DOI QR코드

DOI QR Code

Ultrasound-Guided Fine Needle Aspiration of Thyroid Nodules: A Consensus Statement by the Korean Society of Thyroid Radiology

  • Lee, Young Hen (Department of Radiology, Ansan Hospital, Korea University College of Medicine) ;
  • Baek, Jung Hwan (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jung, So Lyung (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kwak, Jin Young (Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Kim, Ji-hoon (Department of Radiology, Seoul National University College of Medicine) ;
  • Shin, Jung Hee (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Korean Society of Thyroid Radiology (Korean Society of Thyroid Radiology (KSThR)) ;
  • Korean Society of Radiology (Korean Society of Radiology)
  • Received : 2014.09.16
  • Accepted : 2014.12.15
  • Published : 2015.04.01

Abstract

Ultrasound (US)-guided fine needle aspiration (US-FNA) has played a crucial role in managing patients with thyroid nodules, owing to its safety and accuracy. However, even with US guidance, nondiagnostic sampling and infrequent complications still occur after FNA. Accordingly, the Task Force on US-FNA of the Korean Society of Thyroid Radiology has provided consensus recommendations for the US-FNA technique and related issues to improve diagnostic yield. These detailed procedures are based on a comprehensive analysis of the current literature and from the consensus of experts.

Keywords

References

  1. Gharib H, Papini E, Paschke R, Duick DS, Valcavi R, Hegedus L, et al. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: executive summary of recommendations. Endocr Pract 2010;16:468-475 https://doi.org/10.4158/EP.16.3.468
  2. Berner A, Sigstad E, Pradhan M, Groholt KK, Davidson B. Fine-needle aspiration cytology of the thyroid gland: comparative analysis of experience at three hospitals. Diagn Cytopathol 2006;34:97-100 https://doi.org/10.1002/dc.20384
  3. Guth S, Theune U, Aberle J, Galach A, Bamberger CM. Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur J Clin Invest 2009;39:699-706 https://doi.org/10.1111/j.1365-2362.2009.02162.x
  4. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167-1214 https://doi.org/10.1089/thy.2009.0110
  5. Hegedus L. Clinical practice. The thyroid nodule. N Engl J Med 2004;351:1764-1771 https://doi.org/10.1056/NEJMcp031436
  6. Ali SZ. Thyroid cytopathology: Bethesda and beyond. Acta Cytol 2011;55:4-12 https://doi.org/10.1159/000322365
  7. Baloch ZW, Cibas ES, Clark DP, Layfield LJ, Ljung BM, Pitman MB, et al. The National Cancer Institute Thyroid fine needle aspiration state of the science conference: a summation. Cytojournal 2008;5:6 https://doi.org/10.1186/1742-6413-5-6
  8. Cibas ES, Alexander EK, Benson CB, de Agustin PP, Doherty GM, Faquin WC, et al. Indications for thyroid FNA and pre-FNA requirements: a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference. Diagn Cytopathol 2008;36:390-399 https://doi.org/10.1002/dc.20827
  9. Pitman MB, Abele J, Ali SZ, Duick D, Elsheikh TM, Jeffrey RB, et al. Techniques for thyroid FNA: a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference. Diagn Cytopathol 2008;36:407-424 https://doi.org/10.1002/dc.20829
  10. Danese D, Sciacchitano S, Farsetti A, Andreoli M, Pontecorvi A. Diagnostic accuracy of conventional versus sonography-guided fine-needle aspiration biopsy of thyroid nodules. Thyroid 1998;8:15-21 https://doi.org/10.1089/thy.1998.8.15
  11. Cesur M, Corapcioglu D, Bulut S, Gursoy A, Yilmaz AE, Erdogan N, et al. Comparison of palpation-guided fine-needle aspiration biopsy to ultrasound-guided fine-needle aspiration biopsy in the evaluation of thyroid nodules. Thyroid 2006;16:555-561 https://doi.org/10.1089/thy.2006.16.555
