المؤلفون: Lasya, Pallamala¹, Divya G.¹ divya.g1704@gmail.com

المصدر: Journal of Cardiovascular Disease Research (Journal of Cardiovascular Disease Research). 2024, Vol. 15 Issue 6, p1195-1207. 13p.

مصطلحات موضوعية: *THYROID nodules, *THYROID cancer, *MEDICAL sciences, *CYTOLOGY, *SURGERY, *THYROIDECTOMY, *NEEDLE biopsy

مستخلص: Background: thyroid nodule is defined as a lesion that is distinct and may be differentiated from the surrounding thyroid parenchyma by clinical examination, Ultrasound or other sensitive imaging modalities. ¹ It may be solitary or multiple nodular goitres. A nodule can be solid, or cystic and may or may not be functional. The prevalence rates are highly dependent on the method of identification. The purpose of the current research is to evaluate the reliability of TIRADS in determining the malignancy in the thyroid nodule so that invasive cytology and surgery can be avoided in the low-risk group. Material and Methods: This study was done to evaluate and compare the thyroid nodules by sonography with FNAC and biopsy in various disorders of the thyroid gland.This study was conducted in Department of General Surgery, sree mookambika institute of medical sciences, Kanyakumari. Study conducted from November 2022 to September 2023 Result: According to these findings, TI-RADS have a sensitivity of about 95.83%, Specificity of approximately 88.67%, the positive predictive value of approximately 79.31 %, the negative predictive value of approximately 97.92 % compared with FNAC (cytology). Fisher's Exact Test was performed and results shown as 0.000, which is significant. P-Value of this comparison is < 0.001 (p-value = <0.001), which is significant, and there is a strong association between TI-RADS and FNAC. Conclusion: In conclusion, from the study, it was made out that the PPV for malignancy was high for TIRADS category 5 and 4 nodules. TIRADS is a straightforward and practical method of assessing thyroid nodules and can be used in practice as the overall agreement between observers for assigning TIRADS category was substantial. [ABSTRACT FROM AUTHOR]

المؤلفون: Shi, Wenyuan¹ (AUTHOR), Cai, Wenjia¹ (AUTHOR), Wang, Shengcai² (AUTHOR), Gao, Yuanjin¹ (AUTHOR), Yang, Rui¹ (AUTHOR), Liu, Qinglin¹ (AUTHOR), Liu, Yuanhu² (AUTHOR), Peng, Yun³ (AUTHOR), Ni, Xin² (AUTHOR) nixin@bch.com.cn

المصدر: European Radiology. Jun2024, Vol. 34 Issue 6, p3851-3860. 10p.

مصطلحات موضوعية: *THYROID nodules, *MICROWAVES, *CHILD patients, *THYROID hormones, *ABLATION techniques, *THYROIDECTOMY, *NEEDLE biopsy

مستخلص: Objective: To evaluate the efficacy and safety of microwave ablation (MWA) for the treatment of symptomatic benign thyroid nodules in children. Methods: A retrospective study of MWA for the treatment of 34 symptomatic benign thyroid nodules in 25 children was conducted. Volume reduction ratio (VRR), technique efficacy, symptom score, cosmetic score, and thyroid function were used to evaluate the efficacy of the technique. The associated complications and side effects were recorded. Results: The participants were followed for at least 6 months (median 12 months, range 6–48 months). After MWA treatment, the volumes of the targeted nodules decreased gradually (median volume 5.86 mL before MWA and 0.34 mL at the final follow-up assessment), the VRR achieved was up to 85.03% at the final follow-up assessment, and the technical efficacy at this time was 91.2%. The subjective and objective nodule-related symptoms were also ameliorated. The circulating hormone concentrations reflecting thyroid function remained within their normal ranges in all the participants after one month of follow-up. The procedure had no major complications. Conclusions: MWA seems to be an effective and safe technique for the treatment of symptomatic benign thyroid nodules in pediatric patients. Clinical relevance statement: Microwave ablation is a safe and effective method to treat symptomatic benign thyroid nodules in pediatric patients. This treatment may be selected if the patient or parents are not suitable or refuse to undergo surgery. Key Points: • Microwave ablation is effective in reducing the volume of benign thyroid nodules and ameliorating nodule-related symptoms in pediatric patients. • Microwave ablation is a safe method in children, with low complications. • Microwave ablation does not affect the circulating thyroid hormone concentrations of children. [ABSTRACT FROM AUTHOR]

