МATERIALS AND METHODS:

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1 650 KCR 208 SE 3 TH-0 False negative rate of fine-needle aspiration in thyroid nodules: Impact of nodule size and US pattern Hye Shin Ahn, Dong Gyu Na 2, Jung Hwan Baek 3, Jin Yong Sung 4, Ji-Hoon Kim 5 Chung-Ang University Hospital, 2 GangNeung Asan Hospital, 3 Asan Medical Center, 4 Daerim St. Mary s Hospital, 5 Seoul National University Hospital, Korea. nndgna@gmail.com BACKGROUND: To retrospectively evaluate the false negative rate (FNR) of ultrasound (US)-guided fine needle aspiration (FNA) according to the nodule size and US pattern. MATERIALS AND METHODS: From January 200 to May 20, 432 consecutive thyroid nodules from 384 patients who underwent US-guided FNA with benign results ( cm) were included. The FNR in the nodules was assessed according to the nodule size (-.9 cm, cm, and 3 cm) and US pattern based on the Korean- Imaging Reporting and Data System (K-TIRADS). RESULTS: The overall FNR was 3.2% (4/432). Malignant nodules included 8 (57.%) papillary thyroid carcinomas and 6 (42.9%) follicular carcinomas. Although the FNR did not increase as the nodules enlarged among the overall nodules (p = 0.766), the FNR was higher in nodules with a high suspicion US pattern (K-TIRADS 5) (p < 0.00) and there was a trend towards an increasing FNR as the score of K-TIRADS increased (p < 0.00). In low or high suspicion nodules (K-TIRADS 3 and 5), there was no significant difference in FNR according to the nodule size; however, among the intermediate suspicion nodules (K-TIRADS 4), the FNR was significantly higher in large nodules ( 3 cm, p = 0.039) with a trend towards an increasing FNR as the nodules enlarged (p = 0.028). CONCLUSION: The impact of nodule size on the FNR differed according to the US pattern. A large nodule size ( 3 cm) showed a higher FNR than smaller nodules among the intermediate suspicion nodules. SE 3 TH-02 Ultrasonic main and assistant sign research for Hashimoto s chronic inflammation Bolormaa Myagmarjalbuu, Tserendorj Badamsed 2 The First Central Hospital, 2 Institute of Medical Sciences and State Third Central Hospital of Mongolia, Mongolia. m.bolormaa_095@yahoo.com PURPOSE: To determine ultrasonic sign for Hashimoto s chronic inflammation in our country condition first time and through the diagnostic signification we tried to study main and assisting ultrasonic signs. МATERIALS AND METHODS: We studied for 6 patients who diagnosed as Hashimoto s chronic inflammation since 206 to 208. Diagnose of these patients were proved by clinic, laboratory and biopsy tests. RESULTS: From the thyroid gland changes: 33.3% for right lobe, 6.7% for left lobe, 50% for collar, 6.7% for up to sm, 33.3% for -3 sm, 50% for above 3 sm, 33.3% for round shape, 50% for ellipse shape, 6.7% for irregular shape, 50% for unclear, 33.3% for clear, 66.7% for unclear border, 66.7% for homogenous, 33.4% for heterogeneous, 66.7% for contour decreased, 6.7% for mixed contour, 6.7% for calcified, 83.3% for non-calcified, 6.7% for ultrasonic opacification shadow, 83.3% for non-opacification shadow. CONCLUSION: Study determined the main (loss of regular contour, thickness decrease, round or ellipse shape, irregular, unclear border for thyroid gland change) and assisting (various located, various shape, calcification, non-opacification shadow) signs of Hashimoto s chronic inflammation. SE 3 TH radiofrequency ablation guideline: Korean society of thyroid radiology Ji-Hoon Kim Seoul National University Hospital, Korea. jihnkim@gmail.com Thermal ablation using radiofrequency is a new, minimally invasive modality employed as an alternative to surgery in patients with benign thyroid nodules and recurrent thyroid cancers. The Task Force Committee of the Korean Society of Radiology (KSThR) developed recommendations for the optimal use of radiofrequency ablation for thyroid tumors in 202. As new meaningful evidences have accumulated, KSThR decided to revise the guidelines. The revised guideline is based on a comprehensive analysis of the current literature and expert consensus.

