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Ana Isabel Álvarez-Mancha Department of Medicine, University of Malaga, Malaga, Spain
Department of Pathology, General University Hospital of Ciudad Real, Ciudad Real, Spain

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Isabel Mancha-Doblas Department of Medicine, University of Malaga, Malaga, Spain
Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain

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María Molina-Vega 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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Diego Fernández-García Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain

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Ana María Gómez-Pérez 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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Elena Gallego-Domínguez Department of Medicine, University of Malaga, Malaga, Spain
Department of Pathology, Virgen de la Victoria University Hospital, Málaga, Spain

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María Victoria Ortega-Jiménez Department of Medicine, University of Malaga, Malaga, Spain
Department of Pathology, Virgen de la Victoria University Hospital, Málaga, Spain

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Isabel Hierro-Martín Department of Pathology, Virgen de la Victoria University Hospital, Málaga, Spain

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Francisco J Tinahones Department of Medicine, University of Malaga, Malaga, Spain
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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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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procedure ( 2 , 3 , 4 ). Despite the worldwide acceptance of US in evaluating the malignancy risk of TN, recent efforts aim to standardize the procedure to further improve its performance ( 5 ). In the past decade, prominent scientific societies have

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Alessia Cozzolino Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy

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Tiziana Filardi Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy

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Ilaria Simonelli Service of Medical Statistics and Information Technology, Fatebenefratelli Foundation for Health Research and Education, Rome, Italy
Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy

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

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Camilla Virili Endocrinology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ‘Sapienza’ University of Rome, Latina, Italy

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Ilaria Stramazzo Endocrinology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ‘Sapienza’ University of Rome, Latina, Italy

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Maria Giulia Santaguida Endocrinology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ‘Sapienza’ University of Rome, Latina, Italy

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Pietro Locantore Endocrinology Unit, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

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Massimo Maurici Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy

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Daniele Gianfrilli Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy

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Andrea M Isidori Department of Experimental 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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Carlotta Pozza Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy

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on behalf of TALENT Group
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on behalf of TALENT Group

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

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M Grussendorf Department of Internal Medicine, University Hospital, Düsseldorf, Germany

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I Ruschenburg MVZ Wagnerstibbe Center for Cytology and Pathology, Einbeck, Germany

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G Brabant Department of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, UK

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age, only the risk of young patients under 30 years of age appears to be increased (ROM: 2.8%; see Table 3 ). Table 4 relates ROM to the presenting thyroid disorder. Table 2 Histological findings in patients with thyroid malignancies in

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

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

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Agnieszka Czarniecka M. Sklodowska-Curie National Research, Institute of Oncology Gliwice Branch, Gliwice, Poland

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Ralf Paschke Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

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Gilles Russ Thyroid and Endocrine Tumors Department, Pitié-Salpêtrière Hospital, Sorbonne University GRC N°16, Paris, France

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Fernando Schmitt Faculty of Medicine of University of Porto, CINTESIS@RISE and Institute of Molecular Pathology and Immunology, University of Porto (Ipatimup), Porto, Portugal

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Paula Soares Institute of Investigation and Innovation in Health (I3S), Faculty of Medicine of the University of Porto, Porto, Portugal

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Tamas Solymosi Endocrinology and Metabolism Clinic, Bugat Hospital, Gyöngyös, Hungary

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Enrico Papini Department of Endocrine and Metabolic Diseases, Regina Apostolorum Hospital, Albano, Rome, Italy

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largest diameter over 5 years: 4.9 mm (95% CI, 4.2–5.5 mm)) ( 106 ), changes in TIRADS category which qualify for further workup (rate of change over 5 years: 6.3–8.3%) ( 126 ), risk of overlooking malignancy over the next 5 years (rate: 0.6%) ( 106 ), we

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Aglaia Kyrilli Department of Endocrinology, Hôpital Universitaire de Bruxelles (H.U.B.)– Hôpital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik 808, Brussels, Belgium

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Nunzia Tacelli Department of Radiology, Hôpital Universitaire de Bruxelles (H.U.B.)– Hôpital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik 808, Brussels, Belgium

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Lucia Russo Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Via Giustiniani 2, 35128, Padova, Italy

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Laetitia Lebrun Department of Pathology, Hôpital Universitaire de Bruxelles (H.U.B.)– Hôpital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik 808, Brussels, Belgium

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Isabelle Salmon Department of Pathology, Hôpital Universitaire de Bruxelles (H.U.B.)– Hôpital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik 808, Brussels, Belgium

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Gilles Russ Thyroid and Endocrine Tumors, Institute of Endocrinology, Pitié Salpêtrière Hospital, Pierre et Marie Curie University, Paris, France

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Rodrigo Moreno-Reyes Department of Nuclear Medicine, Hôpital Universitaire de Bruxelles (H.U.B.)– Hôpital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik, Brussels, Belgium

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Bernard Corvilain Department of Endocrinology, Hôpital Universitaire de Bruxelles (H.U.B.)– Hôpital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik 808, Brussels, Belgium

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(US), the first-line tool to stratify malignancy risk of thyroid nodules, does not, unlike scintigraphy, evaluate the nodule’s functional characteristics. The utility to effectively diagnose AFTN relies on the generally admitted assumption that AFTN

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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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X Y Hu Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

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J Wu Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

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P Seal EFW Radiology, Calgary, Alberta, Canada

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S A Ghaznavi Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Department of Medicine, Section of Endocrinology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

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C Symonds Department of Medicine, Section of Endocrinology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

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S Kinnear Department of Medicine, Section of Endocrinology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

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R Paschke Department of Medicine, Section of Endocrinology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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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TUS malignancy risk assessment should be performed ( 2 , 3 ). Currently, there are multiple guidelines for the malignancy risk stratification of thyroid nodules based on TUS features, which include: the 2015 American Thyroid Association (ATA

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Ziyu Wan Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China

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Ying Li Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China

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Xiaoqian Dong Xiangya School of Nursing, Central South University, Changsha, Hunan, China

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Yue Kang Xiangya School of Nursing, Central South University, Changsha, Hunan, China

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Juan Luo Xiangya School of Nursing, Central South University, Changsha, Hunan, China

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Jiangang Wang Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China

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Pingting Yang Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China

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Yaqin Wang Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China

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Yinglong Duan Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China

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Jianfei Xie Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China

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Andy S K Cheng Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China

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providing an effective tool to investigate factors that influence their occurrence. Given the high prevalence of TNs and the potential for malignancy, it is imperative to understand the various factors that contribute to their development. This knowledge can

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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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