chandra Departments of Histopathology/Cytology, London, UK

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Hosahalli Krishnamurthy Mohan Departments of Nuclear Medicine, London, UK
Departments of Clinical PET Centre, King's College London, London, UK

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]. The prevalence of focal uptake within the thyroid (incidentaloma) on 18 F-FDG PET has been noted to range from 0.2 to 10.1% in various studies. This is clinically more significant due to its high risk of malignancy in these lesions and the reported

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Stamatina Ioakim CEDM, Centre of Endocrinology, Diabetes & Metabolism, Limassol, Cyprus
Medical School, University of Milan, Milan, Italy

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Akheel A Syed Department of Diabetes, Endocrinology & Obesity Medicine, Salford Royal NHS Foundation & University Teaching Trust, Salford, UK
Division of Diabetes, Endocrinology & Gastroenterology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK

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George Zavros CEDM, Centre of Endocrinology, Diabetes & Metabolism, Limassol, Cyprus

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Michalis Picolos Alithias Endocrinology Centre, Nicosia, Cyprus

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Luca Persani Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
Department of Endocrinology and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy

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Angelos Kyriacou CEDM, Centre of Endocrinology, Diabetes & Metabolism, Limassol, Cyprus
Department of Diabetes, Endocrinology & Obesity Medicine, Salford Royal NHS Foundation & University Teaching Trust, Salford, UK
Medical School, European University of Cyprus, Nicosia, Cyprus

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). Reassuringly, a recent long-term study of a 17,500-patient cohort with nodules greater than 10 mm in size showed an even lower risk of malignancy at 1.1% ( 6 ). The latter study differed from previous studies in that there was less selection bias and papillary

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Dong Gyu Na Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, South Korea

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Hye Sook Min Departments of Pathology, Seoul, South Korea

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Hunkyung Lee Department of Pathology, Ewha Clinical Laboratory, Seoul, South Korea

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Jae-Kyung Won Departments of Pathology, Seoul, South Korea

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Hyo Bin Seo Department of Radiology, Seoul National University Hospital Kangnam Center, Seoul, South Korea

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Ji-Hoon Kim Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea

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7 Renshaw AA: Does a repeated benign aspirate change the risk of malignancy after an initial atypical thyroid fine-needle aspiration? Am J Clin Pathol 2010;134:788-792. 10.1309/AJCPRA9Y2XQVFOFV 20959662 8 VanderLaan PA, Marqusee E, Krane JF

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Francesco Quaglino General Surgery Unit, Turin, Italy

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Valentina Marchese General Surgery Unit, Turin, Italy

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Enrico Mazza Endocrinology and Metabolism Unit, Turin, Italy

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Cristina Gottero Endocrinology and Metabolism Unit, Turin, Italy

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Riccardo Lemini General Surgery Unit, Turin, Italy

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Stefano Taraglio Pathology Unit, Maria Vittoria Hospital ASL TO2, Turin, Italy

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achieved its aim of standardizing thyroid-reporting cytopathology, the TIR-3 category remains the most controversial. “Indeterminate” lesions have been associated with a variable risk of malignancy, ranging from 5 to 30% [ 7 ]. For this reason, in 2012 the

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Maria Mavromati Department of Endocrinology, Diabetology, Nutrition and Therapeutic Education, Geneva University Hospitals, Rue Gabrielle Perret Gentil, Geneva University, Geneva, Switzerland

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Essia Saiji Department of Pathology, Geneva University Hospitals, Rue Gabrielle Perret Gentil, Geneva, Switzerland

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Marco Stefano Demarchi Department of Endocrine Surgery, Geneva University Hospitals, Rue Gabrielle Perret Gentil, Geneva, Switzerland

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Vincent Lenoir Department of Radiology, Geneva University Hospitals, Rue Gabrielle Perret Gentil, Geneva, Switzerland

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Amanda Seipel Department of Pathology, Geneva University Hospitals, Rue Gabrielle Perret Gentil, Geneva, Switzerland

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Paulina Kuczma Department of Endocrine Surgery, Geneva University Hospitals, Rue Gabrielle Perret Gentil, Geneva, Switzerland

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François R Jornayvaz Department of Endocrinology, Diabetology, Nutrition and Therapeutic Education, Geneva University Hospitals, Rue Gabrielle Perret Gentil, Geneva University, Geneva, Switzerland

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Minerva Becker Department of Radiology, Geneva University Hospitals, Rue Gabrielle Perret Gentil, Geneva, Switzerland

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Eugenio Fernandez Department of Oncology, Geneva University Hospitals, Rue Gabrielle Perret Gentil, Geneva, Switzerland

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Claudio De Vito Department of Pathology, Geneva University Hospitals, Rue Gabrielle Perret Gentil, Geneva, Switzerland

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Frédéric Triponez Department of Endocrine Surgery, Geneva University Hospitals, Rue Gabrielle Perret Gentil, Geneva, Switzerland

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Sophie Leboulleux Department of Endocrinology, Diabetology, Nutrition and Therapeutic Education, Geneva University Hospitals, Rue Gabrielle Perret Gentil, Geneva University, Geneva, Switzerland

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, ultrasound scores are used to determine which nodules should undergo FNAC and the Bethesda classification is used to assess management based on the risk of malignancy ( 7 , 8 ). Suspicious nodules with Bethesda III, Bethesda IV, and Bethesda V cytology

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Laura Fugazzola Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

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Maurilio Deandrea Endocrinology, Diabetes and Metabolism Department and Center for Thyroid Diseases, Ordine Mauriziano Hospital, Turin, Italy

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Stefano Borgato Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy

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Marco Dell’Acqua Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy

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Francesca Retta Endocrinology, Diabetes and Metabolism Department and Center for Thyroid Diseases, Ordine Mauriziano Hospital, Turin, Italy

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Alberto Mormile Endocrinology, Diabetes and Metabolism Department and Center for Thyroid Diseases, Ordine Mauriziano Hospital, Turin, Italy

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Chiara Carzaniga Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy

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Giacomo Gazzano Pathology Unit, Istituto Auxologico Italiano IRCCS, Milan, Italy

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Gabriele Pogliaghi Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

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Marina Muzza Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy

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Luca Persani Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy

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( 5 ), nodules classified as atypia of undetermined significance or follicular lesion of undetermined significance – AUS/FLUS, Bethesda III – harbor a risk of malignancy of 22% (range: 13–30%) and the recommended management is to repeat cytology or to

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