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Review ArticleThe Revised 2016 Korean Thyroid Association Guidelines for Thyroid Nodules and Cancers: Differences from the 2015 American Thyroid Association Guidelines
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Ka Hee Yi
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Endocrinology and Metabolism 2016;31(3):373-378.
DOI: https://doi.org/10.3803/EnM.2016.31.3.373
Published online: September 26, 2016
Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
- Corresponding author: Ka Hee Yi. Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea. Tel: +82-2-870-3203, Fax: +82-2-870-3866, khyi@snu.ac.kr
• Received: August 9, 2016 • Revised: August 16, 2016 • Accepted: August 20, 2016
Copyright © 2016 Korean Endocrine Society
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
- Increased detection of thyroid nodules using high-resolution ultrasonography has resulted in a world-wide increase in the incidence of differentiated thyroid cancer (DTC). Despite the steep increase in its incidence, the age-standardized mortality rate of thyroid cancer has remained stable, which leads toward a trend of more conservative treatment. The latest American Thyroid Association (ATA) guidelines for thyroid nodules and thyroid cancer revised in 2015 suggested that fine needle aspiration biopsy should be performed for thyroid nodules larger than 1 cm and lobectomy might be sufficient for 1 to 4 cm intrathyroidal DTC. In addition, active surveillance instead of immediate surgical treatment was also recommended as a treatment option for papillary thyroid microcarcinoma based on the results of a few observational studies from Japan. The Korean Thyroid Association (KTA) has organized a task force team to develop revised guidelines for thyroid nodules and DTC after an extensive review of articles and intense discussion on whether we should accept the changes in the 2015 ATA guidelines. This paper introduces and discusses the updated major issues and differences in the ATA and the KTA guidelines.
- Thyroid nodules have become a very common clinical problem after the introduction of high resolution ultrasonography (US) in the 2000s that can detect nonpalpable nodules (incidentalomas). The prevalence of thyroid nodules detected by US has been reported as 19% to 68% depending on the study population [1], which resulted in an increase in the incidence of thyroid cancer since 5% to 15% of the identified nodules are malignant. Despite the steep increase in its incidence, the age-standardized mortality rate of thyroid cancer has remained stable [2], which leads to a shift toward more conservative approaches to the diagnosis and treatment of this disease. In the latest American Thyroid Association (ATA) guidelines for thyroid nodules and differentiated thyroid cancer (DTC) published in early 2016 [3], fine needle aspiration (FNA) is recommended for thyroid nodules larger than 1 cm even with highly suspicious sonographic features while lobectomy might be sufficient for 1 to 4 cm intrathyroidal DTC to avoid complications from total thyroidectomy. In addition, active surveillance instead of immediate surgical treatment is also recommended as a treatment option for papillary thyroid microcarcinoma (PTMC) based on the results of a few observational studies from Japan [45]. The Korean Thyroid Association (KTA) has organized a task force team to develop revised guidelines for thyroid nodules and thyroid cancer after an extensive review of articles including guidelines from other endocrine or thyroid associations and intense discussion on whether we should accept the changes in the 2015 ATA guidelines. The product will be published as the revised KTA guidelines for thyroid nodules and DTC later this year. Here, we focus on three major issues in the revised KTA: (1) size criteria for FNA; (2) active surveillance as one of the treatment options for PTMC; and (3) extent of surgery including surgery for grey zone tumors.