  12. Degirmenci B, Haktanir A, Albayrak R, Acar M, Sahin DA, Sahin O, et al. Sonographically guided fine-needle biopsy of thyroid nodules: the effects of nodule characteristics, sampling technique, and needle size on the adequacy of cytological material. Clin Radiol 2007;62:798-803 https://doi.org/10.1016/j.crad.2007.01.024
  13. Choi SH, Han KH, Yoon JH, Moon HJ, Son EJ, Youk JH, et al. Factors affecting inadequate sampling of ultrasound-guided fine-needle aspiration biopsy of thyroid nodules. Clin Endocrinol (Oxf) 2011;74:776-782 https://doi.org/10.1111/j.1365-2265.2011.04011.x
  14. De Fiori E, Rampinelli C, Turco F, Bonello L, Bellomi M. Role of operator experience in ultrasound-guided fine-needle aspiration biopsy of the thyroid. Radiol Med 2010;115:612-618 https://doi.org/10.1007/s11547-010-0528-x
  15. Alexander EK, Heering JP, Benson CB, Frates MC, Doubilet PM, Cibas ES, et al. Assessment of nondiagnostic ultrasound-guided fine needle aspirations of thyroid nodules. J Clin Endocrinol Metab 2002;87:4924-4927 https://doi.org/10.1210/jc.2002-020865
  16. Moon HJ, Son E, Kim EK, Yoon JH, Kwak JY. The diagnostic values of ultrasound and ultrasound-guided fine needle aspiration in subcentimeter-sized thyroid nodules. Ann Surg Oncol 2012;19:52-59 https://doi.org/10.1245/s10434-011-1813-1
  17. Mahony GT, Mahony BS. Low nondiagnostic rate for fine-needle capillary sampling biopsy of thyroid nodules: a singular experience. J Ultrasound Med 2013;32:2155-2161 https://doi.org/10.7863/ultra.32.12.2155
  18. Moon HJ, Kwak JY, Kim EK, Kim MJ. Ultrasonographic characteristics predictive of nondiagnostic results for fine-needle aspiration biopsies of thyroid nodules. Ultrasound Med Biol 2011;37:549-555 https://doi.org/10.1016/j.ultrasmedbio.2011.01.015
  19. Gursoy A, Anil C, Erismis B, Ayturk S. Fine-needle aspiration biopsy of thyroid nodules: comparison of diagnostic performance of experienced and inexperienced physicians. Endocr Pract 2010;16:986-991 https://doi.org/10.4158/EP10077.OR
  20. Wu H, Zhang B, Zang Y, Wang J, Zhu B, Cao Y, et al. Ultrasound-guided fine-needle aspiration for solid thyroid nodules larger than 10 mm: correlation between sonographic characteristics at the needle tip and nondiagnostic results. Endocrine 2014;46:272-278 https://doi.org/10.1007/s12020-013-0042-8
  21. Grani G, Calvanese A, Carbotta G, D'Alessandri M, Nesca A, Bianchini M, et al. Intrinsic factors affecting adequacy of thyroid nodule fine-needle aspiration cytology. Clin Endocrinol (Oxf) 2013;78:141-144 https://doi.org/10.1111/j.1365-2265.2012.04507.x
  22. Baier ND, Hahn PF, Gervais DA, Samir A, Halpern EF, Mueller PR, et al. Fine-needle aspiration biopsy of thyroid nodules: experience in a cohort of 944 patients. AJR Am J Roentgenol 2009;193:1175-1179 https://doi.org/10.2214/AJR.08.1840
  23. Choi YS, Hong SW, Kwak JY, Moon HJ, Kim EK. Clinical and ultrasonographic findings affecting nondiagnostic results upon the second fine needle aspiration for thyroid nodules. Ann Surg Oncol 2012;19:2304-2309 https://doi.org/10.1245/s10434-012-2288-4
  24. Chung J, Youk JH, Kim JA, Kwak JY, Kim EK, Ryu YH, et al. Initially non-diagnostic ultrasound-guided fine needle aspiration cytology of thyroid nodules: value and management. Acta Radiol 2012;53:168-173 https://doi.org/10.1258/ar.2011.110133
  25. Polyzos SA, Anastasilakis AD. Clinical complications following thyroid fine-needle biopsy: a systematic review. Clin Endocrinol (Oxf) 2009;71:157-165 https://doi.org/10.1111/j.1365-2265.2009.03522.x
  26. Borget I, Vielh P, Leboulleux S, Allyn M, Iacobelli S, Schlumberger M, et al. Assessment of the cost of fine-needle aspiration cytology as a diagnostic tool in patients with thyroid nodules. Am J Clin Pathol 2008;129:763-771 https://doi.org/10.1309/H86KM785Q9KBWPW5
  27. Kwak JY, Jung I, Baek JH, Baek SM, Choi N, Choi YJ, et al. Image reporting and characterization system for ultrasound features of thyroid nodules: multicentric Korean retrospective study. Korean J Radiol 2013;14:110-117 https://doi.org/10.3348/kjr.2013.14.1.110
