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Bülent Öcal Department of Otolaryngology, Ministry of Health Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey

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Mehmet Hakan Korkmaz Department of Otolaryngology, Yıldırım Beyazıt University Medical School, Ankara, Turkey

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Demet Yılmazer Department of Pathology, Ministry of Health Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey

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Tuğba Taşkın Türkmenoğlu Department of Pathology, Ministry of Health Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey

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Ömer Bayır Department of Otolaryngology, Ministry of Health Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey

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Güleser Saylam Department of Otolaryngology, Ministry of Health Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey

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Emel Çadallı Tatar Department of Otolaryngology, Ministry of Health Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey

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Sevilay Karahan Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey

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Erman Çakal Department of Endocrinology, Ministry of Health Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey

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Introduction The estimated prevalence of thyroid nodules in an adult population is 4–7% by palpation and 10–41% by ultrasound (US) scanning [ 1 , 2 ]. The overall malignancy risk, regardless of nodule size, is < 10%, and even smaller nodules

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

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Steen J. Bonnema Department of Endocrinology, Odense University Hospital, Odense, Denmark

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Murat Faik Erdogan Department of Endocrinology and Metabolism, University of Ankara School of Medicine, İbni Sina Hastanesi, Ankara, Turkey

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Cosimo Durante Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy

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Rose Ngu Head Neck and Thyroid Imaging, Department of Radiology, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, United Kingdom

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Laurence Leenhardt Thyroid and Endocrine Tumors, Institute of Endocrinology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, Paris, France

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clinical parameters, indications for FNA should be based on ultrasonographic malignancy risk stratification alongside clinical risk factors. Accuracy of Thyroid Ultrasound Features Certain features of thyroid nodules on ultrasound (US) are

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Signe Buhl Gram Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark

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Jacob Høygaard Rasmussen Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark

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Ulla Feldt-Rasmussen Department of Medical Endocrinology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark

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Jens Bentzen Department of Oncology, Herlev Hospital, Copenhagen University, Copenhagen, Denmark

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Giedrius Lelkaitis Department of Pathology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark

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Christian von Buchwald Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark

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Christoffer Holst Hahn Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark

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diagnosis [ 6 - 8 ]. Another diagnostic problem concerns patients with thyrotoxicosis or multinodular goitre without a cold nodule by scintigraphy, in which case FNA is not performed due to low risk of malignancy or because the patient will be referred to

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Catherine Brophy Departments of Otolaryngology - Head and Neck Surgery, Cork, Ireland

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Rania Mehanna Departments of Otolaryngology - Head and Neck Surgery, Cork, Ireland

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Julie McCarthy Departments of Cytopathology, Cork University Hospital, Cork, Ireland

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Antoinette Tuthill Departments of Endocrinology, Cork University Hospital, Cork, Ireland

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Matthew S. Murphy Departments of Endocrinology, South Infirmary Victoria University Hospital, Cork, Ireland

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Patrick Sheahan Departments of Otolaryngology - Head and Neck Surgery, Cork, Ireland

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clinically apparent thyroid nodules is between 5 and 15% [ 2 ]. Fine-needle aspiration (FNA) cytology has demonstrated high utility in the diagnosis of thyroid nodules. In an effort to stratify thyroid nodules according to risk of malignancy in a consistent

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Aly Bernard Khalil Imperial College London Diabetes Center, Abu Dhabi, United Arab Emirates

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Roberto Dina Hammersmith Hospital, London, United Kingdom

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Karim Meeran Hammersmith Hospital, London, United Kingdom

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Ali M. Bakir Imperial College London Diabetes Center, Abu Dhabi, United Arab Emirates

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Saf Naqvi Imperial College London Diabetes Center, Abu Dhabi, United Arab Emirates

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Alia Al Tikritti Imperial College London Diabetes Center, Abu Dhabi, United Arab Emirates

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Nader Lessan Imperial College London Diabetes Center, Abu Dhabi, United Arab Emirates

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Maha T. Barakat Imperial College London Diabetes Center, Abu Dhabi, United Arab Emirates

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” diagnosis or Thy3 [ 8 , 9 ]. The reported risk of malignancy in this group is variable among different centers, ranging from 6 to 48% [ 10 ]. In this regard, the role of ultrasound has emerged as a practical and accurate tool in the risk stratification of

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Diana Borges Duarte Division of Endocrinology, Centro Hospitalar e Universitário do Porto, Porto, Portugal

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Vânia Benido Silva Division of Endocrinology, Centro Hospitalar e Universitário do Porto, Porto, Portugal

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Guilherme Assunção Division of Endocrinology, Centro Hospitalar e Universitário do Porto, Porto, Portugal

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André Couto Carvalho Division of Endocrinology, Centro Hospitalar e Universitário do Porto, Porto, Portugal

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Cláudia Freitas Division of Endocrinology, Centro Hospitalar e Universitário do Porto, Porto, Portugal

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years, thyroid cancer has an excellent prognosis with a 5-year disease-specific survival rate of over 95% ( 2 ). Increased risk of non-thyroidal second primary malignancy (NTSPM) in DTC patients has been reported in several cancer epidemiological and

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Gilles Russ Thyroid and Endocrine Tumor Unit, Department of Nuclear Medicine, Pitié Salpêtrière Hospital, University Pierre et Marie Curie, Paris, France

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Sophie Leboulleux Department of Nuclear Medicine and Endocrine Oncology, Institut Gustave Roussy, University Paris-Sud, Villejuif, France

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Laurence Leenhardt Thyroid and Endocrine Tumor Unit, Department of Nuclear Medicine, Pitié Salpêtrière Hospital, University Pierre et Marie Curie, Paris, France

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

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between 1995 and 2005 increased more than threefold, and the number of MRIs more than doubled [ 13 ]. It follows, not surprisingly, that the number of FNAs has also increased correspondingly [ 13 ]. Risk of Malignancy according to the Way of

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Berna Evranos Ogmen Department of Endocrinology and Metabolism, Ankara Bilkent City Hospital, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey

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Cevdet Aydin Department of Endocrinology and Metabolism, Ankara Bilkent City Hospital, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey

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Ibrahim Kilinc Department of General Surgery, Ankara Bilkent City Hospital, Ankara, Turkey

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Aysegul Aksoy Altinboga Department of Pathology, Ankara Bilkent City Hospital, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey

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Reyhan Ersoy Department of Endocrinology and Metabolism, Ankara Bilkent City Hospital, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey

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Bekir Cakir Department of Endocrinology and Metabolism, Ankara Bilkent City Hospital, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey

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undetermined significance (AUS/FLUS), follicular neoplasm/suspicion of follicular neoplasm (FN/SFN), suspicion of malignancy (SFM), and malignant, respectively. A malignancy risk is assigned to each category to guide appropriate clinical management. In a

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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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