Ultrasonography in Diagnosis and Management of Thyroid Cancer: Current International Recommendations

  • Dong Gyu Na
  • Ji-hoon Kim
  • Eun Ju Ha


The rate of detection of thyroid carcinoma has increased with the widespread use of ultrasonography (US). The role of US has become increasingly important for assessing malignancy risk, fine-needle aspiration (FNA) decision, and management decision after FNA in patients with thyroid nodules. US also has an important role in preoperative staging and postoperative surveillance in patients with thyroid cancer. Many international society guidelines have been recently updated for a more personalized management strategy. Most international society guidelines propose risk stratification systems based on US patterns of thyroid nodules. Although they have similar US criteria and size cutoff for FNA, there are some differences in the sensitivity and specificity of FNA criteria for the diagnosis of thyroid cancer. The clinically feasible and accurate US risk stratification system needs to be standardized in the future. Most current international guidelines suggest more potentiated roles of US in the management of thyroid nodules after FNA, and agree that US has an essential role in preoperative staging and postoperative surveillance in patients with thyroid cancer.


Ultrasonography Thyroid gland Thyroid neoplasms Thyroid nodule Lymph nodes lymphatic metastasis classification Practice guidelines as topic Biopsy Fine-needle Biopsy Large-core needle 


  1. 1.
    Vaccarella S, Dal Maso L, Laversanne M, Bray F, Plummer M, Franceschi S. The impact of diagnostic changes on the rise in thyroid cancer incidence: a population-based study in selected high-resource countries. Thyroid. 2015;25:1127–36. Scholar
  2. 2.
    Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1–133. Scholar
  3. 3.
    Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedus L, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical Guidelines for clinical practice for the diagnosis and management of thyroid nodules--2016 update. Endocr Pract. 2016;22(5):622–39. Scholar
  4. 4.
    Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G, et al. Guidelines for the management of thyroid cancer. Clin Endocrinol. 2014;81(Suppl 1):1–122. Scholar
  5. 5.
    Mitchell AL, Gandhi A, Scott-Coombes D, Perros P. Management of thyroid cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(S2):S150–60. Scholar
  6. 6.
    National Comprehensive Cancer Network. 2014 Practice Guidelines in Oncology-Thyroid Carcinoma v.2. Accessed 18 May 2015.
  7. 7.
    Yi KH, Lee EK, Kang HC, Koh Y, Kim SW, Kim IJ, et al. 2016 revised Korean thyroid association management guidelines for patients with thyroid nodules and thyroid cancer. Int J Thyroidol. 2016;9:59–126. Scholar
  8. 8.
    Shin JH, Baek JH, Chung J, Ha EJ, Kim JH, Lee YH, et al. Ultrasonography diagnosis and imaging-based management of thyroid nodules: revised Korean Society of Thyroid Radiology Consensus Statement and Recommendations. Korean J Radiol. 2016;17(3):370–95. Scholar
  9. 9.
    Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, Teefey SA, et al. ACR thyroid imaging, reporting and data system (TI-RADS): white paper of the ACR TI-RADS Committee. J Am Coll Radiol. 2017;14(5):587–95. Scholar
  10. 10.
    Russ G, Bonnema SJ, Erdogan MF, Durante C, Ngu R, Leenhardt L. European Thyroid Association Guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: the EU-TIRADS. Eur Thyroid J. 2017;6:225–37. Scholar
  11. 11.
    Brito JP, Gionfriddo MR, Al Nofal A, Boehmer KR, Leppin AL, Reading C, et al. The accuracy of thyroid nodule ultrasound to predict thyroid cancer: systematic review and meta-analysis. J Clin Endocrinol Metab. 2014;99(4):1253–63. Scholar
  12. 12.
    Campanella P, Ianni F, Rota CA, Corsello SM, Pontecorvi A. Quantification of cancer risk of each clinical and ultrasonographic suspicious feature of thyroid nodules: a systematic review and meta-analysis. Eur J Endocrinol. 2014;170(5):R203–11. Scholar
  13. 13.