INTRODUCTION
- The change in size criteria for FNA has drawn keen attention after the publication of the clinical guidelines for thyroid nodules. In the 2015 ATA guidelines, ultrasound stratification of thyroid nodules according to the estimated risk of malignancy was introduced (Table 1). FNA was recommended for nodules ≥1 cm, rather than >0.5 cm as in the 2009 ATA guidelines, that show a high suspicion US pattern, i.e., solid hypoechoic nodules with one or more of the following features: irregular margins, microcalcifications, taller than wide shape, extrathyroidal extension, and rim calcifications with small extrusive soft tissue components. The size criteria for intermediate (≥1.0 cm), low (≥1.5 cm), and very low suspicion (≥2.0 cm) did not drastically change. However, they strongly recommended against FNA for nodules with a benign pattern (purely cystic) and the nodules that do not meet the FNA criteria. The high suspicion sonographic features also changed; extrathyroidal extension and rim calcifications with small extrusive soft tissue components are now regarded as new suspicious features; however, hypoechogenicity and increased nodular vascularity have been excluded. More than half of benign nodules are hypoechoic in US especially when their size is small which makes nodule hypoechogenicity less specific [6]. In the 2010 KTA guideline, intranodular hypervascularity has already been excluded from highly suspicious patterns based on the result reported by Korean radiologists showing that intranodular vascularity was higher in benign nodules than in papillary thyroid cancer (PTC) [7]. The ATA also cited this result as evidence to exclude increased vascularity from high suspicion sonographic patterns. The Korean Society of Thyroid Radiology also developed a new clinically feasible US risk-stratification system, the Korean Thyroid Imaging Reporting and Data System (K-TIRADS), primarily based on the solidity and echogenicity of thyroid nodules by analyzing 2,000 nodules including 454 nodules that were pathologically proven as malignant [89]. Major differences in risk stratification by US between the K-TIRADS and ATA were: (1) isohyperechoic or partially cystic nodules with any suspicious features were classified as intermediate suspicion (category 4), and (2) nodules of very low suspicion and in the benign group in the ATA guidelines were combined and categorized as benign (category 2) in the K-TIRADS (Table 2, Fig. 1). Korean radiologists recommend FNA for category 5 nodules when the size is ≥1.0 cm; however, the size criteria is lowered to >0.5 cm in the presence of extrathyroidal extensions, cervical lymph node or distant metastasis, trachea or recurrent laryngeal nerve invasion, and tumor progression.
- What is the evidence for changing the size criteria for high suspicion nodules from >0.5 cm in the 2009 ATA guidelines to ≥1.0 cm in the 2015 ATA guidelines? In 2009, they referred to a study showing that PTCs >0.5 cm had significantly higher lymph node metastasis and recurrence [10]. While in 2015, they described that PTMCs, the PTCs ≤1 cm size have disease-specific mortality rates reported to be <1%, locoregional recurrence rates of 2% to 6%, and distant recurrence rates of 1% to 2% based on Mazzaferri's review [11]. They also insisted that these excellent outcomes are more related to the indolent nature of the disease rather than to the effectiveness of treatment. Furthermore, they suggested that a conservative approach of active surveillance management may be appropriate as an alternative to FNA in selected patients. However, FNA for US high suspicion nodules ≤1 cm size is appropriate considering that: (1) unnecessary long-term follow-up study for benign nodules with a high suspicion US pattern (approximately 20% to 40% of nodules with a high suspicion pattern) can be avoided; (2) a small percentage of patients with PTMC present with clinically significant regional or distant metastases; and (3) active surveillance for cytologically proven PTMC is also possible. For these reasons, the KTA guidelines will adopt the K-TIRADS recommendations to determine FNA indication instead of using the ATA system.
SIZE CRITERIA FOR FINE NEEDLE ASPIRATION
- When a cytology result is diagnostic for thyroid malignancy, active surveillance as well as immediate surgery was recommended in the 2015 ATA guidelines as a treatment option for patients with (1) very low risk of tumors clinically (without local invasion or metastasis) or cytologically (no evidence of aggressive disease), (2) high surgical risk because of comorbid conditions, or (3) a relatively short life expectancy. This recommendation is based on the results from two prospective clinical studies on active surveillance of patients with low risk PTMC from Japan started in the 1990s [45]. These studies enrolled 1,465 patients with biopsy-proven PTMCs that were not surgically removed and were followed for up to 15 years (average, 5 to 6 years). Most patients showed stable tumor size after an average follow-up of 60 months whereas 5% to 7% of patients showed tumor enlargement (>3 mm) by US on 5-year follow-up, and 8% showed this enlargement on 10-year follow-up. Additionally, 1% to 1.7% and 3.8% of patients at 5- and 10-year follow-up, respectively, showed evidence for lymph node metastases (Table 3). Furthermore, recurrence after delayed surgery was very rare (1/196 and 0/16) with an average of 6 years of follow-up. Interestingly, clinical progression (tumor growth or new lymph node metastasis) was related to patient age; younger patients (<40 years old) had a significantly higher progression rate (8.9%) than patients >60 years old (1.6%) [4]. Citing these results, the 2015 ATA guidelines suggested that active surveillance could be a treatment option for PTMC patients instead of immediate surgery. Until now, there are no reliable clinical features (including molecular tests) that can differentiate PTMC in patients who develop progressive disease from indolent PTMC that does not cause significant disease [121314151617]. Further studies are needed not only on the natural history of PTMC but also on the identification of markers indicating progressiveness or indolence in PTMC. The KTA will cautiously adopt active surveillance for selective PTMC patients as a treatment option, particularly for older patients.
