Ultrasound imaging classifications of thyroid nodules for malignancy risk stratification and clinical management: state of the art

Chiara Floridi, Michaela Cellina, Giorgio Buccimazza, Antonio Arrichiello, Andrea Sacrini, Francesco Arrigoni, Giovanni Pompili, Antonio Barile, Gianpaolo Carrafiello


Assessing the risk of malignancy in the thyroid with ultrasound (US) is crucial in patients with nodules, as it can aid in selecting those who should have a fine-needle aspiration (FNA) biopsy performed. Many studies have examined whether the US characteristics of thyroid nodules are useful indicators of histological malignancy. Overall, these investigations have identified a few US features that are significantly more frequent in malignant thyroid nodules which can be coalesced into a defining set to be used as an indicator of a higher risk of malignancy. Despite these efforts, none of these classifications have been widely adopted worldwide, and there are still conflicting recommendations from different institutions. Understanding the role and appropriate utilization of these systems could facilitate the effective interpretation and communication of thyroid US findings among referring physicians and radiologists. In this comprehensive review, we outline the major US classification systems of thyroid nodules published in the last few years.