    Remonti LR, Kramer CK, Leitao CB, Pinto LC, Gross JL. Thyroid ultrasound features and risk of carcinoma: a systematic review and meta-analysis of observational studies. Thyroid. 2015;25(5):538–50. Scholar
  14. 14.
    Moon WJ, Jung SL, Lee JH, Na DG, Baek JH, Lee YH, et al. Benign and malignant thyroid nodules: US differentiation--multicenter retrospective study. Radiology. 2008;247(3):762–70. Scholar
  15. 15.
    Ha EJ, Moon WJ, Na DG, Lee YH, Choi N, Kim SJ, et al. A multicenter prospective validation study for the Korean Thyroid Imaging Reporting and Data System in patients with thyroid nodules. Korean J Radiol. 2016;17(5):811–21. Scholar
  16. 16.
    Na DG, Baek JH, Sung JY, Kim JH, Kim JK, Choi YJ, et al. Thyroid imaging reporting and data system risk stratification of thyroid nodules: categorization based on solidity and echogenicity. Thyroid. 2016;26(4):562–72. Scholar
  17. 17.
    Middleton WD, Teefey SA, Reading CC, Langer JE, Beland MD, Szabunio MM, Desser TS. Multiinstitutional analysis of thyroid nodule risk stratification using the American College of Radiology Thyroid Imaging Reporting and Data System. AJR Am J Roentgenol. 2017;12:1–11. Scholar
  18. 18.
    Andrioli M, Carzaniga C, Persani L. Standardized ultrasound report for thyroid nodules: the Endocrinologist’s viewpoint. Eur Thyroid J. 2013;2(1):37–48. Scholar
  19. 19.
    Su HK, Dos Reis LL, Lupo MA, Milas M, Orloff LA, Langer JE, et al. Striving toward standardization of reporting of ultrasound features of thyroid nodules and lymph nodes: a multidisciplinary consensus statement. Thyroid. 2014;24(9):1341–9. Scholar
  20. 20.
    Grant EG, Tessler FN, Hoang JK, Langer JE, Beland MD, Berland LL, et al. Thyroid ultrasound reporting lexicon: white paper of the ACR thyroid imaging, reporting and data system (TIRADS) Committee. J Am Coll Radiol. 2015;12(12 Pt A):1272–9. Scholar
  21. 21.
    Moon HJ, Kwak JY, Kim EK, Kim MJ. A taller-than-wide shape in thyroid nodules in transverse and longitudinal ultrasonographic planes and the prediction of malignancy. Thyroid. 2011;21(11):1249–53. Scholar
  22. 22.
    Beland MD, Kwon L, Delellis RA, Cronan JJ, Grant EG. Nonshadowing echogenic foci in thyroid nodules: are certain appearances enough to avoid thyroid biopsy? J Ultrasound Med. 2011;30(6):753–60.CrossRefGoogle Scholar
  23. 23.
    Malhi H, Beland MD, Cen SY, Allgood E, Daley K, Martin SE, et al. Echogenic foci in thyroid nodules: significance of posterior acoustic artifacts. AJR Am J Roentgenol. 2014;203(6):1310–6. Scholar
  24. 24.
    Lu Z, Mu Y, Zhu H, Luo Y, Kong Q, Dou J, et al. Clinical value of using ultrasound to assess calcification patterns in thyroid nodules. World J Surg. 2011;35(1):122–7. Scholar
  25. 25.
    Na DG, Kim DS, Kim SJ, Ryoo JW, Jung SL. Thyroid nodules with isolated macrocalcification: malignancy risk and diagnostic efficacy of fine-needle aspiration and core needle biopsy. Ultrasonography. 2016;35(3):212–9. Scholar
  26. 26.
    Reading CC, Charboneau JW, Hay ID, Sebo TJ. Sonography of thyroid nodules: a “classic pattern” diagnostic approach. Ultrasound Q. 2005;21:157–65.CrossRefGoogle Scholar
  27. 27.