ACTIVE SURVEILLANCE FOR PAPILLARY THYROID MICROCARCINOMA
- Surgery is the most important component of treatment for DTC, and the extent of surgery has been debated for a long time. In previous guidelines including the 2009 ATA guidelines, total thyroidectomy had been endorsed as the primary initial surgical treatment for DTCs >1 cm regardless of locoregional or distant metastases based on study results showing that total thyroidectomy improved survival and decreased recurrence [18]. Moreover, remnant ablation using radioactive iodine (RAI) which has been routinely performed to facilitate detection of recurrent or persistent disease during follow-up is much more efficient after total thyroidectomy. However, recent data have demonstrated that clinical outcomes are very similar following lobectomy or total thyroidectomy in patients with PTCs sized 1 to 2 cm and 2 to 4 cm [192021]. Furthermore, RAI remnant ablation has not been proven to be completely efficient and improve outcomes in low to intermediate risk patients, so total thyroidectomy to facilitate RAI therapy in these groups is needed in selective cases.
- Surgical complications are another factor supporting lobectomy instead of total thyroidectomy in the 2015 ATA guidelines. Postoperative hypoparathyroidism and recurrent laryngeal nerve injury are well-known surgical complications after total thyroidectomy. Surgical complication rates naturally correlate with surgical volumes [2223], although even in high volume surgeons (>100 thyroidectomies per year), complication rates were significantly higher after total thyroidectomy [24]. Based on this rationale, the 2015 ATA guidelines recommend (1) total thyroidectomy only for high risk patients with a tumor >4 cm and gross extrathyroidal extension (T4), clinical cervical nodes metastasis (cN1), or distant metastasis (M1); (2) either a bilateral or a unilateral thyroidectomy as an initial surgical treatment for DTC patients with 1 to 4 cm tumors without extrathyroidal extension and without clinical node metastasis (cN0): lobectomy alone may be sufficient for low-risk DTC patients; and (3) lobectomy as an initial treatment for patients with <1 cm tumors without extrathyroidal extension and cN0. However, in actual clinical practice, 1 to 4 cm DTCs without extrathyroidal extension and without clinical node metastasis (cN0) are so rare that total thyroidectomy would be necessary for patients with tumors in these ranges. Moreover, in Korea, surgical volume is much higher and postoperative complication rates are reported to be lower compared to other countries. The KTA guidelines flexibly accept the surgical extent for DTCs recommended by the ATA.
SURGICAL EXTENT FOR DIFFERENTIATED THYROID CANCER
- DTCs, especially PTMCs, have excellent prognosis with very low mortality, which makes it difficult to determine the most efficient treatment options based on prospective, randomized controlled studies. Many of the published guidelines for the management of thyroid nodules and DTCs were necessarily based on retrospective experiential reviews. In the 2015 ATA guidelines, more conservative approaches to the diagnosis and treatment of DTCs were recommended because it was not certain if aggressive treatments were clearly beneficial rather than harmful for patients. The KTA will 'flexibly' and 'selectively' adopt the 2015 ATA guidelines such as active surveillance for PTMC patients and surgical extents for DTCs sized 1 to 4 cm; however, for FNA criteria according to US features, the K-TIRADS system will be used. Research to identify markers that can differentiate progressive from indolent PTMC as well as on the natural history of this disease should be continued in the future.
CONCLUSIONS
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Acknowledgements
- The revised KTA guidelines for the management of thyroid nodules and thyroid cancer will be published this year in the Journal of Korean Thyroid Association.