  28. Hor T, Lahiri SW. Bilateral thyroid hematomas after fine-needle aspiration causing acute airway obstruction. Thyroid 2008;18:567-569 https://doi.org/10.1089/thy.2007.0363
  29. Veverkova L, Bakaj-Zbrozkova L, Hallamova L, Herman M. Computed tomography diagnosis of active bleeding into the thyroid gland. Thyroid 2013;23:1326-1328 https://doi.org/10.1089/thy.2012.0536
  30. Tsilchorozidou T, Vagropoulos I, Karagianidou C, Grigoriadis N. Huge intrathyroidal hematoma causing airway obstruction: a multidisciplinary challenge. Thyroid 2006;16:795-799 https://doi.org/10.1089/thy.2006.16.795
  31. Crockett JC. The thyroid nodule: fine-needle aspiration biopsy technique. J Ultrasound Med 2011;30:685-694 https://doi.org/10.7863/jum.2011.30.5.685
  32. Kim MJ, Kim EK, Park SI, Kim BM, Kwak JY, Kim SJ, et al. US-guided fine-needle aspiration of thyroid nodules: indications, techniques, results. Radiographics 2008;28:1869-1886; discussion 1887 https://doi.org/10.1148/rg.287085033
  33. Ferreira JS, Gil VM. Cardiovascular risk associated with interruption of antiplatelet and oral anticoagulation therapy. Rev Port Cardiol 2009;28:845-858
  34. Abu-Yousef MM, Larson JH, Kuehn DM, Wu AS, Laroia AT. Safety of ultrasound-guided fine needle aspiration biopsy of neck lesions in patients taking antithrombotic/anticoagulant medications. Ultrasound Q 2011;27:157-159 https://doi.org/10.1097/RUQ.0b013e31822b5681
  35. Rausch P, Nowels K, Jeffrey RB Jr. Ultrasonographically guided thyroid biopsy: a review with emphasis on technique. J Ultrasound Med 2001;20:79-85 https://doi.org/10.7863/jum.2001.20.1.79
  36. Zempsky WT. Pharmacologic approaches for reducing venous access pain in children. Pediatrics 2008;122 Suppl 3:S140-S153 https://doi.org/10.1542/peds.2008-1055g
  37. Kim DW, Choo HJ, Park JS, Lee EJ, Kim SH, Jung SJ, et al. Ultrasonography-guided fine-needle aspiration cytology for thyroid nodules: an emphasis on one-sampling and biopsy techniques. Diagn Cytopathol 2012;40 Suppl 1:E48-E54 https://doi.org/10.1002/dc.21669
  38. Moon WJ, Baek JH, Jung SL, Kim DW, Kim EK, Kim JY, et al. Ultrasonography and the ultrasound-based management of thyroid nodules: consensus statement and recommendations. Korean J Radiol 2011;12:1-14 https://doi.org/10.3348/kjr.2011.12.1.1
  39. Anderson TJ, Atalay MK, Grand DJ, Baird GL, Cronan JJ, Beland MD. Management of nodules with initially nondiagnostic results of thyroid fine-needle aspiration: can we avoid repeat biopsy? Radiology 2014;272:777-784 https://doi.org/10.1148/radiol.14132134
  40. Romitelli F, Di Stasio E, Santoro C, Iozzino M, Orsini A, Cesareo R. A comparative study of fine needle aspiration and fine needle non-aspiration biopsy on suspected thyroid nodules. Endocr Pathol 2009;20:108-113 https://doi.org/10.1007/s12022-009-9074-2
  41. Haddadi-Nezhad S, Larijani B, Tavangar SM, Nouraei SM. Comparison of fine-needle-nonaspiration with fine-needle-aspiration technique in the cytologic studies of thyroid nodules. Endocr Pathol 2003;14:369-373 https://doi.org/10.1385/EP:14:4:369
  42. Kamal MM, Arjune DG, Kulkarni HR. Comparative study of fine needle aspiration and fine needle capillary sampling of thyroid lesions. Acta Cytol 2002;46:30-34 https://doi.org/10.1159/000326712
  43. Tublin ME, Martin JA, Rollin LJ, Pealer K, Kurs-Lasky M, Ohori NP. Ultrasound-guided fine-needle aspiration versus fine-needle capillary sampling biopsy of thyroid nodules: does technique matter? J Ultrasound Med 2007;26:1697-1701 https://doi.org/10.7863/jum.2007.26.12.1697
  44. Kandil E, Khalek MA, Alabbas H, Moroz K, Islam T, Friedlander P, et al. Comparison of ultrasound-guided biopsy technique for thyroid nodules with respect to adequacy of cytological material. ORL J Otorhinolaryngol Relat Spec 2011;73:177-181 https://doi.org/10.1159/000323005