    Moon HJ, Kwak JY, Kim MJ, Son EJ, Kim EK. Can vascularity at power Doppler US help predict thyroid malignancy? Radiology. 2010;255(1):260–9. Scholar
  28. 28.
    Ma JJ, Ding H, Xu BH, Xu C, Song LJ, Huang BJ, et al. Diagnostic performances of various gray-scale, color Doppler, and contrast-enhanced ultrasonography findings in predicting malignant thyroid nodules. Thyroid. 2014;24(2):355–63. Scholar
  29. 29.
    Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab. 2002;87(5):1941–6.CrossRefGoogle Scholar
  30. 30.
    Shin JJ, Caragacianu D, Randolph GW. Impact of thyroid nodule size on prevalence and post-test probability of malignancy: a systematic review. Laryngoscope. 2015;125(1):263–72. Scholar
  31. 31.
    Kamran SC, Marqusee E, Kim MI, Frates MC, Ritner J, Peters H, et al. Thyroid nodule size and prediction of cancer. J Clin Endocrinol Metab. 2013;98:564–70. Scholar
  32. 32.
    Cavallo A, Johnson DN, White MG, Siddiqui S, Antic T, Mathew M, et al. Thyroid nodule size at ultrasound as a predictor of malignancy and final pathologic size. Thyroid. 2017;27(5):641–50. Scholar
  33. 33.
    Singh Ospina N, Maraka S, Espinosa DeYcaza A, O’Keeffe D, Brito JP, Gionfriddo MR, et al. Diagnostic accuracy of thyroid nodule growth to predict malignancy in thyroid nodules with benign cytology: systematic review and meta-analysis. Clin Endocrinol. 2016;85(1):122–31. Scholar
  34. 34.
    Yoon JH, Lee HS, Kim EK, Moon HJ, Kwak JY. Malignancy risk stratification of thyroid nodules: comparison between the thyroid imaging reporting and data system and the 2014 American Thyroid Association Management Guidelines. Radiology. 2016;278(3):917–24. Scholar
  35. 35.
    Ha EJ, Na DG, Baek JH, Sung JY, Kim JH, Kang SY. US fine-needle aspiration biopsy for thyroid malignancy: diagnostic performance of seven society guidelines applied to 2000 thyroid nodules. Radiology. 2018;287(3):893–900. Scholar
  36. 36.
    Choi YJ, Baek JH, Baek SH, Shim WH, Lee KD, Lee HS, et al. Web-based malignancy risk estimation for thyroid nodules using ultrasonography characteristics: development and validation of a predictive model. Thyroid. 2015;25(12):1306–12. Scholar
  37. 37.
    Ito Y, Miyauchi A, Inoue H, Fukushima M, Kihara M, Higashiyama T, et al. An observational trial for papillary thyroid microcarcinoma in Japanese patients. World J Surg. 2010;34(1):28–35. Scholar
  38. 38.
    Ito Y, Miyauchi A, Kihara M, Higashiyama T, Kobayashi K, Miya A. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid. 2014;24(1):27–34. Scholar
  39. 39.
    Brito JP, Ito Y, Miyauchi A, Tuttle RM. A clinical framework to facilitate risk stratification when considering an active surveillance alternative to immediate biopsy and surgery in papillary microcarcinoma. Thyroid. 2016;26:144–9. Scholar
  40. 40.
    Moon HJ, Kim EK, Yoon JH, Kwak JY. Malignancy risk stratification in thyroid nodules with nondiagnostic results at cytologic examination: combination of thyroid imaging reporting and data system and the Bethesda System. Radiology. 2015;274(1):287–95. Scholar
  41. 41.
    Kwak JY, Koo H, Youk JH, Kim MJ, Moon HJ, Son EJ, Kim EK. Value of US correlation of a thyroid nodule with initially benign cytologic results. Radiology. 2010;254(1):292–300. Scholar
  42. 42.
