Endocrinology and Metabolism

Original Article

Thyroid
The Diagnostic Role of Repeated Biopsy of Thyroid Nodules with Atypia of Undetermined Significance with Architectural Atypia on Core-Needle Biopsy: Hye Hyeon Moon, Sae Rom Chung, Young Jun Choi, Tae-Yon Sung, Dong Eun Song, Tae Yong Kim, Jeong Hyun Lee, Jung Hwan Baek; Endocrinol Metab. 2024;39(2):300-309. Published online January 3, 2024; DOI: https://doi.org/10.3803/EnM.2023.1818

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Abstract PDF Supplementary Material PubReader ePub: Background
We aimed to evaluate the utility of repeat biopsy of thyroid nodules classified as atypia of undetermined significance with architectural atypia (IIIB) on core-needle biopsy (CNB).
Methods
This retrospective study evaluated patients with thyroid nodules categorized as IIIB on CNB between 2013 and 2015. Demographic characteristics, subsequent biopsy results, and ultrasound (US) images were evaluated. The malignancy rates of nodules according to number of CNBs and the number of IIIB diagnoses was compared. Demographic and US features were evaluated to determine factors predictive of malignancy.
Results
Of 1,003 IIIB nodules on CNB, the final diagnosis was determined for 328 (32.7%) nodules, with 121 of them confirmed as malignant, resulting in a malignancy rate of 36.9% (95% confidence interval, 31.7% to 42.1%). Repeat CNB was performed in 248 nodules (24.7%), with 75 (30.2%), 131 (52.8%), 13 (5.2%), 26 (10.5%), one (0.4%), and two (0.8%) reclassified into categories II, IIIB, IIIA, IV, V, and VI, respectively. Malignancy rates were not significantly affected by the number of CNBs (P=0.291) or the number of IIIB diagnoses (P=0.473). None of the nodules confirmed as category II on repeat CNB was malignant. US features significantly associated with malignancy (P<0.003) included solid composition, irregular margins, microcalcifications, and high suspicion on the US risk stratification system.
Conclusion
Repeat biopsy of nodules diagnosed with IIIB on CNB did not increase the detection of malignancy but can potentially reduce unnecessary surgery. Repeat biopsy should be performed selectively, with US features guiding the choice between repeat biopsy and diagnostic surgery.

Editorial

Thyroid Thyroid Cancer Screening
Thyroid Cancer Screening: How to Maximize Its Benefits and Minimize Its Harms: Jung Hwan Baek; Endocrinol Metab. 2023;38(1):75-77. Published online February 27, 2023; DOI: https://doi.org/10.3803/EnM.2023.105

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Citations

Citations to this article as recorded by

Multidimensional Prediction Method for Thyroid Cancer Based on Spatiotemporally Imbalanced Distribution Data
Zhiwei Jia, Yuqi Huang, Yanhui Lin, Min Fu, Chenhao Sun
IEEE Access.2024; 12: 4674. CrossRef

Original Articles

Clinical Study
Effectiveness of Injecting Cold 5% Dextrose into Patients with Nerve Damage Symptoms during Thyroid Radiofrequency Ablation: Min Kyoung Lee, Jung Hwan Baek, Sae Rom Chung, Young Jun Choi, Yu-Mi Lee, Tae Yong Kim, Jeong Hyun Lee; Endocrinol Metab. 2020;35(2):407-415. Published online June 24, 2020; DOI: https://doi.org/10.3803/EnM.2020.35.2.407

