European Radiology

, Volume 29, Issue 1, pp 133–140 | Cite as

Malignancy risk of initially benign thyroid nodules: validation with various Thyroid Imaging Reporting and Data System guidelines

  • Su Min Ha
  • Jung Hwan BaekEmail author
  • Young Jun Choi
  • Sae Rom Chung
  • Tae Yon Sung
  • Tae Yong Kim
  • Jeong Hyun Lee
Head and Neck



Some authors have found little or no diagnostic benefit from repeated biopsy of benign thyroid nodules. However, to our knowledge, integration of Thyroid Imaging Reporting and Data System (TIRADS) guidelines with one biopsy for sufficient benign thyroid nodule diagnosis has not been previously described. We investigated malignancy rate and probability by using various malignancy stratification systems in initially biopsy-proven benign nodules and sought to determine their clinical relevance in management of benign thyroid nodules.


This retrospective study collected 6762 thyroid nodules from 6493 consecutive patients who underwent biopsy between January 2013 and December 2013. The initial biopsy with ≥1 year of follow-up was used as the gold standard for benign diagnosis. For our study purpose, we analyzed 2747 (57.0%, 2747 of 4822, 532 women, 2111 men; 229 malignant and 2518 benign) thyroid nodules diagnosed by initial biopsy with 28.2 ± 9.1 (range, 12–41) months of follow-up. We calculated the malignancy probability of thyroid nodules by using various malignancy risk stratification systems.


The overall calculated thyroid malignancy rate was 8.3% (229 of 2747). Initially biopsy-proven benign nodules exhibited a ≤3.0% malignancy probability when assessed as “low suspicion” by Korean-TIRADS (K-TIRADS), “low suspicion” by the ATA guideline, and “very probably benign” by the French TIRADS guideline and gave a score of ≤3 by the web-based TIRADS.


When initially biopsy-proven benign nodules exhibit a “low suspicion” US pattern and low malignancy probability, as stratified by various TIRADS guidelines, imaging surveillance instead of second biopsy is warranted.

Key Points

• One biopsy is sufficient for initially biopsy-proven benign nodules.

• Repetitive biopsy is necessary for imaging–pathology mismatched nodules.

• Scoring risk stratification permits personalized management.


Thyroid nodule Core needle biopsy Fine needle aspiration Diagnostic imaging Guideline 



American Thyroid Association


Core needle biopsy


Fine needle aspiration


Thyroid Imaging Reporting and Data System





The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Jung Hwan, Baek

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in Scientific Report 7:8242 by Suh CH et al.


• retrospective

• case-control study

• performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Su Min Ha
    • 1
  • Jung Hwan Baek
    • 2
    Email author
  • Young Jun Choi
    • 2
  • Sae Rom Chung
    • 2
  • Tae Yon Sung
    • 3
  • Tae Yong Kim
    • 4
  • Jeong Hyun Lee
    • 2
  1. 1.Department of Radiology and Thyroid Center, Chung-Ang University HospitalChung-Ang University College of MedicineSeoulKorea
  2. 2.Department of Radiology and the Research Institute of RadiologyUniversity of Ulsan College of MedicineSeoulKorea
  3. 3.Department of SurgeryUniversity of Ulsan College of MedicineSeoulKorea
  4. 4.Department of Internal MedicineUniversity of Ulsan College of MedicineSeoulKorea

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