    Ha EJ, Baek JH, Lee JH, Song DE, Kim JK, Shong YK, Hong SJ. Sonographically suspicious thyroid nodules with initially benign cytologic results: the role of a core needle biopsy. Thyroid. 2013;23(6):703–8. Scholar
  43. 43.
    Rosário PW, Calsolari MR. What is the best criterion for repetition of fine-needle aspiration in thyroid nodules with initially benign cytology? Thyroid. 2015;25(10):1115–20. Scholar
  44. 44.
    Jeong SH, Hong HS, Lee EH, Cha JG, Park JS, Kwak JJ. Outcome of thyroid nodules characterized as atypia of undetermined significance or follicular lesion of undetermined significance and correlation with ultrasound features and BRAF(V600E) mutation analysis. AJR Am J Roentgenol. 2013;201(6):W854–60. Scholar
  45. 45.
    Rosario PW. Thyroid nodules with atypia or follicular lesions of undetermined significance (Bethesda category III): importance of ultrasonography and cytological subcategory. Thyroid. 2014;24(7):1115–20. Scholar
  46. 46.
    Maia FF, Matos PS, Pavin EJ, Zantut-Wittmann DE. Thyroid imaging reporting and data system score combined with Bethesda system for malignancy risk stratification in thyroid nodules with indeterminate results on cytology. Clin Endocrinol. 2015;82(3):439–44. Scholar
  47. 47.
    Chng CL, Kurzawinski TR, Beale T. Value of sonographic features in predicting malignancy in thyroid nodules diagnosed as follicular neoplasm on cytology. Clin Endocrinol. 2015;83(5):711–6. Scholar
  48. 48.
    Kuru B, Atmaca A, Tarim IA, Kefeli M, Topgul K, Yoruker S, et al. Risk factors associated with malignancy and with triage to surgery in thyroid nodules classified as Bethesda category III (AUS/FLUS). Eur J Surg Oncol. 2016;42(1):87–93. Scholar
  49. 49.
    Hong MJ, Na DG, Baek JH, Sung JY, Kim JH. Cytology-ultrasonography (CU) risk stratification scoring system based on fine-needle aspiration cytology and the Korean-thyroid imaging reporting and data system (K-TIRADS). Thyroid. 2017;27(7):953–9. Scholar
  50. 50.
    Nardi F, Basolo F, Crescenzi A, Fadda G, Frasoldati A, Orlandi F, et al. Italian consensus for the classification and reporting of thyroid cytology. J Endocrinol Investig. 2014;37(6):593–9. Scholar
  51. 51.
    The Royal College of Pathologists. Guidance on the Reporting of Thyroid Cytology Specimens. London. 2016. Accessed 24 April 2017.
  52. 52.
    Cibas ES, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid. 2017;27(11):1341–6. Scholar
  53. 53.
    Bongiovanni M, Spitale A, Faquin WC, Mazzucchelli L, Baloch ZW. The Bethesda system for reporting thyroid cytopathology: a meta-analysis. Acta Cytol. 2012;56:333–9. Scholar
  54. 54.
    Chehade JM, Silverberg AB, Kim J, Case C, Mooradian AD. Role of repeated fine-needle aspiration of thyroid nodules with benign cytologic features. Endocr Pract. 2001;7:237–43.CrossRefGoogle Scholar
  55. 55.
    Orlandi A, Puscar A, Capriata E, Fideleff H. Repeated fine needle aspiration of the thyroid in benign nodular thyroid disease: critical evaluation of long-term follow-up. Thyroid. 2005;15:274–8.CrossRefGoogle Scholar
  56. 56.
    Shin JH, Han BK, Ko K, Choe YH, Oh YL. Value of repeat ultrasound-guided fine-needle aspiration in nodules with benign cytological diagnosis. Acta Radiol. 2006;47:469–73.CrossRefGoogle Scholar
  57. 57.