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Background
Although radiofrequency ablation (RFA) is a safe treatment for thyroid tumors, nerve damage is a frequent complication. A previous retrospective study suggested that an injection of cold 5% dextrose in water (5% DW) can reduce nerve damage during RFA. This study validated the efficacy of injecting cold 5% DW for management of nerve damage during RFA.
Methods
Between November 2017 and December 2018, 242 patients underwent 291 RFA sessions for treatment of benign thyroid nodules or recurrent thyroid cancers. Using a standardized technique, cold (0°C to 4°C) 5% DW was immediately injected around the damaged nerve into patients with any symptoms suggesting nerve damage. The incidence of nerve damage, the volume of 5% DW injected, symptom recovery time and the incidence of permanent nerve damage were evaluated.
Results
Nineteen patients experienced nerve damage symptoms related to 21 RFA sessions, including 17 patients during 19 sessions and two patients on the day after two sessions. Patients with nerve damage symptoms detected during RFA were treated by injection of a mean 41 mL (range, 3 to 260) cold 5% DW, but the two patients who experienced symptoms the next day did not receive cold 5% DW injections. Immediate recovery was observed after 15 RFA sessions in 14 patients. No patient experienced permanent nerve damage.
Conclusion
Injection of cold 5% DW is effective in managing nerve damage during RFA of thyroid lesions.

Citations

Citations to this article as recorded by

The Role of Radiofrequency Ablation in Benign and Malignant Thyroid Nodules
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Hui-hui Chai, Zhan-jing Dai, Bai Xu, Qiao-hong Hu, Hong-feng He, Ying Xin, Wen-wen Yue, Cheng-zhong Peng
Academic Radiology.2023; 30(11): 2647. CrossRef
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Shahzad Ahmad, Jules Aljammal, Ian Orozco, Sheharyar Raashid, Fizza Zulfiqar, Sean P Nikravan, Iram Hussain
Journal of the Endocrine Society.2023;[Epub] CrossRef
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So Yeong Jeong, Jung Hwan Baek, Sae Rom Chung, Young Jun Choi, Ki-Wook Chung, Tae Yong Kim, Jeong Hyun Lee
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Ultrasonography.2022; 41(1): 204. CrossRef
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Pia Pace-Asciak, Jon O. Russell, Ralph P. Tufano
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Continuous neuromonitoring during radiofrequency ablation of benign thyroid nodules provides objective evidence of laryngeal nerve safety
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Clinical Study
Long-Term Results of Thermal Ablation of Benign Thyroid Nodules: A Systematic Review and Meta-Analysis: Se Jin Cho, Jung Hwan Baek, Sae Rom Chung, Young Jun Choi, Jeong Hyun Lee; Endocrinol Metab. 2020;35(2):339-350. Published online June 24, 2020; DOI: https://doi.org/10.3803/EnM.2020.35.2.339

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Background
Ultrasound-guided thermal ablations have become one of the main options for treating benign thyroid nodules. To determine efficacy of thermal ablation of benign thyroid nodules, we performed a meta-analysis of studies with long-term follow-up of more than 3 years.
Methods
Databases were searched for studies published up to August 25, 2019, reporting patients with benign thyroid nodules treated with thermal ablation and with follow-up data of more than 3 years. Data extraction and quality assessment were performed according to PRISMA guidelines. The analysis yielded serial volume reduction rates (VRRs) of ablated nodules for up to 3 years or more, and adverse effect of ablation during follow-up. Radiofrequency ablation (RFA) and laser ablation (LA) were compared in a subgroup analysis.
Results
The pooled VRRs for ablated nodules showed rapid volume reduction before 12 months, a plateau from 12 to 36 months, and more volume reduction appearing after 36 months, demonstrating long-term maintenance of treatment efficacy. Thermal ablation had an acceptable complication rate of 3.8%. Moreover, patients undergoing nodule ablation showed no unexpected delayed complications during the follow-up period. In the subgroup analysis, RFA was shown to be superior to LA in terms of the pooled VRR and the number of patients who underwent delayed surgery.
Conclusion
Thermal ablations are safe and effective methods for treating benign thyroid nodules, as shown by a long follow-up analysis of more than 3 years. In addition, RFA showed superior VRRs compared with LA for the treatment of benign thyroid nodules, with less regrowth and less delayed surgery.

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Clinical Study
Revisiting Rupture of Benign Thyroid Nodules after Radiofrequency Ablation: Various Types and Imaging Features: Sae Rom Chung, Jung Hwan Baek, Jin Yong Sung, Ji Hwa Ryu, So Lyung Jung; Endocrinol Metab. 2019;34(4):415-421. Published online December 23, 2019; DOI: https://doi.org/10.3803/EnM.2019.34.4.415

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Abstract PDF PubReader ePub

Background

To evaluate the imaging features, clinical manifestations, and prognosis of patients with thyroid nodule rupture after radiofrequency ablation (RFA).