ACKNOWLEDGMENTS
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CONFLICTS OF INTEREST: No potential conflict of interest relevant to this article was reported.
Article information
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References
Fig. 1
Algorithm used in the Korean Thyroid Imaging Reporting and Data System for malignancy risk stratification based on solidity and echogenicity of thyroid nodules. Adapted from Shin et al. [9]. US, ultrasonography. aMicrocalcification, taller than wide shape, spiculated/microlobulated margin.
Table 1
![enm-31-373-i001.jpg]()
Sonographic Patterns, Risk of Malignancy, and FNA Guidance for Thyroid Nodules in the 2015 American Thyroid Association Guidelines
Adapted from Haugen et al., with permission from Mary Ann Liebert, Inc. [3].
FNA, fine needle aspiration; US, ultrasonography; ETE, extrathyroidal extension.
aThe estimate is derived from high volume centers, the overall risk of malignancy may be lower given the interobserver variability in sonography; bAspiration of the cyst may be considered for symptomatic or cosmetic drainage.
Table 2
![enm-31-373-i002.jpg]()
Malignancy Risk Stratification according to K-TIRADS and FNA Indications
Adapted from Shin et al. [9]. LV and HV indicate low and high cancer volume data, respectively. Solid hypoechoic nodules include solid nodules with marked or mild hypoechogenicity.
K-TIRADS, Korean Thyroid Imaging Reporting and Data System; FNA, fine needle aspiration; US, ultrasonography; LV, low volume; HV, high volume; NA, not applicable for FNA.
aFNA is indicated regardless of size and US feature of nodule in presence of poor prognostic factors including suspected lymph node metastasis by US or clinical evaluation, suspected extrathyroidal tumor extension, patients with diagnosed distant metastasis from thyroid cancer; bMicrocalcification, nonparallel orientation (taller-than-wide), spiculated/microlobulated margin; cMalignancy risk calculated from nodules excluding spongiform or partially cystic nodules with comet tail artifacts; dK-TIRADS 2 (benign category) includes partially cystic nodules with spongiform appearance or comet tail artifacts which do not have any suspicious US feature.
Table 3
![enm-31-373-i003.jpg]()
Results of Two Studies on Active Surveillance in Japan
| Variable | Ito et al. (2014) [4] | Sugitani et al. (2010) [5] |
|---|---|---|
| No. of patients | 1,235 | 230 |
| Mean follow-up duration, mo | 60 | 60 |
| Progression, % | ||
| Size enlargement >3 mm | ||
| 5 yr | 5 | 7 |
| 10 yr | 8 | |
| LN metastasis | ||
| 5 yr | 1.7 | 1 |
| 10 yr | 3.8 | |
| Recurrence after delayed Op | 1/191 | 0/16 |
Figure & Data
References
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Ying Liu, Sheng Li, Cuiju Yan, Caiyun He, Miao Yun, Min Liu, Jianhua Zhou, Longzhong Liu
Clinical Imaging.2021; 75: 5. CrossRef - Clinical outcomes of T4a papillary thyroid cancer with recurrent laryngeal nerve involvement: a retrospective analysis
Han-Seul Na, Hyun-Keun Kwon, Sung-Chan Shin, Yong-Il Cheon, Myeonggu Seo, Jin-Choon Lee, Eui-Suk Sung, Minhyung Lee, In-Joo Kim, Bo Hyun Kim, Byung-Joo Lee
Scientific Reports.2021;[Epub] CrossRef - Protocol for a Korean Multicenter Prospective Cohort Study of Active Surveillance or Surgery (KoMPASS) in Papillary Thyroid Microcarcinoma