المؤلفون: Hassan, Iyad¹ (AUTHOR) lapsim1970@yahoo.de, Hassan, Lina¹ (AUTHOR) mohammad.askar@burjeel.com, Balalaa, Nahed² (AUTHOR) nbalalaa@ssmc.ae, Askar, Mohamad¹ (AUTHOR) hussa.alshehhi@burjeelmedicalcity.com, Alshehhi, Hussa¹ (AUTHOR) mohamed.almarzooqi@burjeel.com, Almarzooqi, Mohamad¹ (AUTHOR)

المصدر: Diagnostics (2075-4418). May2024, Vol. 14 Issue 10, p1026. 11p.

مصطلحات موضوعية: *THYROID cancer, *THYROID nodules, *THYROIDECTOMY, *RETROSPECTIVE studies, *DISEASE risk factors, *NEEDLE biopsy, *SURGERY

مصطلحات جغرافية: BETHESDA (Md.)

مستخلص: Background: Fine-needle aspiration cytology (FNAC) is widely used to diagnose and monitor thyroid nodules. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is the standard for interpreting FNAC specimens. The risk of malignancy in Bethesda III nodules, also known as Atypia of Undetermined Significance (AUS), varies significantly throughout several studies published worldwide. This retrospective study examines the risk of cancer in thyroid FNAC categorized as Bethesda III as identified in the final histopathology of thyroidectomy specimens at a single endocrine surgery center. Methods: This retrospective cohort analysis included 1038 consecutive patients who underwent elective thyroid surgery with complete follow-up data between January 2020 and March 2024. Preoperative data on clinical and pathological characteristics have been collected. The final histopathology report from the thyroidectomy specimen was compared to the results of the preoperative FNAC on nodules that were judged to be Bethesda category III. Statistical methods were performed using SPSS version 29. Results: A total of 670 ultrasound-guided FNACs (64.5%) performed during the study period were included in the final analysis. The study population was predominantly female, represented by 79.6% of patients with a mean age of 42.5 (SD 12.1), while 20.4% were male and significantly older with mean age of 45.13 years (p = 0.02). The FNAC inadequacy rate was 5.1%, which was associated with a high risk of malignancy (6 out of 34; 17.6%). Out of the total sample size of 170 patients classified as group III, 57 were found to have malignancies in final surgical histopathology, representing 33.5% of the cases within this category. The secondary gender-related outcome analysis showed that female patients classified under the Bethesda II category had a significantly higher risk of malignancy, with a rate of 21.2%, compared to males who had a malignancy rate of 3.4% in the same Bethesda category (p = 0.001, chi-square test). However, the female patients exhibited prognostically superior non-invasive tumors compared to male individuals (p = 0.02, chi-square test). Conclusion: This study's results indicate that Bethesda categories II and III are associated with a higher risk of malignancy in comparison to the reports of the first and third editions of the TBSRTC, particularly for female patients classified under category II. [ABSTRACT FROM AUTHOR]

المؤلفون: Munoz-Zuluaga, Carlos A^1,2 (AUTHOR), Heymann, Jonas J¹ (AUTHOR), Solomon, James P³ (AUTHOR), Patel, Ami¹ (AUTHOR), Siddiqui, Momin T¹ (AUTHOR), Scognamiglio, Theresa² (AUTHOR), Gokozan, Hamza N^1,2,4 (AUTHOR) hamza.gokozan@osumc.edu

المصدر: American Journal of Clinical Pathology. May2024, Vol. 161 Issue 5, p463-468. 6p.

مصطلحات موضوعية: *THYROID nodules, *THYROID gland, *CLINICAL pathology, *NEEDLE biopsy, *SURGICAL pathology, *PAPILLARY carcinoma

مصطلحات جغرافية: BETHESDA (Md.)