2 Scientific Exhibitions 65 SE 3 TH-04 Shear-wave elastography as a predictor of extrathyroidal extension and cervical lymph node metastasis in papillary thyroid carcinoma Dong Yoon Han, Seong Jong Yun 2, Mirinae Seo, Yu-Mee Sohn 3 Kyung Hee University Medical Center, 2 Kyung Hee University Hospital at Gangdong, 3 Kyung Hee University Hospital, Korea. sonyumee@naver.com PURPOSE: To investigate whether extrathyroidal extension (ETE) and cervical lymph node metastasis (LNM) can be predicted using elasticity parameters of shear-wave elastography (SWE) combined with B-mode ultrasound (US) in papillary thyroid carcinoma (PTC) and their diagnostic performances. MATERIALS AND METHODS: We retrospectively reviewed 89 patients who underwent preoperative SWE evaluation among PTC patients who were performed US guided fine needle aspiration and surgery from July 206 to March 208. ETE positive groups and ETE negative groups were divided by pathologic report. Univariate and multivariate analysis were performed in clinical and radiologic features including B-mode US features and ATA US patterns and SWE parameters (Emax, Emean, Emin, Eratio). LNM positive and LNM negative groups were also analyzed as same above. In addition, the diagnostic performance of the SWE parameters in predicting ETE was determined by sensitivity, specificity, positive predictive value, negative predictive value and accuracy. RESULTS: Of the 89 patients, 28 (3%) were ETE positive, 6 (69%) were ETE negative, 37 (42%) were LNM positive and 52 (58%) were LNM negative. In univariate analysis, US size and T stage on US was predictive value of ETE (p < 0.00). In multivariate logistic regression analysis, taller than wide shape (p = 0.048) and T stage on US (p = 0.008) was to be associated with ETE. Gender (p = 0.033), types of surgery (p = 0.00) and size (p = 0.004) were significant difference on LNM in univariate analysis. And in multivariate logistic regression analysis, gender (p = 0.028) and types of surgery (p = 0.009) were significant difference on LNM. No significant differences were detected in SWE parameters on ETE and LNM. When combined with B-mode US and SWE, the sensitivity was higher than B-mode US without significance. CONCLUSION: SWE parameters could not predict ETE and LNM. SE 3 TH-05 Accuracy of US features of thyroid nodules based on the Image Reporting and Data System (TI-RADS) using histopathologic report as the gold standard Sean Sindo, Irene Bandong, Harold James Estrada Chong Hua Hospital, Philippines. seanqsindo@gmail.com BACKGROUND: nodule is a common ultrasound (US) finding. At present, there is no guideline in determining the need for a nodule to be biopsied. Imaging Reporting and Data system (TI-RADS), although not yet universally applied, has been used in several institutions to describe patterns of thyroid nodules and predict the rate of malignancy. A major benefit of TI-RADS is that it limits the number of thyroid biopsies when the nodule is deemed to have less malignant features. PURPOSE: To determine the accuracy of TI-RADS in detecting thyroid malignant lesions. Design: Cross-sectional analytical study. Population: A total of 97 patients were included in the study. These patients underwent biopsy and US. METHODS: Patients who underwent thyroid nodule biopsy were noted. Their US imaging findings were reviewed, described and graded according to TI-RADS. Statistical analysis: Chi square test / Fisher exact test of association. RESULTS: This study had a total of 97 patients, 88 patients had benign result and 9 patients had malignant result. A higher proportion of patients with malignant thyroid lesion was noted among those with higher TI- RADS classification. CONCLUSION: TI-RADS as seen on US is an accurate in determining the nodule as benign or malignant. SE 3 TH-06 Does RFA treatment induce neoplastic changes in benign thyroid nodules: A preliminary study Su Min Ha, Jung Hwan Baek 2, Dong Eun Song 2, Jun Young Shin 2, Sae Rom Chung 2, Young Jun Choi 2, Jeong Hyun Lee 2 Chung-Ang University Hospital, 2 Asan Medical Center, Korea. radbaek@naver.com PURPOSE: Radiofrequency ablation (RFA) is being accepted as the treatment of choice in cases of symptomatic thyroid nodules instead of surgery. To our knowledge, no data is yet available on whether RFA promotes neoplastic transformation of the undertreated peripheral portion of the benign nodules. Our study

