editorials June 01, 2017 June 01, 2017

Two themes in thyroid cancer: artful diagnosis and shortened lives

DOI: 10.1590/2359-3997000000275

Patients presenting with a thyroid nodule are common in the clinical practice of endocrinologists, even for those who are not thyroidologists. When seeing a patient with a thyroid nodule, the question that typically occurs first is whether the nodule could be malignant and how can the diagnosis be most efficiently and accurately determined. Then, once a diagnosis of cancer might be confirmed, and discussion turns to details about management, the next prominent question in the patient’s mind relates to their prognosis. The importance of these two questions, precise diagnosis and prognosis, forms the basis for two papers appearing in this issue of the Archives of Endocrinology and Metabolism.

Detection of thyroid nodules has been increasing significantly due to the more widespread use of ultrasonography of the neck. Our professional society guidelines recommend fine-needle aspiration (FNA) as the procedure of choice for nodules > 1 cm, and the routine use of thyroid ultrasonography to characterize the nodules. Yet the subjective nature of sonogram evaluations and the lack of uniformity in the reports of the characteristics of thyroid nodules may be troublesome for management decision-making. This is the setting in which Delfim and cols. () propose and offer a new classification system to distinguish the ultrasound features between benign and malignant thyroid nodules. In fact, similar efforts to develop a thyroid imaging reporting and data system (TIRADS) to categorize thyroid nodules and evaluate their risk of malignancy date back to 2009 (-), in parallel to what has been done for breast imaging with the development of the Breast Imaging Reporting and Data System (BI-RADS) (). The Korean Society of Thyroid Radiology has recently revised its recommendations, the K-TIRADS () and the American College of Radiology has just released a white paper of the TI-RADS Committee (). The current guidelines of the American Thyroid Association (ATA) () recommend the use of sonographic patterns, instead of isolated sonographic features, to estimate the risk of malignancy of thyroid nodules.

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