مستخلص: Objectives Afirma has recently introduced its Xpression Atlas (XA) as an adjunct to its Genomic Sequencing Classifier (GSC) for risk stratification of cytologically indeterminate thyroid nodules. We evaluated the performance of Afirma XA and associated pathologic findings for Afirma GSC suspicious nodules. Methods Intradepartmental records of thyroid fine-needle aspirations (FNAs) from January 2021 to December 2022 were identified and reviewed for patient and nodule characteristics, FNA findings, molecular test results, and final surgical pathology, if available. Results Material for Afirma GSC testing was collected in 624 thyroid FNAs, and 148 (24%) were classified as cytologically indeterminate. Afirma GSC testing was successful in 132 (89%) of those cases, of which 35 (27%) were Afirma GSC suspicious. Afirma XA testing was positive in 11 cases (11/35 [31%]). Eight (73%) patients underwent surgery that revealed 7 patients with papillary thyroid carcinoma and 1 patient with noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) (risk of malignancy: 100% [8/8]). Among the 24 patients with negative Afirma XA results, 19 (79%) underwent surgery, revealing 5 patients with malignancy and 3 patients with NIFTP (risk of malignancy: 42% [8/19]). Overall, the risk of malignancy for Afirma GSC suspicious nodules was 59% (16/27). Conclusions Afirma XA improved risk stratification of thyroid disease with a high risk of malignancy in Afirma GSC suspicious nodules. A negative Afirma XA result, however, should not be used as a rule-out test. [ABSTRACT FROM AUTHOR]

المؤلفون: Sohn, Heeseung¹ (AUTHOR), Kakudo, Kennichi² (AUTHOR), Jung, Chan Kwon^1,3 (AUTHOR) ckjung@catholic.ac.kr

المصدر: Cytopathology. May2024, Vol. 35 Issue 3, p383-389. 7p.

مصطلحات موضوعية: *THYROID nodules, *THYROID gland, *CYTODIAGNOSIS, *NEEDLE biopsy, *SENSITIVITY & specificity (Statistics), *THYROTROPIN receptors, *CELLULAR pathology

مصطلحات جغرافية: BETHESDA (Md.)

مستخلص: Objective: Thyroid fine‐needle aspiration (FNA) is a principal diagnostic procedure for thyroid nodules. A specific cytomorphological structure, known as the thyroid spherule, is often seen in FNA specimens. The clinical significance of these spherules in terms of diagnosis and prevalence remains largely unexplored. Methods: We performed a retrospective study on 310 thyroid FNA specimens and categorized them according to the Bethesda System for Reporting Thyroid Cytopathology. The presence, size and number of thyroid spherules in each specimen were examined and these data were subsequently correlated with the clinicopathological features. Results: Thyroid spherules were almost exclusively detected in benign cases, comprising 7.6% of all benign diagnoses. The average diameter of spherules in benign cases was 84.9 μm. Benign cases and cases with atypia of undetermined significance cases primarily exhibited low cellularity, while follicular neoplasms and malignant cases typically showed moderate to high cellularity. In the subgroup of FNA cases with moderate to high cellularity, spherules were identified in 12 (20%) of 59 benign FNA cases. Within this group, the sensitivity and specificity of thyroid spherules for detecting benign FNA cases were 20% and 100%, respectively. Conclusions: Our results suggest that the presence of thyroid spherules in FNA specimens can serve as a highly specific marker for benign thyroid conditions. The prevalence of spherule detection is strongly influenced by the cellularity. In cases with moderate to high cellularity, the identification of spherules can assist the cytopathologists in diagnosing thyroid FNA cases as benign. [ABSTRACT FROM AUTHOR]

المؤلفون: Wang, Feihang^1,2,3 (AUTHOR), Zhao, Danyang^1,2,3 (AUTHOR), Xu, Wang-yang⁴ (AUTHOR), Liu, Yiying⁴ (AUTHOR), Sun, Huiyi^1,2,3 (AUTHOR), Lu, Shanshan⁵ (AUTHOR), Ji, Yuan⁵ (AUTHOR), Jiang, Jingjing⁶ (AUTHOR), Chen, Yi^1,2,3 (AUTHOR), He, Qiye⁴ (AUTHOR), Gong, Chengxiang⁴ (AUTHOR), Liu, Rui⁴ (AUTHOR), Su, Zhixi⁴ (AUTHOR) zhixi.su@singleragenomics.com, Dong, Yi⁷ (AUTHOR) drdaisydong@hotmail.com, Yan, Zhiping^1,2,3 (AUTHOR) zhipingyan@fudan.edu.cn, Liu, Lingxiao^1,2,3 (AUTHOR) liulingxiao2022@163.com

المصدر: BMC Medicine. 4/2/2024, Vol. 22 Issue 1, p1-15. 15p.