    Chernyavsky VS, Shanker BA, Davidov T, Crystal JS, Eng O, Ibrahim K, et al. Is one benign fine needle aspiration enough? Ann Surg Oncol. 2012;19:1472–6. Scholar
  58. 58.
    Kim SY, Han KH, Moon HJ, Kwak JY, Chung WY, Kim EK. Thyroid nodules with benign findings at cytologic examination: results of long-term follow-up with US. Radiology. 2014;271:272–81. Scholar
  59. 59.
    Kholová I, Ludvíková M. Thyroid atypia of undetermined significance or follicular lesion of undetermined significance: an indispensable Bethesda 2010 diagnostic category or waste garbage? Acta Cytol. 2014;58(4):319–29. Scholar
  60. 60.
    Straccia P, Rossi ED, Bizzarro T, Brunelli C, Cianfrini F, Damiani D, et al. A meta-analytic review of the Bethesda system for reporting thyroid cytopathology: has the rate of malignancy in indeterminate lesions been underestimated? Cancer Cytopathol. 2015;123(12):713–22. Scholar
  61. 61.
    Radowsky JS, Howard RS, Burch HB, Stojadinovic A. Impact of degree of extrathyroidal extension of disease on papillary thyroid cancer outcome. Thyroid. 2014;24:241–4. Scholar
  62. 62.
    Youngwirth LM, Adam MA, Scheri RP, Roman SA, Sosa JA. Extrathyroidal extension is associated with compromised survival in patients with thyroid cancer. Thyroid. 2017;27(5):626–31. Scholar
  63. 63.
    Greene FL, Page DL, Fleming ID, Fritz AG, Balch CM, Haller DG, et al. AJCC cancer staging handbook: TNM classification of malignant tumors. 7th ed. New York: Springer; 2002.CrossRefGoogle Scholar
  64. 64.
    Ito Y, Tomoda C, Uruno T, Takamura Y, Miya A, Kobayashi K, et al. Prognostic significance of extrathyroid extension of papillary thyroid carcinoma: massive but not minimal extension affects the relapse-free survival. World J Surg. 2006;30:780–6.CrossRefGoogle Scholar
  65. 65.
    Edge SB, Greene FL, Byrd DR, Brookland RK, Washington MK, Gershenwald JE, et al. AJCC cancer staging handbook: TNM classification of malignant tumors. 8th ed. New York: Springer; 2017.Google Scholar
  66. 66.
    Andersen PE, Kinsella J, Loree TR, Shaha AR, Shah JP. Differentiated carcinoma of the thyroid with extrathyroidal extension. Am J Surg. 1995;170(5):467–70.CrossRefGoogle Scholar
  67. 67.
    Nixon IJ, Ganly I, Patel S, Palmer FL, Whitcher MM, Tuttle RM, Shaha AR, Shah JP. The impact of microscopic extrathyroid extension on outcome in patients with clinical T1 and T2 well-differentiated thyroid cancer. Surgery. 2011;150(6):1242–9. Scholar
  68. 68.
    Hay ID, Johnson TR, Thompson GB, Sebo TJ, Reinalda MS. Minimal extrathyroid extension in papillary thyroid carcinoma does not result in increased rates of either cause-specific mortality or postoperative tumor recurrence. Surgery. 2016;159:11–9. Scholar
  69. 69.
    Su HK, Wenig BM, Haser GC, et al. Inter-observer variation in the pathologic identification of minimal extrathyroidal extension in papillary thyroid carcinoma. Thyroid. 2016;26:512–7. Scholar
  70. 70.
    Ito Y, Miyauchi A, Oda H, Kobayashi K, Kihara M, Miya A. Revisiting low-risk thyroid papillary microcarcinomas resected without observation: was immediate surgery necessary? World J Surg. 2016;40:523–8. Scholar
  71. 71.