Min Ji Jeon, Yea Eun Kang, Jae Hoon Moon, Dong Jun Lim, Chang Yoon Lee, Yong Sang Lee, Sun Wook Kim, Min-Hee Kim, Bo Hyun Kim, Ho-Cheol Kang, Minho Shong, Sun Wook Cho, Won Bae Kim
Endocrinology and Metabolism.2021; 36(2): 359. CrossRef - Thyroid nodules in childhood‐onset Hashimoto's thyroiditis: Frequency, risk factors, follow‐up course and genetic alterations of thyroid cancer
Yun Jeong Lee, Yeon Jin Cho, You Joung Heo, Eun‐Jae Chung, Young Hun Choi, Jong‐Il Kim, Young Joo Park, Choong Ho Shin, Young Ah Lee
Clinical Endocrinology.2021; 95(4): 638. CrossRef - Clinical implications of age and excellent response to therapy in patients with high‐risk differentiated thyroid carcinoma
Meihua Jin, Jonghwa Ahn, Yu‐Mi Lee, Tae‐Yon Sung, Dong Eun Song, Tae Yong Kim, Ki‐Wook Chung, Jin‐Sook Ryu, Won Bae Kim, Young Kee Shong, Min Ji Jeon, Won Gu Kim
Clinical Endocrinology.2021; 95(6): 882. CrossRef - Ecografía clínica de la glándula tiroides y del cuello
Pepa Bertrán Culla, David Teixidó Gimeno, Pere Guirado Vila
FMC - Formación Médica Continuada en Atención Primaria.2021; 28(7): 390. CrossRef - Active Surveillance as an Effective Management Option for Low-Risk Papillary Thyroid Microcarcinoma
Min Ji Jeon, Won Gu Kim, Tae Yong Kim, Young Kee Shong, Won Bae Kim
Endocrinology and Metabolism.2021; 36(4): 717. 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 - Optimization of follow-up in patients with papillary thyroid cancer who show no evidence of disease 9–12 months after treatment
Fabian Nordell, Ghadir Hallal, Pernilla Asp, Martin Almquist
BJS Open.2021;[Epub] CrossRef - The most reliable time point for intact parathyroid hormone measurement to predict hypoparathyroidism after total thyroidectomy with central neck dissection to treat papillary thyroid carcinoma: a prospective cohort study
Jae Won Chang, Ki Wan Park, Seung-Nam Jung, Lihua Liu, Sung Min Kim, Bon Seok Koo
European Archives of Oto-Rhino-Laryngology.2020; 277(2): 549. CrossRef - Time Trends for Prostate Cancer Incidence from 2003 to 2013 in South Korea: An Age-Period-Cohort Analysis
Hyun Young Lee, Do Kyoung Kim, Seung Whan Doo, Won Jae Yang, Yun Seob Song, Bora Lee, Jae Heon Kim
Cancer Research and Treatment.2020; 52(1): 301. CrossRef - Clinical behavior and outcome of papillary T1 thyroid cancers: South Korea vs. Turkey vs. Colombia in a cohort study analyzing oncological outcomes
Murat Ozdemir, Yong-Sang Lee, Ozer Makay, Juan Pablo Dueñas, Bulent Yazici, Aysegul Akgun, Gokhan Icoz, Mahir Akyildiz, Soo Young Kim, Seok-Mo Kim, Hojin Chang, Hang-Seok Chang, Cheong Soo Park
Asian Journal of Surgery.2020; 43(8): 795. CrossRef - Radioiodine ablation in thyroid cancer patients: renal function and external radiation dose rate at discharge according to patient preparation
Yeon-Hee Han, Hwan-Jeong Jeong, Myung-Hee Sohn, Sun Y. Lee, Seok T. Lim
The Quarterly Journal of Nuclear Medicine and Molecular Imaging.2020;[Epub] CrossRef - Effect of the location and size of thyroid nodules on the diagnostic performance of ultrasound elastography: A retrospective analysis
Xinxin Xie, Yongqiang Yu
Clinics.2020; 75: e1720. CrossRef Fine-Needle Aspiration of Subcentimeter Thyroid Nodules in the Real-World Management