Methods

The records of 12 patients who experienced thyroid nodule rupture after RFA at four Korean thyroid centers between March 2010 and July 2017 were retrospectively reviewed. Clinical data evaluated included baseline patient characteristics, treatment methods, initial presenting symptoms, imaging features, treatment, and prognosis.

Results

The most common symptoms of post-RFA nodule rupture were sudden neck bulging and pain. Based on imaging features, the localization of nodule rupture was classified into three types: anterior, posterolateral, and medial types. The anterior type is the most often, followed by posterolateral and medial type. Eight patients recovered completely after conservative treatment. Four patients who did not improve with conservative management required invasive procedures, including incision and drainage or aspiration.

Conclusion

Thyroid nodule rupture after RFA can be classified into three types based on its localization: anterior, posterolateral, and medial types. Because majority of thyroid nodule ruptures after RFA can be managed conservatively, familiarity with these imaging features is essential in avoiding unnecessary imaging workup or invasive procedures.

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Response

Thyroid
Response: Long-Term Outcomes Following Thermal Ablation of Benign Thyroid Nodules as an Alternative to Surgery: The Importance of Controlling Regrowth (Endocrinol Metab 2019;34:117–23, Jung Suk Sim et al.): Jung Suk Sim, Jung Hwan Baek; Endocrinol Metab. 2019;34(3):325-326. Published online September 26, 2019; DOI: https://doi.org/10.3803/EnM.2019.34.3.325; [Original]

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Citations

Citations to this article as recorded by

Five-year follow-up results of thermal ablation for benign thyroid nodules: Systematic review and meta-analysis
Xidong Xu, Ying Peng, Guoxin Han
American Journal of Otolaryngology.2024; 45(1): 104025. CrossRef
How to Monitor and Manage Nodule Regrowth after Thermal Ablation of Benign Thyroid Nodules
Sang Ik Park, Jung Hwan Baek
Korean Journal of Radiology.2021; 22(2): 293. CrossRef

Review Article

Thyroid
Long-Term Outcomes Following Thermal Ablation of Benign Thyroid Nodules as an Alternative to Surgery: The Importance of Controlling Regrowth: Jung Suk Sim, Jung Hwan Baek; Endocrinol Metab. 2019;34(2):117-123. Published online June 24, 2019; DOI: https://doi.org/10.3803/EnM.2019.34.2.117

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Thermal ablation (TA) procedures, such as radiofrequency ablation and laser ablation, are used for the treatment of benign thyroid nodules. Short-term studies (<2 years) have demonstrated that TA is an effective and safe procedure to improve cosmetic or symptomatic problems. However, studies including a longer follow-up period show that treated thyroid nodules can increase in size after 2 to 3 years. Several studies suggest that this results from regrowth at the undertreated nodule margins. Here, we review current data on regrowth after TA and describe factors related to it and possible approaches to prevent it.

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Response: Long-Term Outcomes Following Thermal Ablation of Benign Thyroid Nodules as an Alternative to Surgery: The Importance of Controlling Regrowth (Endocrinol Metab 2019;34:117–23, Jung Suk Sim et al.)
Jung Suk Sim, Jung Hwan Baek
Endocrinology and Metabolism.2019; 34(3): 325. CrossRef
Letter: Long-Term Outcomes Following Thermal Ablation of Benign Thyroid Nodules as an Alternative to Surgery: The Importance of Controlling Regrowth (Endocrinol Metab 2019;34:117-23, Jung Suk Sim et al.)
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Original Articles

Clinical Study
Does Radiofrequency Ablation Induce Neoplastic Changes in Benign Thyroid Nodules: A Preliminary Study: Su Min Ha, Jun Young Shin, Jung Hwan Baek, Dong Eun Song, Sae Rom Chung, Young Jun Choi, Jeong Hyun Lee; Endocrinol Metab. 2019;34(2):169-178. Published online May 15, 2019; DOI: https://doi.org/10.3803/EnM.2019.34.2.169

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Background

To evaluate the clinical feasibility of radiofrequency ablation (RFA) of benign thyroid nodules along with cytomorphological alteration, and any malignant transformation through biopsy.