مصطلحات موضوعية: *THYROID nodules, *NEEDLE biopsy, *THYROID cancer, *LEUCOCYTES, *BLOOD substitutes, *DNA methylation, *COHORT analysis

مصطلحات جغرافية: CHINA

مستخلص: Background: Thyroid nodule (TN) patients in China are subject to overdiagnosis and overtreatment. The implementation of existing technologies such as thyroid ultrasonography has indeed contributed to the improved diagnostic accuracy of TNs. However, a significant issue persists, where many patients undergo unnecessary biopsies, and patients with malignant thyroid nodules (MTNs) are advised to undergo surgery therapy. Methods: This study included a total of 293 patients diagnosed with TNs. Differential methylation haplotype blocks (MHBs) in blood leukocytes between MTNs and benign thyroid nodules (BTNs) were detected using reduced representation bisulfite sequencing (RRBS). Subsequently, an artificial intelligence blood leukocyte DNA methylation (BLDM) model was designed to optimize the management and treatment of patients with TNs for more effective outcomes. Results: The DNA methylation profiles of peripheral blood leukocytes exhibited distinctions between MTNs and BTNs. The BLDM model we developed for diagnosing TNs achieved an area under the curve (AUC) of 0.858 in the validation cohort and 0.863 in the independent test cohort. Its specificity reached 90.91% and 88.68% in the validation and independent test cohorts, respectively, outperforming the specificity of ultrasonography (43.64% in the validation cohort and 47.17% in the independent test cohort), albeit with a slightly lower sensitivity (83.33% in the validation cohort and 82.86% in the independent test cohort) compared to ultrasonography (97.62% in the validation cohort and 100.00% in the independent test cohort). The BLDM model could correctly identify 89.83% patients whose nodules were suspected malignant by ultrasonography but finally histological benign. In micronodules, the model displayed higher specificity (93.33% in the validation cohort and 92.00% in the independent test cohort) and accuracy (88.24% in the validation cohort and 87.50% in the independent test cohort) for diagnosing TNs. This performance surpassed the specificity and accuracy observed with ultrasonography. A TN diagnostic and treatment framework that prioritizes patients is provided, with fine-needle aspiration (FNA) biopsy performed only on patients with indications of MTNs in both BLDM and ultrasonography results, thus avoiding unnecessary biopsies. Conclusions: This is the first study to demonstrate the potential of non-invasive blood leukocytes in diagnosing TNs, thereby making TN diagnosis and treatment more efficient in China. [ABSTRACT FROM AUTHOR]

المؤلفون: Hye Hyeon Moon¹, Sae Rom Chung¹ jserom@naver.com, Young Jun Choi¹, Tae-Yon Sung², Dong Eun Song³, Tae Yong Kim⁴, Jeong Hyun Lee¹, Jung Hwan Baek¹

المصدر: Endocrinology & Metabolism. Apr2024, Vol. 39 Issue 2, p300-309. 10p.

مصطلحات موضوعية: *NEEDLE biopsy, *THYROID nodules, *BIOPSY, *CORE needle biopsy, *UNNECESSARY surgery, *DEMOGRAPHIC characteristics, *MONOCLONAL gammopathies

مستخلص: Background: We aimed to evaluate the utility of repeat biopsy of thyroid nodules classified as atypia of undetermined significance with architectural atypia (IIIB) on core-needle biopsy (CNB). Methods: This retrospective study evaluated patients with thyroid nodules categorized as IIIB on CNB between 2013 and 2015. Demographic characteristics, subsequent biopsy results, and ultrasound (US) images were evaluated. The malignancy rates of nodules according to number of CNBs and the number of IIIB diagnoses was compared. Demographic and US features were evaluated to determine factors predictive of malignancy. Results: Of 1,003 IIIB nodules on CNB, the final diagnosis was determined for 328 (32.7%) nodules, with 121 of them confirmed as malignant, resulting in a malignancy rate of 36.9% (95% confidence interval, 31.7% to 42.1%). Repeat CNB was performed in 248 nodules (24.7%), with 75 (30.2%), 131 (52.8%), 13 (5.2%), 26 (10.5%), one (0.4%), and two (0.8%) reclassified into categories II, IIIB, IIIA, IV, V, and VI, respectively. Malignancy rates were not significantly affected by the number of CNBs (P=0.291) or the number of IIIB diagnoses (P=0.473). None of the nodules confirmed as category II on repeat CNB was malignant. US features significantly associated with malignancy (P<0.003) included solid composition, irregular margins, microcalcifications, and high suspicion on the US risk stratification system. Conclusion: Repeat biopsy of nodules diagnosed with IIIB on CNB did not increase the detection of malignancy but can potentially reduce unnecessary surgery. Repeat biopsy should be performed selectively, with US features guiding the choice between repeat biopsy and diagnostic surgery. [ABSTRACT FROM AUTHOR]

