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Department of Pathology, General University Hospital of Ciudad Real, Ciudad Real, Spain
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Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain
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The Biomedical Research Institute of Malaga and Platform in Nanomedicine (IBIMA-BIONAND Platform), University of Malaga, Malaga, Spain
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The Biomedical Research Institute of Malaga and Platform in Nanomedicine (IBIMA-BIONAND Platform), University of Malaga, Malaga, Spain
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Department of Pathology, Virgen de la Victoria University Hospital, Málaga, Spain
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Department of Pathology, Virgen de la Victoria University Hospital, Málaga, Spain
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Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain
The Biomedical Research Institute of Malaga and Platform in Nanomedicine (IBIMA-BIONAND Platform), University of Malaga, Malaga, Spain
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, 6 , 7 , 8 , 9 ). A cytological diagnosis carries a certain risk of malignancy (ROM), which has implications for clinical recommendations. While FNA is an efficient and cost-effective diagnostic procedure, it is important to note that histological
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Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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observational studies, mostly retrospective, have been conducted to identify the US features associated with the risk of malignancy in pediatric thyroid nodules. In 2016, they have been summarized in a meta-analysis reporting that the presence of internal
Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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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
Servizio di Endocrinologia e Diabetologia, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
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University of Latvia, Faculty of Medicine, Riga, Latvia
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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
Medical School, University of Milan, Milan, Italy
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Division of Diabetes, Endocrinology & Gastroenterology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Department of Endocrinology and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
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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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, 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
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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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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-thyroidal extension. CNB, core-needle biopsy; FNA, fine-needle aspiration; ROM, risk of malignancy; US, ultrasound. Table 1 Summary of recommendations. a Initial evaluation Initial evaluation should include personal and family
Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Taiwan
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Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Departments of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Taiwan
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Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Taiwan
Department of Radiology, Jen-Ai Hospital, Dali Branch, Taichung, Taiwan
School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung City, Taiwan
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. Previous studies have reported a consecutive AUS/FLUS diagnosis in 38.5% of patients, while 42.7–63.5% of repeat FNACs were found to be benign ( 13 , 17 ). The risk of malignancy (ROM) in thyroid nodules classified as Bethesda III (AUS/FLUS) is 10
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Department of Medicine, Section of Endocrinology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Departments of Medicine, Oncology, Pathology and Laboratory Medicine, Biochemistry and Molecular Biology, and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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that when a thyroid nodule FNA result is indeterminate, the ATA and ACR-TIRADS risk classification of the nodule can be very useful in estimating the risk of malignancy ( 10 , 11 , 12 , 13 ). Depending on the Bethesda category of the nodule, the