  45. Fadda G, Rossi ED. Liquid-based cytology in fine-needle aspiration biopsies of the thyroid gland. Acta Cytol 2011;55:389-400 https://doi.org/10.1159/000329029
  46. Chang H, Lee E, Lee H, Choi J, Kim A, Kim BH. Comparison of diagnostic values of thyroid aspiration samples using liquid-based preparation and conventional smear: one-year experience in a single institution. APMIS 2013;121:139-145 https://doi.org/10.1111/j.1600-0463.2012.02944.x
  47. Saleh H, Bassily N, Hammoud MJ. Utility of a liquid-based, monolayer preparation in the evaluation of thyroid lesions by fine needle aspiration biopsy: comparison with the conventional smear method. Acta Cytol 2009;53:130-136 https://doi.org/10.1159/000325113
  48. Ceresini G, Corcione L, Morganti S, Milli B, Bertone L, Prampolini R, et al. Ultrasound-guided fine-needle capillary biopsy of thyroid nodules, coupled with on-site cytologic review, improves results. Thyroid 2004;14:385-389 https://doi.org/10.1089/105072504774193230
  49. Redman R, Zalaznick H, Mazzaferri EL, Massoll NA. The impact of assessing specimen adequacy and number of needle passes for fine-needle aspiration biopsy of thyroid nodules. Thyroid 2006;16:55-60 https://doi.org/10.1089/thy.2006.16.55
  50. Witt BL, Schmidt RL. Rapid onsite evaluation improves the adequacy of fine-needle aspiration for thyroid lesions: a systematic review and meta-analysis. Thyroid 2013;23:428-435 https://doi.org/10.1089/thy.2012.0211
  51. Ghofrani M, Beckman D, Rimm DL. The value of onsite adequacy assessment of thyroid fine-needle aspirations is a function of operator experience. Cancer 2006;108:110-113 https://doi.org/10.1002/cncr.21715
  52. O'Malley ME, Weir MM, Hahn PF, Misdraji J, Wood BJ, Mueller PR. US-guided fine-needle aspiration biopsy of thyroid nodules: adequacy of cytologic material and procedure time with and without immediate cytologic analysis. Radiology 2002;222:383-387 https://doi.org/10.1148/radiol.2222010201
  53. Zanocco K, Pitelka-Zengou L, Dalal S, Elaraj D, Nayar R, Sturgeon C. Routine on-site evaluation of specimen adequacy during initial ultrasound-guided fine needle aspiration of thyroid nodules: a cost-effectiveness analysis. Ann Surg Oncol 2013;20:2462-2467 https://doi.org/10.1245/s10434-013-2954-1
  54. Anastasilakis AD, Polyzos SA, Nikolopoulos P. Subendothelial carotid hematoma after fine-needle aspiration biopsy of a solitary thyroid nodule. J Ultrasound Med 2008;27:1517-1520 https://doi.org/10.7863/jum.2008.27.10.1517
  55. Sidiropoulos N, Dumont LJ, Golding AC, Quinlisk FL, Gonzalez JL, Padmanabhan V. Quality improvement by standardization of procurement and processing of thyroid fine-needle aspirates in the absence of on-site cytological evaluation. Thyroid 2009;19:1049-1052 https://doi.org/10.1089/thy.2009.0161
  56. Ljung BM, Langer J, Mazzaferri EL, Oertel YC, Wells SA, Waisman J. Training, credentialing and re-credentialing for the performance of a thyroid FNA: a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference. Diagn Cytopathol 2008;36:400-406 https://doi.org/10.1002/dc.20828
  57. Layfield LJ, Abrams J, Cochand-Priollet B, Evans D, Gharib H, Greenspan F, et al. Post-thyroid FNA testing and treatment options: a synopsis of the National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Diagn Cytopathol 2008;36:442-448 https://doi.org/10.1002/dc.20832
  58. Lee HY, Baek JH, Yoo H, Kim JK, Lim MK, Chu YC, et al. Repeat Fine-Needle Aspiration Biopsy within a Short Interval Does Not Increase the Atypical Cytologic Results for Thyroid Nodules with Previously Nondiagnostic Results. Acta Cytol 2014;58:330-334 https://doi.org/10.1159/000363277
  59. Lubitz CC, Nagarkatti SS, Faquin WC, Samir AE, Hassan MC, Barbesino G, et al. Diagnostic yield of nondiagnostic thyroid nodules is not altered by timing of repeat biopsy. Thyroid 2012;22:590-594 https://doi.org/10.1089/thy.2011.0442