    Kamaya A, Tahvildari AM, Patel BN, Willmann JK, Jeffrey RB, Desser TS. Sonographic detection of extracapsular extension in papillary thyroid cancer. J Ultrasound Med. 2015;34:2225–30. Scholar
  72. 72.
    Scheumann GF, Gimm O, Wegener G, Hundeshagen H, Dralle H. Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer. World J Surg. 1994;18(4):559–67.CrossRefGoogle Scholar
  73. 73.
    Mulla M, Schulte KM. Central cervical lymph node metastases in papillary thyroid cancer: a systematic review of imaging guided and prophylactic removal of the central compartment. Clin Endocrinol. 2012;76:131–6. Scholar
  74. 74.
    Qubain SW, Nakano S, Baba M, Takao S, Aikou T. Distribution of lymph node micrometastasis in pN0 well-differentiated thyroid carcinoma. Surgery. 2002;131(3):249–56.CrossRefGoogle Scholar
  75. 75.
    Cranshaw IM, Carnaille B. Micrometastases in thyroid cancer. An important finding? Surg Oncol. 2008;17(3):253–8. Scholar
  76. 76.
    Bardet S, Malville E, Rame JP, Babin E, Samama G, De Raucourt D, et al. Macroscopic lymph-node involvement and neck dissection predict lymph-node recurrence in papillary thyroid carcinoma. Eur J Endocrinol. 2008;158(4):551–60. Scholar
  77. 77.
    Gemsenjäger E, Perren A, Seifert B, Schüler G, Schweizer I, Heitz PU. Lymph node surgery in papillary thyroid carcinoma. J Am Coll Surg. 2003;197(2):182–90.CrossRefGoogle Scholar
  78. 78.
    Kouvaraki MA, Shapiro SE, Fornage BD, et al. Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer. Surgery. 2003;134(6):946–54. discussion 954–5CrossRefGoogle Scholar
  79. 79.
    Yeh MW, Bauer AJ, Bernet VA, et al. American thyroid association statement on preoperative imaging for thyroid cancer surgery. Thyroid. 2015;25(1):3–14. Scholar
  80. 80.
    Wada N, Duh QY, Sugino K, Iwasaki H, Kameyama K, Mimura T, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg. 2003;237(3):399–407.PubMedPubMedCentralGoogle Scholar
  81. 81.
    Ito Y, Tomoda C, Uruno T, Takamura Y, Miya A, Kobayashi K, et al. Preoperative ultrasonographic examination for lymph node metastasis: usefulness when designing lymph node dissection for papillary microcarcinoma of the thyroid. World J Surg. 2004;28:498–501.CrossRefGoogle Scholar
  82. 82.
    Randolph GW, Duh QY, Heller KS, LiVolsi VA, Mandel SJ, Steward DL, et al. The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. Thyroid. 2012;22:1144–52. Scholar
  83. 83.
    Leboulleux S, Girard E, Rose M, et al. Ultrasound criteria of malignancy for cervical lymph nodes in patients followed up for differentiated thyroid cancer. J Clin Endocrinol Metab. 2007;92(9):3590–4.CrossRefGoogle Scholar
  84. 84.
    Leenhardt L, Erdogan MF, Hegedus L, et al. European thyroid association guidelines for cervical ultrasound scan and ultrasound-guided techniques in the postoperative management of patients with thyroid cancer. Eur Thyroid J. 2013;2(3):147–59. Scholar
  85. 85.
    Van den Brekel M, Castelijns JA, Snow GB. The size of lymph nodes in the neck on sonograms as a radiologic criterion for metastasis: how reliable is it? Am J Neuroradiol. 1998;19(4):695–700.PubMedGoogle Scholar
  86. 86.
    Steinkamp H, Cornehl M, Hosten N, Pegios W, Vogl T, Felix R. Cervical lymphadenopathy: ratio of long-to short-axis diameter as a predictor of malignancy. Br J Radiol. 1995;68(807):266–70.CrossRefGoogle Scholar
  87. 87.
