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Francesco Boi Endocrinology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy

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Fabiana Pani Endocrinology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy

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Stefano Mariotti Endocrinology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy

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carcinomas (PTC). An association between HT and PTC has strongly been suggested by retrospective analyses of surgical series [ 4 - 9 ] and more recently re-evaluated in several studies carried out in consecutive patients submitted to fine-needle aspiration

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Laszlo Hegedüs Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark

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Andrea Frasoldati Division of Endocrinology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy

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Roberto Negro Division of Endocrinology, “V. Fazzi” Hospital, Lecce, Italy

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Enrico Papini Division of Endocrinology, Regina Apostolorum Hospital, Albano Laziale, Italy

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disease, is well accepted [ 1 - 3 ]. Fine needle aspiration (FNA) and, to a lesser extent, core needle biopsy (CNB), are currently recognized as the primary diagnostic methods for evaluating thyroid lesions, cervical lymph-node metastases and local

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Mario Rotondi Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri I.R.C.C.S., ISPESL Laboratory for Endocrine Disruptors and Chair of Endocrinology, University of Pavia, Pavia

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Maria Grazia Castagna Departments of Medical, Surgical and Neurological Sciences, Siena

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Carlo Cappelli Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy

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Cristina Ciuoli Departments of Medical, Surgical and Neurological Sciences, Siena

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Francesca Coperchini Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri I.R.C.C.S., ISPESL Laboratory for Endocrine Disruptors and Chair of Endocrinology, University of Pavia, Pavia

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Francesco Chiofalo Departments of Medical, Surgical and Neurological Sciences, Siena

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Fabio Maino Departments of Medical, Surgical and Neurological Sciences, Siena

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Paola Palmitesta Departments of Social, Political and Cognitive Sciences, University of Siena, Siena

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Luca Chiovato Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri I.R.C.C.S., ISPESL Laboratory for Endocrine Disruptors and Chair of Endocrinology, University of Pavia, Pavia

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Furio Pacini Departments of Medical, Surgical and Neurological Sciences, Siena

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subjected to fine-needle aspiration cytology (FNAC) and stratified according to their BMI. This selection approach should theoretically avoid the above-reported bias as well as the bias connected to surgical series where the criteria for surgery may not be

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Alexander Gorshtein Endocrine Institute, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

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Ilana Slutzky-Shraga Endocrine Institute, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

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Eyal Robenshtok Endocrine Institute, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

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Carlos Benbassat Endocrine Institute, Shamir Medical Center (Formerly Assaf Harofeh Medical Center), Beer Yaakov, Israel
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

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Dania Hirsch Endocrine Institute, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

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Introduction The introduction of the Bethesda System of Reporting Thyroid Cytology (BSRTC) in 2009 provided clinicians with a standardized, category-based system for reporting the results of fine-needle aspiration (FNA) of thyroid specimens

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Marko Stojanović Neuroendocrine Department, Diabetes and Metabolic Diseases, Clinical Center of Serbia
Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia

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Sandra Pekić Faculty of Medicine, University of Belgrade
Neuroendocrine Department, Diabetes and Metabolic Diseases, Clinical Center of Serbia
Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia

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Mirjana Doknić Faculty of Medicine, University of Belgrade
Neuroendocrine Department, Diabetes and Metabolic Diseases, Clinical Center of Serbia
Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia

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Dragana Miljić Faculty of Medicine, University of Belgrade
Neuroendocrine Department, Diabetes and Metabolic Diseases, Clinical Center of Serbia
Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia

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Slavica Ćirić Neuroendocrine Department, Diabetes and Metabolic Diseases, Clinical Center of Serbia
Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia

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Aleksandar Diklić Faculty of Medicine, University of Belgrade
Endocrine Surgery Department, Diabetes and Metabolic Diseases, Clinical Center of Serbia
Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia

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Svetislav Tatić Faculty of Medicine, University of Belgrade
Institute of Pathology, Clinical Center of Serbia, Belgrade, Serbia

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Miloje Joksimović Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia

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Emilija Manojlović-Gačić Faculty of Medicine, University of Belgrade
Institute of Pathology, Clinical Center of Serbia, Belgrade, Serbia

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Milica Skender-Gazibara Faculty of Medicine, University of Belgrade
Institute of Pathology, Clinical Center of Serbia, Belgrade, Serbia

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Vera Popović Faculty of Medicine, University of Belgrade
Neuroendocrine Department, Diabetes and Metabolic Diseases, Clinical Center of Serbia
Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia

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regarding the size of the thyroid nodules during previous follow-up. Fine-needle aspiration biopsy (FNAB) was previously not performed. Family history was negative for thyroid malignancy. She was diagnosed with type 2 diabetes mellitus 5 years prior to this

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Giorgio Grani Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy

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Livia Lamartina Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy

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Valeria Ramundo Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy

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Rosa Falcone Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy

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Cristiano Lomonaco Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy

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Laura Ciotti Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy

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Martina Barone Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy

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Marianna Maranghi Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy

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Vito Cantisani Diagnostic and Ultrasound Innovations Unit, Azienda Ospedaliera Universitaria Policlinico Umberto I, “Sapienza” University of Rome, Rome, Italy

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Sebastiano Filetti Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy

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

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Introduction Currently available sonographic risk stratification systems for thyroid nodules were developed to more accurately identify those for which fine-needle aspiration cytology (FNAC) can safely be deferred [ 1 - 5 ]. The likelihood

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Brigitte Decallonne Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium

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Annick Van den Bruel Department of Endocrinology, General Hospital St Jan, Bruges, Belgium

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Gilles Macq Department of Research, Belgian Cancer Registry, Brussels, Belgium

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Nathalie Elaut Department of Research, Belgian Cancer Registry, Brussels, Belgium

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Harlinde De Schutter Department of Research, Belgian Cancer Registry, Brussels, Belgium

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thyroid surgery was preceded by fine-needle aspiration (FNA), suggesting less selective surgery, and the proportion of histological thyroid cancer diagnosis after total thyroidectomy was lower. Finally, in the HIR, less thyroid cancer patients had been

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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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recurrence ( 5 ). As such, physicians managing thyroid nodules need to identify the patients with ‘clinically significant’ carcinomas without subjecting too many people to invasive procedures i.e. fine-needle aspiration (FNA) biopsies and thyroidectomies

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Pedro Marques Endocrinology Department, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal

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Valeriano Leite Endocrinology Department, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal

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Maria João Bugalho Endocrinology Department, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal

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]. Moreover, US-guided fine-needle aspiration cytology is triggering an overdiagnosis of PTC, with the associated risks and harms of overtreatment [ 1 , 2 ]. It is estimated that 49% of the rising incidence of thyroid carcinomas consist of cancers measuring 1

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Min Ren Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

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Qianlan Yao Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

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Longlong Bao Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

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Zhiting Wang Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

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Ran Wei Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

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Qianming Bai Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

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Bo Ping Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

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Cai Chang Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
Department of Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, China

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Yu Wang Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China

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Xiaoyan Zhou Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

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Xiaoli Zhu Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

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, remain limited ( 3 , 4 , 5 ). Fine-needle aspiration (FNA) followed by cytological examination is the standard diagnostic procedure for patients with suspicious thyroid ultrasound features. The diagnoses of most FNA samples are classified into

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