  60. Yeon JS, Baek JH, Lim HK, Ha EJ, Kim JK, Song DE, et al. Thyroid nodules with initially nondiagnostic cytologic results: the role of core-needle biopsy. Radiology 2013;268:274-280 https://doi.org/10.1148/radiol.13122247
  61. Na DG, Kim JH, Sung JY, Baek JH, Jung KC, Lee H, et al. Core-needle biopsy is more useful than repeat fine-needle aspiration in thyroid nodules read as nondiagnostic or atypia of undetermined significance by the Bethesda system for reporting thyroid cytopathology. Thyroid 2012;22:468-475 https://doi.org/10.1089/thy.2011.0185
  62. Lee MJ, Kim EK, Kwak JY, Kim MJ. Partially cystic thyroid nodules on ultrasound: probability of malignancy and sonographic differentiation. Thyroid 2009;19:341-346 https://doi.org/10.1089/thy.2008.0250
  63. Park JM, Choi Y, Kwag HJ. Partially cystic thyroid nodules: ultrasound findings of malignancy. Korean J Radiol 2012;13:530-535 https://doi.org/10.3348/kjr.2012.13.5.530
  64. Park YJ, Kim JA, Son EJ, Youk JH, Kim EK, Kwak JY, et al. Thyroid nodules with macrocalcification: sonographic findings predictive of malignancy. Yonsei Med J 2014;55:339-344 https://doi.org/10.3349/ymj.2014.55.2.339
  65. Beland MD, Anderson TJ, Atalay MK, Grand DJ, Cronan JJ. Resident experience increases diagnostic rate of thyroid fine-needle aspiration biopsies. Acad Radiol 2014;21:1490-1494 https://doi.org/10.1016/j.acra.2014.06.006

Cited by

  1. Web-Based Malignancy Risk Estimation for Thyroid Nodules Using Ultrasonography Characteristics: Development and Validation of a Predictive Model vol.25, pp.12, 2015, https://doi.org/10.1089/thy.2015.0188
  2. Radiofrequency versus Ethanol Ablation for Treating Predominantly Cystic Thyroid Nodules: A Randomized Clinical Trial vol.16, pp.6, 2015, https://doi.org/10.3348/kjr.2015.16.6.1332
  3. Reply: vol.36, pp.9, 2015, https://doi.org/10.3174/ajnr.a4479
  4. Bedside ultrasound procedures: musculoskeletal and non-musculoskeletal vol.42, pp.2, 2016, https://doi.org/10.1007/s00068-015-0539-3
  5. The role of core-needle biopsy in the diagnosis of thyroid malignancy in 4580 patients with 4746 thyroid nodules: a systematic review and meta-analysis vol.54, pp.2, 2016, https://doi.org/10.1007/s12020-016-0991-9
  6. The Role of Core-Needle Biopsy as a First-Line Diagnostic Tool for Initially Detected Thyroid Nodules vol.26, pp.3, 2015, https://doi.org/10.1089/thy.2015.0404
  7. Feasibility Study of a Contrast-Enhanced Multi-Detector CT (64 Channels) Protocol for Papillary Thyroid Carcinoma: The Influence of Different Scan Delays on Tumor Conspicuity vol.26, pp.5, 2016, https://doi.org/10.1089/thy.2015.0415
  8. Thyroid Imaging Reporting and Data System Risk Stratification of Thyroid Nodules: Categorization Based on Solidity and Echogenicity vol.26, pp.4, 2016, https://doi.org/10.1089/thy.2015.0460
  9. Efficacy and Safety of Radiofrequency and Ethanol Ablation for Treating Locally Recurrent Thyroid Cancer: A Systematic Review and Meta-Analysis vol.26, pp.3, 2015, https://doi.org/10.1089/thy.2015.0545
  10. Subcategorization of Bethesda System Category III by Ultrasonography vol.26, pp.6, 2015, https://doi.org/10.1089/thy.2015.0637
  11. Does Immunosuppressive Therapy Improve Outcomes in Graves' Disease? A Systematic Review and Meta-Analysis vol.26, pp.5, 2016, https://doi.org/10.1089/thy.2015.0647
  12. A Multicenter Prospective Validation Study for the Korean Thyroid Imaging Reporting and Data System in Patients with Thyroid Nodules vol.17, pp.5, 2015, https://doi.org/10.3348/kjr.2016.17.5.811
  13. Diagnosis of Metastasis to the Thyroid Gland : Comparison of Core-Needle Biopsy and Fine-Needle Aspiration vol.154, pp.4, 2015, https://doi.org/10.1177/0194599816629632
  14. Thyroid nodules with minimal cystic changes have a low risk of malignancy vol.35, pp.2, 2016, https://doi.org/10.14366/usg.15070
