Ultrasonographic criteria for fine needle aspiration of nonpalpable thyroid nodules 1– 2cm in diameter Ji Yang Kim, Soo Young Kim, Ki Ra Yang European.

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Ultrasonographic criteria for fine needle aspiration of nonpalpable thyroid nodules 1– 2cm in diameter Ji Yang Kim, Soo Young Kim, Ki Ra Yang European Journal of Radiology Volume 82, Issue 2, Pages 321-326 (February 2013) DOI: 10.1016/j.ejrad.2012.10.017 Copyright © 2012 Elsevier Ireland Ltd Terms and Conditions

Fig. 1 A typical malignant thyroid nodule in a 50-year-old female patient. Ultrasonography shows a 12-mm, markedly hypoechoic nodule with irregular, taller-than-wide shape and spiculated margin in the right lobe. Intranodular microcalcification (arrow) is seen. The nodule has 5 US characteristics significant for a malignant nodule. It was confirmed as papillary carcinoma after total thyroidectomy. European Journal of Radiology 2013 82, 321-326DOI: (10.1016/j.ejrad.2012.10.017) Copyright © 2012 Elsevier Ireland Ltd Terms and Conditions

Fig. 2 A benign thyroid nodule with honeycomb appearance in a 56-year-old male patient. Longitudinal ultrasonography shows an 11-mm, hypoechoic, honeycomb-appearing nodule. Multiple small anechoic cystic spaces are seen within the nodule. The cytology report after FNA revealed that it was a benign lesion. European Journal of Radiology 2013 82, 321-326DOI: (10.1016/j.ejrad.2012.10.017) Copyright © 2012 Elsevier Ireland Ltd Terms and Conditions

Fig. 3 A malignant thyroid nodule with hypoechogenecity in a 58-year-old female patient. Transverse US shows a 16.5-mm, hypoechoic nodule (arrow). No other US features suggestive of malignancy is seen. It was confirmed as papillary carcinoma after total thyroidectomy. European Journal of Radiology 2013 82, 321-326DOI: (10.1016/j.ejrad.2012.10.017) Copyright © 2012 Elsevier Ireland Ltd Terms and Conditions

Fig. 4 Malignant thyroid nodule with coarse calcifications in a 53-year-old male patient. Transverse ultrasonography shows a 13.1-mm, hypoechoic nodule with intranodular coarse calcification (arrows). It was confirmed as papillary carcinoma after total thyroidectomy. European Journal of Radiology 2013 82, 321-326DOI: (10.1016/j.ejrad.2012.10.017) Copyright © 2012 Elsevier Ireland Ltd Terms and Conditions

Fig. 5 A typical benign thyroid nodule with isoechogenecity and partial hypoechoic rim in a 57-year-old female patient. Longitudinal ultrasonography shows an 18.5-mm, isoechoic nodule with partial hypoechoic rim. These US characteristics were consistent with benign nodule. The cytology report after FNA was negative for malignant cells. The nodule showed no interval changes in size and shape at 17-month US follow-up. European Journal of Radiology 2013 82, 321-326DOI: (10.1016/j.ejrad.2012.10.017) Copyright © 2012 Elsevier Ireland Ltd Terms and Conditions

Fig. 6 Rim calcification. (a) A malignant nodule in a 54-year-old female patient. Ultrasonography shows a 15-mm nodule with arc calcification (arrow) and posterior shadowing in the left lobe. The nodule shows isoechogenecity except for the hypoechoic portion caused by posterior shadowing. It has a taller-than-wide shape, one of the malignant US characteristics. It was reported after FNA to be a suspected papillary carcinoma and was confirmed as a malignant nodule after total thyroidectomy in an outside hospital. (b) A benign nodule in a 47-year-old female patient. Ultrasonography shows a 10.3-mm, thyroid nodule with rim calcification (curved arrows) in the right lobe. Half of the nodule is veiled by posterior shadowing (straight arrow), and the remaining part is nearly isoechoic. Adenomatous goiter was reported after FNA. The nodule showed no interval changes in size and shape at 12-month US follow-up. European Journal of Radiology 2013 82, 321-326DOI: (10.1016/j.ejrad.2012.10.017) Copyright © 2012 Elsevier Ireland Ltd Terms and Conditions

Fig. 7 A malignant thyroid nodule with US characteristics suggestive of benign nodule in a 46-year-old female patient. Longitudinal US shows a 15-mm, isoechoic, nodule with hypoechoic rim (arrow). The US characteristics are consistent with benign nodules. It was confirmed as papillary carcinoma after total thyroidectomy. European Journal of Radiology 2013 82, 321-326DOI: (10.1016/j.ejrad.2012.10.017) Copyright © 2012 Elsevier Ireland Ltd Terms and Conditions

Fig. 8 Graph shows the decreased number of FNA when NFI is applied to exclude nodules from biopsy. 54 of 72 (75%) true benign nodules and 1 of 51 (1.9%) true malignant nodules would be excluded from biopsy. European Journal of Radiology 2013 82, 321-326DOI: (10.1016/j.ejrad.2012.10.017) Copyright © 2012 Elsevier Ireland Ltd Terms and Conditions