3 652 KCR 208 was designed to evaluate the clinical feasibility of RFA treatment of benign thyroid nodules along with cytomorphological alteration, and any malignant changes through biopsy. MATERIALS AND METHODS: The data were retrospectively collected between April 2008 and June 203 and core needle biopsy (CNB) was performed on 6 benign thyroid nodules previously treated using RFA. The parameters of the patients were compared, between the time of enrollment and the last followup 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 8.2% 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 8.3 ± 5.8% (p < 0.000). 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. SE 3 TH-07 Radiofrequency ablation of benign non-functioning thyroid nodules: More than 7-years follow-up results Su Min Ha, Jin Yong Sung 2, Jung Hwan Baek 3, Hyunju Yoo 2, Dong Whan Choi 2, Ducky Lee 2 Chung-Ang University Hospital, 2 Daerim St. Mary s Hospital, 3 Asan Medical Center, Korea. jysrad68@empas.com PURPOSE: To evaluate the clinical outcomes and safety of radiofrequency (RF) ablation for benign nonfunctioning thyroid nodules over a 7-year follow-up. MATERIALS AND METHODS: We evaluated 85 benign non-functioning thyroid nodules of 68 patients treated with RF ablation and followed up more than 7 years. RF ablation was performed using the RF generator and an internally cooled electrode. Nodule volume and cosmetic and symptom scores were evaluated before treatment and during follow-up. Complications and factors related to efficacy were evaluated. RESULTS: The mean follow-up duration was 96.6 ± months. The mean number of follow-up US examinations after RFA was 9.64 ± At last followup, the longest nodule diameter and the nodule volume significantly decreased (3.39 ±.5 cm vs ±.00 cm and.39 ± 4.7 ml vs..8 ± 3.72 ml, respectively; p < 0.05); a mean volume reduction of ± 7.06%. Both cosmetic and compressive symptoms significantly improved (3.36 ± 0.80 vs..30 ± 0.52 and 3.70 ±.92 vs ± 0.30, respectively; p < 0.05). Mean number of ablation sessions was.90 ±.4. The overall recurrence rate was 0.8% (20/85). The overall complication rate was 6.55% (/68). CONCLUSION: RF ablation was effective in shrinking benign thyroid nodules and in controlling nodule-related problems over a 7-year follow-up. There was no lifethreatening complication. Therefore, RF ablation can be used as a non-surgical treatment for patients with benign non-functioning thyroid nodules. SE 3 TH-08 Various complementary assays from US-guided fine needle aspiration biopsy specimen in the diagnosis of thyroidal or perithyroidal lesion: How to and when Ji-Young Hwang, Jin Hee Moon, Sook Min Hwang, Ji Young Woo, Hye Jeong Kim, Han Myeon Kim, Ik Yang, Hee Young Kim Kangnam Sacred Heart Hospital, Korea. imp9653@naver.com INTRODUCTION: Although ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) with cytological evaluation is the most reliable tool in diagnosis of thyroid and perithyroidal lesions, 0-40% of nodules are diagnosed as indeterminate by cytology. We would describe currently feasible complementary assays from FNA specimen for enhancing the accuracy of FNA diagnosis and discuss appropriate indications. METHODS AND CASE PRESENTATIONS: We would depict cases using various feasible complementary assays from US-guided FNA specimen and discuss appropriate indications.. Washout Thyroglobulin (Tg) measurement in the wash out fluid from FNA for metastatic lymph node or locoregional recurrence in patients with papillary thyroid cancer (PTC) 2. Washout Calcitonin (CT) measurement in the wash out fluid from FNA for suspect medullary thyroid carcinoma (MTC). 3. Tb (Tuberculosis)-PCR (Polymerase Chain Reaction) for diagnosing tuberculous lymphadenopathy or abscess 4. Washout PTH (Parathyroid Hormone) measurement in the wash out fluid from FNA for parathyroidal lesion RESULT/DISCUSSION: US-guided FNAB Tg or CT are valuable tool in the identification of primary PTC or MTC and its neck LN metastases or recurrences. FNAB Tb- PCR facilitate early diagnosis and allowing appropriate therapy and washout PTH may enhance the accuracy of diagnosis of parathyroid lesions.