Methods

The data were retrospectively collected between April 2008 and June 2013 and core needle biopsy (CNB) was performed on 16 benign thyroid nodules previously treated using RFA. The parameters of the patients were compared, between the time of enrollment and the last follow-up examination, using linear mixed model statistical analysis.

Results

No atypical cells or neoplastic transformation were detected in the undertreated peripheral portion of treated benign nodules on the CNB specimen. RFA altered neither the thyroid capsule nor the thyroid tissue adjacent to the treated area. On histopathological examinations, we observed 81.2% acellular hyalinization, which was the most common finding. After a mean follow-up period of over 5 years, the mean volume of thyroid nodule had decreased to 6.4±4.2 mL, with a reduction rate of 81.3%±5.8% (P<0.0001).

Conclusion

RFA is a technically feasible treatment method for benign thyroid nodules, with no carcinogenic effect or tissue damage of the normal thyroid tissue adjacent to the RFA-treated zone.

Citations

Citations to this article as recorded by

Comparison of the Therapeutic Efficacy and Technical Outcomes between Conventional Fixed Electrodes and Adjustable Electrodes in the Radiofrequency Ablation of Benign Thyroid Nodules
Jae Ho Shin, Minkook Seo, Min Kyoung Lee, So Lyung Jung
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Robert M. Eisele, Philipp R. Scherber, Monika Schlüter, Thorsten Drews, Matthias Glanemann, Gereon Gäbelein
Technology and Health Care.2022; 30(3): 683. CrossRef
Radiofrequency ablation and related ultrasound‐guided ablation technologies for treatment of benign and malignant thyroid disease: An international multidisciplinary consensus statement of the American Head and Neck Society Endocrine Surgery Section with
Lisa A. Orloff, Julia E. Noel, Brendan C. Stack, Marika D. Russell, Peter Angelos, Jung Hwan Baek, Kevin T. Brumund, Feng‐Yu Chiang, Mary Beth Cunnane, Louise Davies, Andrea Frasoldati, Anne Y. Feng, Laszlo Hegedüs, Ayaka J. Iwata, Emad Kandil, Jennifer K
Head & Neck.2022; 44(3): 633. CrossRef
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James Y. Lim, Jennifer H. Kuo
Techniques in Vascular and Interventional Radiology.2022; 25(2): 100824. CrossRef
American Association of Clinical Endocrinology Disease State Clinical Review: The Clinical Utility of Minimally Invasive Interventional Procedures in the Management of Benign and Malignant Thyroid Lesions
Sina Jasim, Kepal N. Patel, Gregory Randolph, Stephanie Adams, Roberto Cesareo, Edward Condon, Tara Henrichsen, Malak Itani, Maria Papaleontiou, Leonardo Rangel, John Schmitz, Marius N. Stan
Endocrine Practice.2022; 28(4): 433. CrossRef
Efficacy of radiofrequency and laser thermal ablation in solving thyroid nodule-related symptoms and cosmetic concerns. A systematic review and meta-analysis
Roberto Cesareo, Silvia Egiddi, Anda M. Naciu, Gaia Tabacco, Andrea Leoncini, Nicola Napoli, Andrea Palermo, Pierpaolo Trimboli
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A systematic review and meta-analysis comparing tumor progression and complications between radiofrequency ablation and thyroidectomy for papillary thyroid carcinoma
Yuan-dong Sun, Hao Zhang, Hai-tao Zhu, Chun-xue Wu, Miao-ling Chen, Jian-jun Han
Frontiers in Oncology.2022;[Epub] CrossRef
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Haris Muhammad, Prasanna Santhanam, Jonathon O. Russell, Jennifer H. Kuo
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Haris Muhammad, Prasanna Santhanam, Jonathon O. Russell
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Rahul K. Sharma, Jennifer H Kuo
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Hervé Monpeyssen, Ahmad Alamri, Adrien Ben Hamou
Frontiers in Endocrinology.2021;[Epub] CrossRef
Long-Term Outcomes of Thermal Ablation for Benign Thyroid Nodules: The Issue of Regrowth
Jung Suk Sim, Jung Hwan Baek, Rosaria Meccariello
International Journal of Endocrinology.2021; 2021: 1. CrossRef
Ultrasound-Guided Radiofrequency Ablation Versus Thyroid Lobectomy for Low-Risk Papillary Thyroid Microcarcinoma: A Propensity-Matched Cohort Study of 884 Patients
Lin Yan, Mingbo Zhang, Qing Song, Yukun Luo
Thyroid.2021; 31(11): 1662. CrossRef
Clinical Effects of Microwave Ablation in the Treatment of Low-Risk Papillary Thyroid Microcarcinomas and Related Histopathological Changes
Chenya Lu, Xingjia Li, Xiaoqiu Chu, Ruiping Li, Jie Li, Jianhua Wang, Yalin Wang, Yang Xu, Guofang Chen, Shuhang Xu, Chao Liu
Frontiers in Endocrinology.2021;[Epub] CrossRef
Ultrasound-Guided Thermal Ablation of Thyroid Nodules: Technicalities Progress and Clinical Applications, Especially in Malignant Thyroid Nodules
Enock Adjei Agyekum, Jian-hua Fu, Fei-Ju Xu, Yong-Zhen Ren, Debora Akortia, Qing Chen, Xiao-Qin Qian, Yuguo Wang, Xian Wang
Frontiers in Oncology.2021;[Epub] CrossRef
Comparison Between Radiofrequency Ablation and Microwave Ablation in the Treatment for Benign Thyroid Nodules: a Meta-analysis
Jing Wu, Junguo Liu, Li Liu
Indian Journal of Surgery.2021;[Epub] CrossRef
2020 European Thyroid Association Clinical Practice Guideline for the Use of Image-Guided Ablation in Benign Thyroid Nodules
Enrico Papini, Hervé Monpeyssen, Andrea Frasoldati, Laszlo Hegedüs
European Thyroid Journal.2020; 9(4): 172. CrossRef
Response: Long-Term Outcomes Following Thermal Ablation of Benign Thyroid Nodules as an Alternative to Surgery: The Importance of Controlling Regrowth (Endocrinol Metab 2019;34:117–23, Jung Suk Sim et al.)
Jung Suk Sim, Jung Hwan Baek
Endocrinology and Metabolism.2019; 34(3): 325. CrossRef

