US-guided FNAB was performed by experienced radiologist on nodules suspicious for malignancy based on their US features. In brief, a 25-gauge needle attached to a 2-mL disposable syringe was used to aspirate the thyroid nodule. After aspiration was performed at least twice, the aspirated material was expelled on 2 glass slides, followed by 95% alcohol for cell block processing or saline for Papanicolaou staining. One of 8 experienced cytopathologists reviewed the slides. Cytopathological reports at our institution were categorized according to the criteria recommended by the Bethesda classification (12). