Ji Ye Lee

Background: In patients with low-risk papillary thyroid microcarcinoma (PTMC), the choice between surgery and active surveillance (AS) should be made through shared decision-making. However, implementing this process in routine practice remains challenging. We aimed to examine physicians’ perspectives in South Korea on treatment decision-making for low-risk PTMC. Methods: We conducted an exploratory cross-sectional survey among physicians involved in the management of low-risk PTMC in South Korea. The survey included structured items and open-ended questions addressing information needs, physician concerns, follow-up issues, and medical and socioeconomic priorities related to decision-making between AS and surgery. Structured responses were summarized descriptively, and free-text responses were analyzed using qualitative content analysis and then quantified using counts and percentages. Results: A total of 33 physicians participated in the survey. When determining the initial treatment plan, key factors highlighted included patient age, tumor location, and lymph node metastasis status. When explaining treatment options to patients, prominent themes included cancer progression rate, tumor location, and AS itself. During AS and follow-up, physicians emphasized surveillance frequency and test methods. Physicians also expressed concerns related to disease progression, patient preference for surgery, and patient anxiety. In addition, the need for clearer AS protocols, standardized imaging practices, and broader insurance support emerged as important issues. Conclusions: This survey identifies key clinical, communication-related, and health system factors that physicians consider important in treatment decision-making for low-risk PTMC. These findings support the development of decision-support resources and clearer practice frameworks for shared decision-making.

In patients with differentiated thyroid cancer, initial recurrence-risk stratification based on clinical, histopathological, and perioperative findings remains central to management during the first 1–2 years after initial treatment. Ongoing risk stratification (ORS) complements this initial assessment by continuously integrating longitudinal clinical data and treatment response, thereby refining long-term prognostic assessment and supporting individualized risk-adapted management. Building on the 2024 Korean Thyroid Association (KTA) guidelines, the 2026 KTA guideline incorporates new evidence from large Korean multicenter cohorts and comprehensive systematic reviews. The updated recommendations reinforce the continued application of ORS and provide more specific guidance on risk-adapted thyroid-stimulating hormone (TSH) targets, surveillance strategies for recurrence detection, and long-term follow-up tailored to individual recurrence risk and treatment response. Consistent with the evolving paradigm toward risk-adapted and individualized management, this revision updates recommendations regarding target serum TSH levels, serum thyroglobulin thresholds for response assessment and long-term surveillance, and follow-up intervals based on both initial-risk category and the ORS response category. These evidence-based recommendations aim to minimize unnecessary treatment and excessive surveillance in the majority of patients who have an excellent prognosis after initial therapy while ensuring individualized long-term management for patients who require closer surveillance or additional therapeutic intervention.

Objectives. Differentiated thyroid cancer (DTC) has a favorable prognosis. However, indeterminate lymph nodes (LNs) are common, making it challenging to distinguish recurrent from persistent DTC. Previous studies have not specifically compared the prognosis between recurrent and persistent DTC. Therefore, we aimed to compare prognosis and oncologic characteristics between these two groups.Methods. This retrospective cohort study was conducted at a single tertiary care institution and included 265 patients with DTC (recurrent, 109; persistent, 156) who underwent reoperation between November 1, 1999, and August 31, 2018, for structural disease. Patients with distant metastasis at the time of initial diagnosis were excluded. Clinical and oncological characteristics, patterns of LN metastasis, disease-free survival (DFS), and overall survival (OS) were compared between the two groups. For DFS, time zero was defined as the date of the second operation.Results. Recurrent DTC had a higher incidence of central LN metastasis (P=0.003), infield recurrence (P<0.001), and distant metastasis (P<0.001). In contrast, persistent DTC more frequently exhibited lateral LN metastasis (P=0.003) and outfield recurrence (P<0.001). The most common site of neck LN metastasis was ipsilateral level VI/VII (51.4%) in recurrent DTC and ipsilateral level IV (43.0%) in persistent DTC. Ten-year DFS was significantly lower in recurrent DTC than in persistent DTC (41.0% vs. 67.9%; P<0.001). Recurrent DTC, older age, a higher number of metastatic LNs at the second operation (first reoperation), and R1/R2 resection at the second operation were associated with decreased DFS. OS did not significantly differ between recurrent and persistent DTC (P=0.160).Conclusion. Recurrent DTC is associated with poorer DFS than persistent DTC, although OS does not significantly differ between the two groups.