المؤلفون: Chen, Chen^1,2,3 (AUTHOR), Jiang, Yitao⁴ (AUTHOR), Yao, Jincao^1,5,6 (AUTHOR), Lai, Min⁷ (AUTHOR), Liu, Yuanzhen^1,2,3 (AUTHOR), Jiang, Xianping⁸ (AUTHOR), Ou, Di^1,5,6 (AUTHOR), Feng, Bojian^1,2,3 (AUTHOR), Zhou, Lingyan^1,5,6 (AUTHOR), Xu, Jinfeng⁹ (AUTHOR), Wu, Linghu⁹ (AUTHOR), Zhou, Yuli⁹ (AUTHOR), Yue, Wenwen¹⁰ (AUTHOR) yuewen0902@163.com, Dong, Fajin⁹ (AUTHOR) dongfajin@szhospital.com, Xu, Dong^1,2,3 (AUTHOR) xudong@zjcc.org.cn

المصدر: European Radiology. Apr2024, Vol. 34 Issue 4, p2323-2333. 11p.

مصطلحات موضوعية: *THYROID cancer, *THYROID nodules, *DEEP learning, *CONVOLUTIONAL neural networks, *CLASSIFICATION of mental disorders, *NEEDLE biopsy, *ULTRASONIC imaging

مستخلص: Objectives: This study aimed to propose a deep learning (DL)–based framework for identifying the composition of thyroid nodules and assessing their malignancy risk. Methods: We conducted a retrospective multicenter study using ultrasound images from four hospitals. Convolutional neural network (CNN) models were constructed to classify ultrasound images of thyroid nodules into solid and non-solid, as well as benign and malignant. A total of 11,201 images of 6784 nodules were used for training, validation, and testing. The area under the receiver-operating characteristic curve (AUC) was employed as the primary evaluation index. Results: The models had AUCs higher than 0.91 in the benign and malignant grading of solid thyroid nodules, with the Inception-ResNet AUC being the highest at 0.94. In the test set, the best algorithm for identifying benign and malignant thyroid nodules had a sensitivity of 0.88, and a specificity of 0.86. In the human vs. DL test set, the best algorithm had a sensitivity of 0.93, and a specificity of 0.86. The Inception-ResNet model performed better than the senior physicians (p < 0.001). The sensitivity and specificity of the optimal model based on the external test set were 0.90 and 0.75, respectively. Conclusions: This research demonstrates that CNNs can assist thyroid nodule diagnosis and reduce the rate of unnecessary fine-needle aspiration (FNA). Clinical relevance statement: High-resolution ultrasound has led to increased detection of thyroid nodules. This results in unnecessary fine-needle aspiration and anxiety for patients whose nodules are benign. Deep learning can solve these problems to some extent. Key Points: • Thyroid solid nodules have a high probability of malignancy. • Our models can improve the differentiation between benign and malignant solid thyroid nodules. • The differential performance of one model was superior to that of senior radiologists. Applying this could reduce the rate of unnecessary fine-needle aspiration of solid thyroid nodules. [ABSTRACT FROM AUTHOR]

المؤلفون: Fan, Kang-Yun¹ (AUTHOR), Loh, El-Wui^2,3,4,5 (AUTHOR), Tam, Ka-Wai^2,3,6,7 (AUTHOR) kelvintam@h.tmu.edu.tw

المصدر: European Radiology. Apr2024, Vol. 34 Issue 4, p2310-2322. 13p.

مصطلحات موضوعية: *THYROID nodules, *LARYNGEAL nerve palsy, *THYROID cancer, *HIGH-intensity focused ultrasound, *RECURRENT laryngeal nerve, *HORNER syndrome, *RANDOM effects model, *THYROIDECTOMY, *NEEDLE biopsy