Chaiho Jeong, Hyunsam Kim, Jeongmin Lee, Jeonghoon Ha, Min-Hee Kim, Moo Il Kang, Dong-Jun Lim
Cancer Management and Research.2020; Volume 12: 7611. CrossRef- Continuing controversy regarding individualized surgical decision-making for patients with 1–4 cm low-risk differentiated thyroid carcinoma: A systematic review
Wen Liu, Xuejing Yan, Ruochuan Cheng
European Journal of Surgical Oncology.2020; 46(12): 2174. CrossRef - Clinical Implication of World Health Organization Classification in Patients with Follicular Thyroid Carcinoma in South Korea: A Multicenter Cohort Study
Meihua Jin, Eun Sook Kim, Bo Hyun Kim, Hee Kyung Kim, Hyon-Seung Yi, Min Ji Jeon, Tae Yong Kim, Ho-Cheol Kang, Won Bae Kim, Young Kee Shong, Mijin Kim, Won Gu Kim
Endocrinology and Metabolism.2020; 35(3): 618. CrossRef - Clinical Outcomes of N1b Papillary Thyroid Cancer Patients Treated with Two Different Doses of Radioiodine Ablation Therapy
Meihua Jin, Jonghwa Ahn, Yu-Mi Lee, Tae-Yon Sung, Won Gu Kim, Tae Yong Kim, Jin-Sook Ryu, Won Bae Kim, Young Kee Shong, Min Ji Jeon
Endocrinology and Metabolism.2020; 35(3): 602. CrossRef - A Propensity Score-matched Comparison Study of Surgical Outcomes in Patients with Differentiated Thyroid Cancer After Robotic Versus Open Total Thyroidectomy
Dong Sik Bae, Do Hoon Koo
World Journal of Surgery.2019; 43(2): 540. CrossRef - Diagnostic value of cytology, thyroglobulin, and combination of them in fine-needle aspiration of metastatic lymph nodes in patients with differentiated thyroid cancer
Yixin Xu, Dapeng Wu, Wenting Wu, Jian Jiang, Cheng Xi, Nianyuan Ye, Yibo Wang, Xuezhong Xu
Medicine.2019; 98(45): e17859. CrossRef - Investigation of blood groups in benign thyroid diseases in Turkey
Murat Dağdeviren, İhsan Ateş, Burak Furkan Demir, Emine Ergün, Canan Yıldız, Mustafa Altay
Endocrine Journal.2019; 66(11): 1001. CrossRef - Tumor Volume Doubling Time in Active Surveillance of Papillary Thyroid Carcinoma
Hye-Seon Oh, Hyemi Kwon, Eyun Song, Min Ji Jeon, Tae Yong Kim, Jeong Hyun Lee, Won Bae Kim, Young Kee Shong, Ki-Wook Chung, Jung Hwan Baek, Won Gu Kim
Thyroid.2019; 29(5): 642. CrossRef - Tumor doubling time predicts response to sorafenib in radioactive iodine-refractory differentiated thyroid cancer
Min Joo Kim, Seok-Mo Kim, Eun Kyung Lee, Yul Hwangbo, You Jin Lee, Sun Wook Cho, Do Joon Park, Yumi Lee, Young Joo Park
Endocrine Journal.2019; 66(7): 597. CrossRef - Total thyroidectomy's association with survival in papillary thyroid cancers and the high proportion of total thyroidectomy in low-risk patients: Analysis of Korean nationwide data
Hyun-Soo Zhang, Eun-Kyung Lee, Yuh-Seog Jung, Byung-Ho Nam, Kyu-Won Jung, Hyun-Joo Kong, Young-Joo Won, Boyoung Park
Surgery.2019; 165(3): 629. CrossRef - Individualized Follow-Up Strategy for Patients with an Indeterminate Response to Initial Therapy for Papillary Thyroid Carcinoma
Hye-Seon Oh, Jong Hwa Ahn, Eyun Song, Ji Min Han, Won Gu Kim, Tae Yong Kim, Won Bae Kim, Young Kee Shong, Min Ji Jeon
Thyroid.2019; 29(2): 209. CrossRef - Differentiated Thyroid Cancer and Radioactive Iodine: Past, Present and Future
Jaetae Lee, Il Jo