4 Scientific Exhibitions 653 CONCLUSION:. You would understand currently feasible complementary assays from FNA specimen in the diagnosis of thyroid and perithyroidal lesion. 2. Various complementary assays from US-guided FNA specimen could help to enhance the accuracy of FNAB diagnosis. 3. You could use the appropriate complementary assay at the time of FNAB in your practice. SE 3 TH-09 Two lethal cases of anaplastic carcinoma Miok Sunwoo Samsung Changwon Hospital, Korea. sunwooeh@gmail.com were malignant. At multivariate analysis, US features of nonparallel shape (odds ratio, 9.6; p = 0.002) and microcalcification (odds ratio, 7.3; p = 0.002) of contralateral nodules and US extrathyroidal extension (ETE) of the index cancer (odds ratio, 4.8; p = 0.046) were independently associated with contralateral malignancy. At final pathology, T3 stage of PTMC were associated with contralateral malignancy (p = 0.035). CONCLUSION: US features of nonparellel shape and microcalcification of contralateral nodules and US ETE of the index cancer could predict contralateral carcinoma in patients with unilateral PTMC. Operation or meticulous follow-up US should be performed for contralateral nodules showing these suspicious US features. Anaplastic thyroid cancer (ATC) is a relatively rare tumor of the thyroid follicular epithelium. Recently, I experience two lethal cases of anaplastic carcinoma. The case of an unfortunate man with ATC causing death within weeks of diagnosis. The case 2 was not rapidly enlarged but presented indolent compressive symptom and finally, discharged hopelessly. All Two was confirmed CNB of the thyroid gland. SE 3 TH-0 US findings predicting malignancy in contralateral nodules of unilateral papillary thyroid microcarcinoma Na Lae Eun, Eun Ju Son, Jeong-Ah Kim, Hye Mi Gweon, Ji Hyun Youk Gangnam Severance Hospital, Korea. JAKIM@yuhs.ac PURPOSE: To investigate preoperative ultrasound (US) features and pathologic findings of the index cancer and contralateral nodules to predict contralateral malignancy in patients with unilateral papillary thyroid microcarcionoma (PTMC). MATERIALS AND METHODS: We enrolled 69 consecutive patients who underwent preoperative US and lobectomy for unilateral PTMC with intraoperative frozen section diagnosis for contralateral nodules, between January 204 and December 206. Clinicopathologic variables and preoperative US features of the index cancer and contralateral nodules were retrospectively reviewed. Association between these variables and pathology of the index cancer and contralateral nodules were assessed by using logistic regression analysis. RESULTS: Of the 69 contralateral nodules, 54 (9.%) nodules were benign and 5 nodules (8.9%) SE 3 TH- Korean thyroid imaging reporting and data system features of follicular thyroid adenoma and nodular hyperplasia Eun Young Yoo, Sang Yu Nam, Chorong Seo, Hye-Young Choi, Min Ji Hong Gachon University Gil Medical Center, Korea. sy.nam@gilhospital.co PURPOSE: To comparison of ultrasonography (US) features of follicular thyroid adenoma (FTA) and nodular hyperplasia (NH) by using the most recently published guidelines for the US-based management of thyroid nodules, the Korean Imaging Reporting and Data System (K-TIRADS). MATERIALS AND METHODS: From January 200 to December 20, 06 patients who underwent preoperative thyroid US and thyroid surgery were included. The US features of each thyroid nodule were retrospectively reviewed according to the K-TIRADS. RESULTS: Of the 06 nodules (mean size, 3.8 ±.6 cm), 22 were FTAs (mean size, 4. ±.2 cm) and 84 were NHs (mean size: 3.3 ±.6 cm). A statistically significant difference was found between FTA and NH regarding the halo (p = 0.005), while no significant differences were observed in the solidity, echogenicity, shape, orientation, calcification, or vascularity of the lesion (p > 0.05). The FTAs belonged to K-TIRADS categories 3 (n = 5) and 4 (n = 7), while the NHs belonged to K-TIRADS categories 2 (n = ), 3 (n = 7), 4 (n = ), and 5 (n = ). There was no statistically significant difference in the distribution of K-TIRADS categories between FTAs and NHs (p = 0.9). CONCLUSION: US features were not helpful for distinguishing FTA from NH, although FTAs showed a high prevalence of having halo on US.