مستخلص: Objective: Thyroid nodules are common and sometimes associated with cosmetic issues. Surgical treatment has several disadvantages, including visible scarring. High-intensity focused ultrasound (HIFU) is a recent noninvasive treatment for thyroid nodules. The present study aims to evaluate the effectiveness and safety of HIFU for the treatment of benign thyroid nodules. Methods: We searched PubMed, Embase, and Cochrane Library for studies evaluating the outcomes of HIFU for patients with benign thyroid nodules. We conducted a meta-analysis by using a random effects model and evaluated the volume reduction ratio, treatment success rate, and incidence of treatment-related complications. Results: Thirty-two studies were included in the systematic review. Only 14 studies were used in the meta-analysis because the other 18 involved data collected during overlapping periods. The average volume reduction ratios at 3, 6, and 12 months after treatment were 39.02% (95% CI: 27.57 to 50.47%, I2: 97.9%), 48.55% (95% CI: 35.53 to 61.57%, I2: 98.2%), and 55.02% (95% CI: 41.55 to 68.48%, I2: 99%), respectively. Regarding complications, the incidences of vocal cord paresis and Horner's syndrome after HIFU were 2.1% (95% CI: 0.2 to 4.1%, I2: 14.6%) and 0.7% (95% CI: 0 to 1.9%, I2: 0%), respectively. Conclusions: HIFU is an effective and safe treatment option for patients with benign thyroid nodules. However, the effects of HIFU on nodules of large sizes and with different properties require further investigation. Additional studies, particularly randomized controlled trials involving long-term follow-up, are warranted. Clinical relevance statement: Surgical treatment for thyroid nodules often results in permanent visible scars and is associated with a risk of bleeding, nerve injury, and hypothyroidism. High-intensity focused ultrasound may be an alternative for patients with benign thyroid nodules. Key Points: • The success rate of HIFU treatment for thyroid nodules is 75.8% at 6 months. Average volume reduction ratios are 48.55% and 55.02% at 6 and 12 months. • The incidence of complications such as vocal fold paresis, Horner's syndrome, recurrent laryngeal nerve palsy, hypothyroidism, and skin redness is low. • HIFU is both effective and safe as a treatment for benign thyroid nodules. [ABSTRACT FROM AUTHOR]

المؤلفون: Issa, Peter P.^1,2 (AUTHOR), McCarthy, Christina^1,3 (AUTHOR), Hussein, Mohammad¹ (AUTHOR), Albuck, Aaron L.² (AUTHOR), Emad, Essam¹ (AUTHOR), Shama, Mohamed¹ (AUTHOR), Moroz, Krzysztof⁴ (AUTHOR), Toraih, Eman^1,5 (AUTHOR), Kandil, Emad¹ (AUTHOR) ekandil@tulane.edu

المصدر: Journal of Surgical Research. Apr2024, Vol. 296, p523-531. 9p.

مصطلحات موضوعية: *THYROID nodules, *NEEDLE biopsy, *TREATMENT delay (Medicine), *CONFIDENCE intervals, *ROSES

مصطلحات جغرافية: BETHESDA (Md.)

مستخلص: Fine-needle aspiration (FNA) is the standard form of preoperative evaluation of thyroid nodule cytological status. A significant number FNAs are classified as inadequate for interpretation, requiring a repeat FNA which is potentially avoidable, costly, and delays treatment. To address these concerns and maximize first-time FNA adequacy, rapid onsite evaluation (ROSE) of FNA specimens was introduced. Our study aims to determine the impact of ROSE on FNA adequacy. PubMed, Embase, and Web of Science were searched for primary articles assessing the adequacy of ROSE in thyroid nodules. A total of 17 studies were included for a total of 24,649 thyroid nodes. Thirteen thousand two hundred fifteen (53.6%) thyroid nodules were assessed utilizing ROSE and 11,434 (46.4%) were not. Pooled adequacy increased significantly from 76% without ROSE to 92% with rose (P = 0.001). Use of ROSE increased the odds of adequate FNA by 22% (risk ratio (RR) = 1.22, 95% confidence interval (CI) = 1.12-1.32). At institutions with less than 85% effective diagnostic adequacy without ROSE, the risk for diagnostic adequacy increased by 28% with ROSE implementation (RR = 1.28, 95% CI = 1.20-1.37). In contrast, in studies reported from institutions with an effective diagnostic rate greater than 85% without the use of ROSE, the diagnostic adequacy only increased by 5% with ROSE implementation (RR = 1.05, 95% CI = 1.03-1.06). The use of ROSE during first-time FNA of thyroid nodules can significantly improve adequacy, especially at institutions with baseline high inadequacy rates. Implementation of ROSE can reduce repeat FNAs and its associated consequences. [ABSTRACT FROM AUTHOR]