International Journal of Thyroidology.2019; 12(2): 71. CrossRef - Diagnostic performance of HMGA2 gene expression for differentiation of malignant thyroid nodules: A systematic review and meta‐analysis
Bo Hyun Kim, Seong Jang Kim, Mijin Kim, Sang‐Woo Lee, Shin Young Jeong, Kyoungjune Pak, Keunyoung Kim, In Joo Kim
Clinical Endocrinology.2018; 89(6): 856. CrossRef - Ultrasound risk evaluation of thyroid nodules that are “unspecified” in the 2015 American Thyroid Association management guidelines
Luying Gao, Xuehua Xi, Juanjuan Wang, Xiao Yang, Ying Wang, Shenling Zhu, Xingjian Lai, Xiaoyan Zhang, Ruina Zhao, Bo Zhang
Medicine.2018; 97(52): e13914. CrossRef - Refining the eighth edition AJCC TNM classification and prognostic groups for papillary thyroid cancer with lateral nodal metastasis
Hye In Kim, Kyunga Kim, So Young Park, Jun-Ho Choe, Jung-Han Kim, Jee Soo Kim, Young Lyun Oh, Soo Yeon Hahn, Jung Hee Shin, Hyeon Seon Ahn, Sun Wook Kim, Tae Hyuk Kim, Jae Hoon Chung
Oral Oncology.2018; 78: 80. CrossRef - Thyroid cancer surgery guidelines in an era of de-escalation
K.J. Kovatch, C.W. Hoban, A.G. Shuman
European Journal of Surgical Oncology.2018; 44(3): 297. CrossRef - Changes in Serum Thyroglobulin Levels After Lobectomy in Patients with Low-Risk Papillary Thyroid Cancer
Suyeon Park, Min Ji Jeon, Hye-Seon Oh, Yu-Mi Lee, Tae-Yon Sung, Minkyu Han, Ji Min Han, Tae Yong Kim, Ki-Wook Chung, Won Bae Kim, Young Kee Shong, Won Gu Kim
Thyroid.2018; 28(8): 997. CrossRef - Study Protocol of Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro)
Jae Hoon Moon, Ji-hoon Kim, Eun Kyung Lee, Kyu Eun Lee, Sung Hye Kong, Yeo Koon Kim, Woo-jin Jung, Chang Yoon Lee, Roh-Eul Yoo, Yul Hwangbo, Young Shin Song, Min Joo Kim, Sun Wook Cho, Su-jin Kim, Eun Jae Jung, June Young Choi, Chang Hwan Ryu, You Jin Lee
Endocrinology and Metabolism.2018; 33(2): 278. CrossRef - Low-Dose Radioactive Iodine Ablation Is Sufficient in Patients With Small Papillary Thyroid Cancer Having Minor Extrathyroidal Extension and Central Lymph Node Metastasis (T3 N1a): Reply
Minjung Seo, Yon Seon Kim, Jong Cheol Lee, Myung Woul Han, Eun Sook Kim, Kyung Bin Kim, Seol Hoon Park
Clinical Nuclear Medicine.2018; 43(8): 635. CrossRef - Diagnosis and treatment of low-risk papillary thyroid microcarcinoma
Jae Hoon Moon, Young Joo Park
Journal of the Korean Medical Association.2018; 61(4): 232. CrossRef - Efficacy of a Home-Based Exercise Program After Thyroidectomy for Thyroid Cancer Patients
Kyunghee Kim, Mee Ock Gu, Jung Hwa Jung, Jong Ryeal Hahm, Soo Kyoung Kim, Jin Hyun Kim, Seung Hoon Woo
Thyroid.2018; 28(2): 236. CrossRef - Genome-Wide Association Study Reveals Distinct Genetic Susceptibility of Thyroid Nodules From Thyroid Cancer
Yul Hwangbo, Eun Kyung Lee, Ho-Young Son, Sun-Wha Im, Soo-Jung Kwak, Ji Won Yoon, Min Joo Kim, Jeongseon Kim, Hoon Sung Choi, Chang Hwan Ryu, You Jin Lee, Jong-Il Kim, Nam H Cho, Young Joo Park
The Journal of Clinical Endocrinology & Metabolism.2018; 103(12): 4384. CrossRef - Active Surveillance of Low-Risk Papillary Thyroid Microcarcinoma: A Multi-Center Cohort Study in Korea
Hye-Seon Oh, Jeonghoon Ha, Hye In Kim, Tae Hyuk Kim, Won Gu Kim, Dong-Jun Lim, Tae Yong Kim, Sun Wook Kim, Won Bae Kim, Young Kee Shong, Jae Hoon Chung, Jung Hwan Baek