5 654 KCR 208 SE 3 TH-2 The thickness of hypoechoic rim of thyroid nodules on US: What does it mean? Chorong Seo, Sang Yu Nam, Eun Young Yoo, Min Ji Hong, Hye-Young Choi Gachon University Gil Medical Center, Korea. flyhigh054@naver.com PURPOSE: To comparison of clinicopathologic features of thyroid nodules according to the thickness of hypoechoic rim on ultrasonography (US). MATERIALS AND METHODS: From January 206 to December 206, 235 thyroid nodules were having hypoechoic rim on US were included. All patients underwent preoperative thyroid US and thyroid surgery. The thickness of hypoehoic rim of each thyroid nodule was retrospectively reviewed according to the clinicopathologic features. Thick group was defined as a thickness of hypoechoic rim of mm. RESULTS: Of the 235 thyroid nodules (mean size, 2.0 ±.6 cm; mean thickness, 0.86 mm), 8 were thick group and 54 were thin group. A statistically significant difference was found between thick and thin group regarding the malignant nodules (p = ) and extrathyroidal tumor extension (p = ), while no significant differences were observed in the tumor size, age, sex, op method, status of lymph node metastasis, the number of metastatic lymph node, or lymphovascular tumor extension of the lesion (p > 0.05). CONCLUSION: The thickness of hypoechoic rim of thyroid nodules on preoperative US were helpful for predicting malignancy and extrathyroidal tumor extension. SE 3 TH-3 Comparison of US features of benign thyroid nodules according to the interval changes by using the Korean Imaging Reporting and Data System Sang Yu Nam, Eun Young Yoo, Chorong Seo, Min Ji Hong, Hye Young Choi Gachon University Medical Campus (School), Korea. sangyu.nam7@gmail.com PURPOSE: To comparison of ultrasonography (US) features of benign thyroid nodules according to the interval changes by using the most recently published guidelines for the US-based management of thyroid nodules, the Korean Imaging Reporting and Data System (K-TIRADS). MATERIALS AND METHODS: A retrospective study was conducted on patients performed fine needle aspiration biopsy (FNAB) for benign thyroid nodules from March 204 to February 206. Among the 488 patients who underwent thyroid FNAB, 28 benign thyroid nodules were found, of which 04 were having follow-up imaging. The US images were analyzed according to the US descriptors of the K-TIRADS. RESULTS: Of the 04 benign thyroid nodules (mean size,.86 ±.6 cm), 83 were stable and 2 were increased in size at follow-up period (mean follow-up: 7.9 months). A statistically significant difference was found between stable group and tumor growing group regarding the halo (p = 0.003), while no significant differences were observed in the solidity, echogenicity, shape, orientation, calcification, or vascularity of the lesion (p > 0.05). CONCLUSION: US features of benign thyroid nodules were not helpful for predicting tumor growth, although tumor growing group showed a high prevalence of having halo on US. SE 3 TH-4 Post-thyroidectomy serum thyroglobulin levels in the patients with differentiated thyroid cancer to predict the recurrence: A 4-year, single institutional experience Young Hen Lee, Hyung Suk Seo Korea University Ansan Hospital, Korea. younghen@empal.com PURPOSE: Although serum thyroglobulin (Tg) has been recognized as postoperative surveillance tool to predict the persistent or recurrent disease in differentiated thyroid cancer (DTC), their relationship with extent of recurrence, has not been defined. So we assessed the serum Tg of recurrent patients to guide for postoperative surveillance. MATERIALS AND METHODS: This study was based on the recent 4-year, single academic hospital medical experience of patients with DTC treated with total thyroidectomy, who were regularly followed by serum Tg measurement, neck ultrasound (US) and sometimes other cross-sectional modalities including chest CT examination. We retrospectively enrolled the patients with postoperative recurrence, then their medical records regarding to serum Tg, thyroid-stimulating hormone (TSH), location and size were obtained. We statistically compared the mean serum Tg values between neck and extra-neck recurrence, depending on the thyroxine therapy or after TSH stimulation. RESULTS: From a total of 34 patients (M:F = 45:89; mean age, 5.9 ± 4.7 years), 2 patients had recurrence limited in neck, while recurrent lesions of other 2 patients were found in lung or spine. Basal serum Tg levels were significantly lower in the recurrent group limited in neck than extra-neck (median 0.8 vs.

6 Scientific Exhibitions ng/ml, p < 0.00), therefore cutoff value as 2. ng/ml could distinguish the patients with extra-neck recurrence from neck with a sensitivity of 83.3% and specificity of 83.0% (AUC: 0.9). Basal serum Tg levels significantly decreased by removal of recurrent lesions (p = 0.03). CONCLUSION: Basal serum Tg levels could be helpful to predict the extent of recurrence in patients treated with total thyroidectomy for DTC. -Informal Scientific Presentation Presenting No. ISP 0_NR(NI) TH 03 ISP 0_NR(NI) TH 04 Final Abstract No. Title Presenting Author SE 3 TH-09 Two lethal cases of anaplastic carcinoma Miok Sunwoo 653 SE 3 TH-2 The thickness of hypoechoic rim of thyroid nodules on US: What does it mean? Page No. Chorong Seo 654