    Grani G, Fumarola A. Thyroglobulin in lymph node fine-needle aspiration washout: a systematic review and meta-analysis of diagnostic accuracy. J Clin Endocrinol Metab. 2014;99(6):1970–82. Scholar
  88. 88.
    Torres MR, Nóbrega Neto SH, Rosas RJ, Martins AL, Ramos AL, da Cruz TR. Thyroglobulin in the washout fluid of lymph-node biopsy: what is its role in the follow-up of differentiated thyroid carcinoma? Thyroid. 2014;24(1):7–18. Scholar
  89. 89.
    Pak K, Suh S, Hong H, Cheon GJ, Hahn SK, Kang KW, et al. Diagnostic values of thyroglobulin measurement in fine-needle aspiration of lymph nodes in patients with thyroid cancer. Endocrine. 2015;49(1):70–7. Scholar
  90. 90.
    Baloch ZW, Barroeta JE, Walsh J, Gupta PK, Livolsi VA, Langer JE, et al. Utility of thyroglobulin measurement in fine-needle aspiration biopsy specimens of lymph nodes in the diagnosis of recurrent thyroid carcinoma. Cytojournal. 2008;5:1. Scholar
  91. 91.
    Borel AL, Boizel R, Faure P, Barbe G, Boutonnat J, Sturm N, et al. Significance of low levels of thyroglobulin in fine needle aspirates from cervical lymph nodes of patients with a history of differentiated thyroid cancer. Eur J Endocrinol. 2008;158(5):691–8. Scholar
  92. 92.
    Baldini E, Sorrenti S, Di Gioia C, De Vito C, Antonelli A, Gnessi L, et al. Cervical lymph node metastases from thyroid cancer: does thyroglobulin and calcitonin measurement in fine needle aspirates improve the diagnostic value of cytology? BMC Clin Pathol. 2013;13:7. Scholar
  93. 93.
    Shin JH, Han BK, Ko EY, Kang SS. Sonographic findings in the surgical bed after thyroidectomy: comparison of recurrent tumors and nonrecurrent lesions. J Ultrasound Med. 2007;26:1359–66.CrossRefGoogle Scholar
  94. 94.
    Chua WY, Langer JE, Jones LP. Surveillance neck sonography after thyroidectomy for papillary thyroid carcinoma: pitfalls in the diagnosis of locally recurrent and metastatic disease. J Ultrasound Med. 2017;36(7):1511–30. Scholar
  95. 95.
    Rondeau G, Fish S, Hann LE, Fagin JA, Tuttle RM. Ultrasonographically detected small thyroid bed nodules identified after total thyroidectomy for differentiated thyroid cancer seldom show clinically significant structural progression. Thyroid. 2011;21(8):845–53. Scholar
  96. 96.
    Robenshtok E, Fish S, Bach A, Dominguez JM, Shaha A, Tuttle RM. Suspicious cervical lymph nodes detected after thyroidectomy for papillary thyroid cancer usually remain stable over years in properly selected patients. J Clin Endocrinol Metab. 2012;97(8):2706–13. Scholar
  97. 97.
    Al-Saif O, Farrar WB, Bloomston M, Porter K, Ringel MD, Kloos RT. Long-term efficacy of lymph node reoperation for persistent papillary thyroid cancer. J Clin Endocrinol Metab. 2010;95(5):2187–94. Scholar
  98. 98.
    Choi YJ, Baek JH, Park HS, Shim WH, Kim TY, Shong YK, et al. A computer-aided diagnosis system using artificial intelligence for the diagnosis and characterization of thyroid nodules on ultrasound: initial clinical assessment. Thyroid. 2017;27(4):546–52. Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Dong Gyu Na
    • 1
  • Ji-hoon Kim
    • 2
  • Eun Ju Ha
    • 3
  1. 1.Department of RadiologyGangNeung Asan HospitalGangneung-siSouth Korea
  2. 2.Department of RadiologySeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
  3. 3.Department of RadiologyAjou University School of MedicineSuwonSouth Korea

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