Eun Kyung Lee, Seung Heon Kang, Bon Seok Koo, Mijin Kim, Min Joo Kim, Bo Hyun Kim, Ji Won Kim, Dong Gyu Na, Sohyun Park, Ji-In Bang, Kyorim Back, Youngduk Seo, Young-Ik Son, Young Shin Song, Dong Yeob Shin, Jong-Hyuk Ahn, Hwa Young Ahn, So Won Oh, Ho-Ryun Won, Won Sang Yoo, Min Kyoung Lee, Sang-Woo Lee, Jeongmin Lee, Ji Ye Lee, Dong-Jun Lim, Ki-Wook Chung, Ari Chong, Jin Hyang Jung, Sun Wook Cho, Yoon Young Cho, Chae Moon Hong, Young Joo Park and Korean Thyroid Association Guideline Committee on the Management of Thyroid Nodule and Cancer. Int J Thyroidol 2026;19:1-40. https://doi.org/10.11106/ijt.2026.19.1.1

Purpose: Deep learning reconstruction is a promising technique for improving head CT image quality compared to traditional methods. The purpose of this study was to compare image quality and the potential diagnostic impact of vendor-agnostic deep-learning reconstruction (DLR) versus hybrid iterative reconstruction (IR) for the evaluation of acute ischemic stroke on noncontrast head computed tomography (CT). Methods: This single-institution retrospective study included 100 patients (mean age 69.6 years; 44 women) who visited the emergency department with suspected acute stroke and underwent noncontrast head CT between November 2021 and November 2022. Fifty patients were confirmed to have acute infarction lesions via subsequent DWI, while the remaining 50 had negative DWI results. The CT images were reconstructed with both IR and DLR. Four reviewers (two radiology residents and two neuroradiologists) assessed subjective image quality and the conspicuity of acute ischemic lesions on a 5-point scale. Nonparametric comparisons of scores and ROC curve analysis were performed. Results: Compared with IR, DLR resulted in superior overall image quality (4.02 vs. 3.23, p < 0.01). While no significant differences were found in lesion conspicuity according to one neuroradiologist (3.90 vs. 3.70; p = 0.14), other experienced readers reported significantly enhanced conspicuity with DLR(3.60 vs. 3.12, p = 0.014; 3.84 vs. 3.12, p < 0.01; and 4.06 vs. 3.62, p = 0.018, respectively). ROC curve analysis revealed an increase in the area under the curve (AUC) for radiology resident readers (0.888 vs. 0.844, p = 0.002) and a decrease in AUC for neuroradiologists (0.857 vs. 0.911, p = 0.034). Conclusion: Our study demonstrates that DLR offers subjective improvements in image quality, tissue differentiation, and noise reduction. We observed improvement in the diagnostic performance of less experienced radiologists with DLR .

Purpose: This study analyzed the malignancy rate of lymph nodes (LNs) according to the concordance of ultrasound (US) and computed tomography (CT) imaging features in patients with thyroid cancer.Methods: A retrospective analysis was performed of 277 cytopathologically confirmed cervical LNs (53.1% malignant) from 228 patients with thyroid cancer who underwent US-guided biopsy and preoperative US and CT. Malignancy rates were calculated according to the concordance of US and CT imaging features by matching cortical hyperechogenicity or abnormal vascularity on US (US-echo-vascularity) with strong or heterogeneous enhancement on CT (CT-enhancement), cystic changes on US (US-cystic) with cystic changes on CT (CT-cystic), and echogenic foci on US (US-EF) with calcifications on CT (CT-calcification). Results: Malignancy rates were significantly higher in positively concordant cases across all imaging features compared to negatively concordant cases (US-echo-vascularity/CT-enhancement: 93.5% vs. 8.2%, P<0.001; US-cystic/CT-cystic: 94.4% vs. 41.3%, P<0.001; and US-EF/CT-calcification: 84.4% vs. 34.5%, P<0.001). Discordance in US-cystic/CT-cystic (96.3% vs. 94.4%, P=0.735) or US-EF/CT-calcification (86.0% vs. 84.4%, P=0.873) findings showed malignancy rates comparable to those for positively concordant cases. However, discordance in US-echo-vascularity/CT-enhancement resulted in a significantly lower malignancy rate than in positively concordant cases (66.8% vs. 93.5%, P<0.001). In this discordant group, CT demonstrated a higher diagnostic odds ratio (3.896 vs. 0.257, P=0.002) and higher sensitivity (81.1% vs. 18.9%, P<0.001) than US.Conclusion: Positive US/CT concordance across all imaging features, as well as discordance in US-cystic/CT-cystic or US-EF/CT-calcification, strongly suggested LN metastasis. CT-enhancement was particularly reliable when discordant with US-echo-vascularity.

Lee MK, et al. Korean J Radiol. 2026 ;27:e92. https://doi.org/10.3348/kjr.2026.0042

Jeon YH, et al. Korean J Radiol. 2026 ;27:e79. https://doi.org/10.3348/kjr.2026.0930

Jeon YH, et al. Korean J Radiol. 2026 ;27:e74. https://doi.org/10.3348/kjr.2026.0814

Jeon YH, et al. Korean J Radiol. 2026 ;27:e33. https://doi.org/10.3348/kjr.2025.1073