Thyroid
A Comparison of Ultrasound-Guided Fine Needle Aspiration versus Core Needle Biopsy for Thyroid Nodules: Pain, Tolerability, and Complications: Eun Ji Jeong, Sae Rom Chung, Jung Hwan Baek, Young Jun Choi, Jae Kyun Kim, Jeong Hyun Lee; Endocrinol Metab. 2018;33(1):114-120. Published online March 21, 2018; DOI: https://doi.org/10.3803/EnM.2018.33.1.114

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Background

To compare pain, tolerability, and complications associated with fine needle aspiration (FNA) versus core needle biopsy (CNB).

Methods

FNAs were performed using 23-gauge needles and CNBs were performed using 18-gauge double-action spring-activated needles in 100 patients for each procedure. Patients were asked to record a pain score using a 10-cm visual analog scale and procedure tolerability. Complications and number of biopsies were recorded.

Results

The median pain scores were similar for the FNA and CNB approaches during and 20 minutes after the biopsy procedures (3.7 vs. 3.6, P=0.454; 0.9 vs. 1.1, P=0.296, respectively). The procedure was tolerable in all 100 FNA patients and in 97 CNB patients (P=0.246). The mean number of biopsies was fewer in the CNB group (1.4 vs. 1.2, P=0.002). By subgroup analysis (staff vs. non-staff), no significant difference was detected in any parameter. There were no major complications in either group, but three patients who underwent CNB had minor complications (P=0.246).

Conclusion

FNA and CNB show no significant differences for diagnosing thyroid nodules in terms of pain, tolerability, or complications.