  15. Thyroid nodules with isolated macrocalcification: malignancy risk and diagnostic efficacy of fine-needle aspiration and core needle biopsy vol.35, pp.3, 2015, https://doi.org/10.14366/usg.15074
  16. The impact of presence of Hashimoto's thyroiditis on diagnostic accuracy of ultrasound‐guided fine‐needle aspiration biopsy in subcentimeter thyroid nodules: A retrospective study from F vol.6, pp.5, 2015, https://doi.org/10.1002/cam4.997
  17. Radiofrequency ablation of low-risk small papillary thyroidcarcinoma: preliminary results for patients ineligible for surgery vol.33, pp.2, 2015, https://doi.org/10.1080/02656736.2016.1230893
  18. A Computer-Aided Diagnosis System Using Artificial Intelligence for the Diagnosis and Characterization of Thyroid Nodules on Ultrasound: Initial Clinical Assessment vol.27, pp.4, 2015, https://doi.org/10.1089/thy.2016.0372
  19. Ultrasound-Pathology Discordant Nodules on Core-Needle Biopsy: Malignancy Risk and Management Strategy vol.27, pp.5, 2015, https://doi.org/10.1089/thy.2016.0462
  20. Cytology-Ultrasonography Risk-Stratification Scoring System Based on Fine-Needle Aspiration Cytology and the Korean-Thyroid Imaging Reporting and Data System vol.27, pp.7, 2015, https://doi.org/10.1089/thy.2016.0603
  21. Comparison of Core-Needle Biopsy and Fine-Needle Aspiration for Evaluating Thyroid Incidentalomas Detected by 18 F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography: A Pr vol.27, pp.10, 2017, https://doi.org/10.1089/thy.2017.0192
  22. Core Needle Biopsy of the Thyroid: 2016 Consensus Statement and Recommendations from Korean Society of Thyroid Radiology vol.18, pp.1, 2017, https://doi.org/10.3348/kjr.2017.18.1.217
  23. Innovative Techniques for Image-Guided Ablation of Benign Thyroid Nodules: Combined Ethanol and Radiofrequency Ablation vol.18, pp.3, 2015, https://doi.org/10.3348/kjr.2017.18.3.461
  24. Thyroid Radiofrequency Ablation: Updates on Innovative Devices and Techniques vol.18, pp.4, 2015, https://doi.org/10.3348/kjr.2017.18.4.615
  25. Virtual Touch Tissue Imaging and Quantification in the Evaluation of Thyroid Nodules : Virtual Touch Tissue Imaging and Quantification of Thyroid Nodules vol.36, pp.2, 2015, https://doi.org/10.7863/ultra.15.12070
  26. Follicular variant of papillary thyroid carcinoma: comparison of ultrasound‐guided core needle biopsy and ultrasound‐guided fine needle aspiration in a multicentre study vol.86, pp.1, 2015, https://doi.org/10.1111/cen.13144
  27. Core‐needle biopsy versus repeat fine‐needle aspiration for thyroid nodules initially read as atypia/follicular lesion of undetermined significance vol.39, pp.2, 2015, https://doi.org/10.1002/hed.24597
  28. Determination of the ideal sampling technique to reduce repeated procedures:a comparative study including 393 fine-needle aspirations for thyroid nodules vol.47, pp.1, 2015, https://doi.org/10.3906/sag-1601-61
  29. The Role of Core Needle Biopsy for Thyroid Nodules with Initially Indeterminate Results on Previous Fine-Needle Aspiration: A Systematic Review and Meta-Analysis vol.38, pp.7, 2015, https://doi.org/10.3174/ajnr.a5182
  30. Metastatic renal cell carcinoma in the thyroid gland: ultrasonographic features and the diagnostic role of core needle biopsy vol.36, pp.3, 2017, https://doi.org/10.14366/usg.16037
  31. Efficacy and safety of core-needle biopsy in initially detected thyroid nodules via propensity score analysis vol.7, pp.None, 2017, https://doi.org/10.1038/s41598-017-07924-z
  32. The role of core needle biopsy in the diagnosis of initially detected thyroid nodules: a systematic review and meta-analysis vol.28, pp.11, 2018, https://doi.org/10.1007/s00330-018-5494-z
  33. Assessment of pain score and specimen adequacy for ultrasound-guided fine-needle aspiration biopsy of thyroid nodules vol.11, pp.None, 2018, https://doi.org/10.2147/jpr.s148088