Thyroid.2018; 28(12): 1587. CrossRef - Ultrasound criteria for risk stratification of thyroid nodules in the previously iodine deficient area of Austria - a single centre, retrospective analysis
Christina Tugendsam, Veronika Petz, Wolfgang Buchinger, Brigitta Schmoll-Hauer, Iris Pia Schenk, Karin Rudolph, Michael Krebs, Georg Zettinig
Thyroid Research.2018;[Epub] CrossRef - Practical Initial Risk Stratification Based on Lymph Node Metastases in Pediatric and Adolescent Differentiated Thyroid Cancer
Min Ji Jeon, Young Nam Kim, Tae-Yong Sung, Suck Joon Hong, Yoon Young Cho, Tae Yong Kim, Young Kee Shong, Won Bae Kim, Sun Wook Kim, Jae Hoon Chung, Tae Hyuk Kim, Won Gu Kim
Thyroid.2018; 28(2): 193. CrossRef - Current Radiological Approach in Thyroid Nodules
Duzgun Yildirim, Deniz Alis, Sabri Sirolu, Cesur Samanci, Fethi Emre Ustabasioglu, Bulent Colakoglu
Journal of Cancer Therapy.2017; 08(05): 423. CrossRef - A new paradigm in low-risk papillary microcarcinoma: active surveillance
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Endocrinology, Diabetes & Metabolism Case Reports.2017;[Epub] CrossRef - Serial Neck Ultrasonographic Evaluation of Changes in Papillary Thyroid Carcinoma During Pregnancy
Hye-Seon Oh, Won Gu Kim, Suyeon Park, Mijin Kim, Hyemi Kwon, Min Ji Jeon, Jeong Hyun Lee, Jung Hwan Baek, Dong Eun Song, Tae Yong Kim, Young Kee Shong, Won Bae Kim
Thyroid.2017; 27(6): 773. CrossRef - Restratification of survival prognosis of N1b papillary thyroid cancer by lateral lymph node ratio and largest lymph node size
Hye In Kim, Tae Hyuk Kim, Jun‐Ho Choe, Jung‐Han Kim, Jee Soo Kim, Young Lyun Oh, Soo Yeon Hahn, Jung Hee Shin, Hye Won Jang, Young Nam Kim, Hosu Kim, Hyeon Seon Ahn, Kyunga Kim, Sun Wook Kim, Jae Hoon Chung
Cancer Medicine.2017; 6(10): 2244. CrossRef - Comparison on Fine Needle Aspiration Cytology (FNAC) and Thyroid Ultrasonography in Management of Thyroid Nodules
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International Clinical Pathology Journal.2017;[Epub] CrossRef - Current Practices of Thyroid Fine-Needle Aspiration in Asia: A Missing Voice
Andrey Bychkov, Kennichi Kakudo, SoonWon Hong
Journal of Pathology and Translational Medicine.2017; 51(6): 517. CrossRef - Clinical outcomes after delayed thyroid surgery in patients with papillary thyroid microcarcinoma
Min Ji Jeon, Won Gu Kim, Hyemi Kwon, Mijin Kim, Suyeon Park, Hye-Seon Oh, Minkyu Han, Tae-Yon Sung, Ki-Wook Chung, Suck Joon Hong, Tae Yong Kim, Young Kee Shong, Won Bae Kim
European Journal of Endocrinology.2017; 177(1): 25. CrossRef - Articles inEndocrinology and Metabolismin 2016
Won-Young Lee
Endocrinology and Metabolism.2017; 32(1): 62. CrossRef - The Impact of Thyroid Nodule Size and Fine-Needle Aspiration Biopsy Result on the Risk of Malignancy in the Patients Who Underwent Thyroidectomy
Hwibin Im, Yu-Young Park, Jae-Gu Cho, Seung-Kuk Baek, Soon-Young Kwon, Kwang-Yoon Jung, Jeong-Soo Woo
Korean Journal of Otorhinolaryngology-Head and Neck Surgery.2017; 60(6): 308. CrossRef - Active Surveillance of Papillary Thyroid Microcarcinoma: A Mini-Review from Korea
Tae Yong Kim, Young Kee Shong
Endocrinology and Metabolism.2017; 32(4): 399. CrossRef
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