Citations

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Review Article

Recent Advances in Core Needle Biopsy for Thyroid Nodules: Chan Kwon Jung, Jung Hwan Baek; Endocrinol Metab. 2017;32(4):407-412. Published online December 14, 2017; DOI: https://doi.org/10.3803/EnM.2017.32.4.407

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Core needle biopsy (CNB) was introduced as an alternative diagnostic tool to fine-needle aspiration (FNA), and is increasingly being used in the preoperative assessment of thyroid nodules. CNB provides a definitive diagnosis in most cases, but it sometimes may be inconclusive. CNB has the advantage of enabling a histologic examination in relation to the surrounding thyroid tissue, immunohistochemistry, and molecular testing that can provide a more accurate assessment than FNA in selected cases. Nevertheless, CNB should be performed only by experienced experts in thyroid interventions to prevent complications because CNB needles are larger in caliber than FNA needles. As recent evidence has accumulated, and with improvements in the technique and devices for thyroid CNB, the Korean Society of Thyroid Radiology released its 2016 thyroid CNB guidelines and the Korean Endocrine Pathology Thyroid Core Needle Biopsy Study Group published a consensus statement on the pathology reporting system for thyroid CNB in 2015. This review presents the current consensus and recommendations regarding thyroid CNB, focusing on indications, complications, and pathologic classification and reporting.

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Original Article

Thyroid
Lack of Associations between Body Mass Index and Clinical Outcomes in Patients with Papillary Thyroid Carcinoma: Hyemi Kwon, Mijin Kim, Yun Mi Choi, Eun Kyung Jang, Min Ji Jeon, Won Gu Kim, Tae Yong Kim, Young Kee Shong, Dong Eun Song, Jung Hwan Baek, Suck Joon Hong, Won Bae Kim; Endocrinol Metab. 2015;30(3):305-311. Published online November 26, 2014; DOI: https://doi.org/10.3803/EnM.2015.30.3.305

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Background

Obesity is associated with aggressive pathological features and poor clinical outcomes in breast and prostate cancers. In papillary thyroid carcinoma (PTC), these relationships remain still controversial. This study aimed to evaluate the associations between body mass index (BMI) and the clinical outcomes of patients with PTC.

Methods

This retrospective study included 1,189 patients who underwent total thyroidectomy for PTCs equal to or larger than 1 cm in size. Clinical outcomes were evaluated and compared based on the BMI quartiles.

Results

There were no significant associations between BMI quartiles and primary tumor size, extrathyroidal invasion, cervical lymph node metastasis, or distant metastasis. However, an increase in mean age was associated with an increased BMI (P for trend <0.001). Multifocality and advanced tumor-node-metastasis (TNM) stage (stage III or IV) were significantly associated with increases of BMI (P for trend 0.02 and <0.001, respectively). However, these associations of multifocality and advanced TNM stage with BMI were not significant in multivariate analyses adjusted for age and gender. Moreover, there were no differences in recurrence-free survivals according to BMI quartiles (P=0.26).

Conclusion

In the present study, BMI was not associated with the aggressive clinicopathological features or recurrence-free survivals in patients with PTC.

Citations

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Review Article

Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer.: Won Bae Kim, Tae Yong Kim, Hyuk Sang Kwon, Won Jin Moon, Jae Bok Lee, Young Sik Choi, Seok Ki Kim, Sun Wook Kim, Ki wook Chung, Jung Hwan Baek, Byung Il Kim, Do Joon Park, Dong Gyu Na, Jun Ho Choe, Jae Hoon Chung, Hye Seung Jung, Jeong Han Kim, Kee Hyun Nam, Hang Seok Chang, Woong Youn Chung, Soon Won Hong, Suck Joon Hong, Jeong Hyun Lee, Ka Hee Yi, Young Suk Jo, Ho Cheol Kang, Minho Shong, Jin Woo Park, Jong Ho Yoon, Seong Joon Kang, Kwang Woo Lee; J Korean Endocr Soc. 2007;22(3):157-187. Published online June 1, 2007; DOI: https://doi.org/10.3803/jkes.2007.22.3.157

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