  34. Ultrasonographic Interval Changes in Solid Thyroid Nodules after Ultrasonography-Guided Fine-Needle Aspiration vol.19, pp.1, 2015, https://doi.org/10.3348/kjr.2018.19.1.158
  35. Efficacy and Safety of Radiofrequency Ablation for Benign Thyroid Nodules: A Prospective Multicenter Study vol.19, pp.1, 2015, https://doi.org/10.3348/kjr.2018.19.1.167
  36. Impact of Nodule Size on Malignancy Risk Differs according to the Ultrasonography Pattern of Thyroid Nodules vol.19, pp.3, 2018, https://doi.org/10.3348/kjr.2018.19.3.534
  37. Primary Imaging Test and Appropriate Biopsy Methods for Thyroid Nodules: Guidelines by Korean Society of Radiology and National Evidence-Based Healthcare Collaborating Agency vol.19, pp.4, 2018, https://doi.org/10.3348/kjr.2018.19.4.623
  38. A Comparison of Ultrasound-Guided Fine Needle Aspiration versus Core Needle Biopsy for Thyroid Nodules: Pain, Tolerability, and Complications vol.33, pp.1, 2015, https://doi.org/10.3803/enm.2018.33.1.114
  39. Comparison of diagnostic values between ultrasound elastography and ultrasound-guided thyroid nodular puncture in thyroid nodules vol.16, pp.4, 2018, https://doi.org/10.3892/ol.2018.9257
  40. Trucut/Core Biopsy versus FNAC: Who Wins the Match? Thyroid Lesions and Salivary Gland Lesions: An Overview vol.35, pp.3, 2015, https://doi.org/10.4103/joc.joc_18_18
  41. Sonographic Criteria Predictive of Malignant Thyroid Nodules : Which Lesions Should be Biopsied? vol.25, pp.2, 2015, https://doi.org/10.1016/j.acra.2017.09.006
  42. Contributory Factors to Hemorrhage After Ultrasound-Guided Fine Needle Aspiration of Thyroid Nodules with an Emphasis on Patients Taking Antithrombotic or Anticoagulant Medications vol.15, pp.2, 2018, https://doi.org/10.5812/iranjradiol.57231
  43. Factors influencing the outcome from ultrasonography-guided fine-needle aspiration of benign thyroid cysts and partially cystic thyroid nodules: A multicenter study vol.43, pp.2, 2015, https://doi.org/10.1080/07435800.2017.1381973
  44. Role of core needle biopsy as a first-line diagnostic tool for thyroid nodules: a retrospective cohort study vol.37, pp.3, 2015, https://doi.org/10.14366/usg.17041
  45. Core needle biopsy of thyroid nodules: outcomes and safety from a large single-center single-operator study vol.59, pp.8, 2015, https://doi.org/10.1177/0284185117741916
  46. Web‐based thyroid imaging reporting and data system: Malignancy risk of atypia of undetermined significance or follicular lesion of undetermined significance thyroid nodules calculated by a comb vol.40, pp.9, 2015, https://doi.org/10.1002/hed.25173
  47. So wird die Feinnadelpunktion der Schilddrüse in Österreich durchgeführt - die Ergebnisse einer landesweiten Umfrage vol.11, pp.3, 2015, https://doi.org/10.1007/s41969-018-0036-5
  48. Value of CT added to ultrasonography for the diagnosis of lymph node metastasis in patients with thyroid cancer vol.40, pp.10, 2015, https://doi.org/10.1002/hed.25202
  49. PREDICTION OF NONDIAGNOSTIC RESULTS IN FINE-NEEDLE ASPIRATION OF THYROID NODULES: UTILITY OF ON-SITE GROSS VISUAL ASSESSMENT OF SPECIMENS FOR LIQUID-BASED CYTOLOGY vol.24, pp.10, 2015, https://doi.org/10.4158/ep-2018-0183
  50. Updates on the pathogenesis of advanced lung cancer‐induced cachexia vol.10, pp.1, 2015, https://doi.org/10.1111/1759-7714.12910
  51. Technical Report: A Cost-Effective, Easily Available Tofu Model for Training Residents in Ultrasound-Guided Fine Needle Thyroid Nodule Targeting Punctures vol.20, pp.1, 2015, https://doi.org/10.3348/kjr.2017.0772
  52. False negative rate of fine‐needle aspiration in thyroid nodules: impact of nodule size and ultrasound pattern vol.41, pp.4, 2015, https://doi.org/10.1002/hed.25530
  53. Diagnostic Performance of Practice Guidelines for Thyroid Nodules: Thyroid Nodule Size versus Biopsy Rates vol.291, pp.1, 2015, https://doi.org/10.1148/radiol.2019181723
  54. Ethanol ablation as a treatment strategy for benign cystic thyroid nodules: a comparison of the ethanol retention and aspiration techniques vol.38, pp.2, 2015, https://doi.org/10.14366/usg.18033
  55. Risk of Malignancy According to the Sub-classification of Atypia of Undetermined Significance and Suspicious Follicular Neoplasm Categories in Thyroid Core Needle Biopsies vol.30, pp.2, 2015, https://doi.org/10.1007/s12022-019-9577-4
  56. Validation of web‐based thyroid imaging reporting and data system in atypia or follicular lesion of undetermined significance thyroid nodules vol.41, pp.7, 2015, https://doi.org/10.1002/hed.25677
  57. Clinical practice guidelines on ultrasound-guided fine needle aspiration biopsy of thyroid nodules: a critical appraisal using AGREE II vol.65, pp.2, 2015, https://doi.org/10.1007/s12020-019-01898-w
  58. Changes in the Diagnostic Efficiency of Thyroid Fine-Needle Aspiration Biopsy during the Era of Increased Thyroid Cancer Screening in Korea vol.51, pp.4, 2019, https://doi.org/10.4143/crt.2018.534
  59. Could Serum TSH Levels Predict Malignancy in Euthyroid Patients Affected by Thyroid Nodules with Indeterminate Cytology? vol.2020, pp.None, 2015, https://doi.org/10.1155/2020/7543930
  60. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults : vol.271, pp.3, 2015, https://doi.org/10.1097/sla.0000000000003580
  61. CT features of thyroid nodules with isolated macrocalcifications detected by ultrasonography vol.39, pp.2, 2015, https://doi.org/10.14366/usg.19045
  62. The relationship of thyroid nodule size on malignancy risk according to histological type of thyroid cancer vol.61, pp.5, 2015, https://doi.org/10.1177/0284185119875642
  63. Thyroid Radiology Practice: Diagnosis and Interventional Treatment of Patients with Thyroid Nodules vol.81, pp.3, 2015, https://doi.org/10.3348/jksr.2020.81.3.530
  64. Diagnostic Efficacy and Safety of Core Needle Biopsy as a First-Line Diagnostic Method for Thyroid Nodules: A Prospective Cohort Study vol.30, pp.8, 2015, https://doi.org/10.1089/thy.2019.0444
  65. Thyroid fine needle aspiration biopsy: The effect of radiological features of nodules on cytological adequacy vol.4, pp.9, 2020, https://doi.org/10.28982/josam.792221
  66. Clinical applications of Doppler ultrasonography for thyroid disease: consensus statement by the Korean Society of Thyroid Radiology vol.39, pp.4, 2015, https://doi.org/10.14366/usg.20072
  67. Ultrasound-Guided Thyroid Fine Needle Aspiration Biopsy: Basic Techniques for Clinicians vol.5, pp.2, 2015, https://doi.org/10.18525/cu.2020.5.2.42
  68. Roles of contrast-enhanced ultrasonography in identifying volume change of benign thyroid nodule and optical time of secondary radiofrequency ablation vol.20, pp.1, 2015, https://doi.org/10.1186/s12880-020-00476-1
  69. Percutaneous Ultrasound-Guided Fine-Needle Aspiration Cytology and Core-Needle Biopsy for Laryngeal and Hypopharyngeal Masses vol.22, pp.4, 2021, https://doi.org/10.3348/kjr.2020.0396
  70. Introducing “Recommendation and Guideline” of the Korean Journal of Radiology vol.22, pp.12, 2015, https://doi.org/10.3348/kjr.2021.0785
  71. Whirling technique for thyroid fine needle aspiration biopsy: a preliminary study of effectiveness and safety vol.40, pp.1, 2015, https://doi.org/10.14366/usg.20031
  72. Diagnostic performance of core needle biopsy as a first‐line diagnostic tool for thyroid nodules according to ultrasound patterns: Comparison with fine needle aspiration using propensity score m vol.94, pp.3, 2015, https://doi.org/10.1111/cen.14321
  73. Ultrasound Guided Thyroid Biopsy vol.24, pp.3, 2015, https://doi.org/10.1016/j.tvir.2021.100768
  74. Effect of needle gauge on thyroid FNA diagnostic rate vol.74, pp.3, 2015, https://doi.org/10.1007/s12020-021-02797-9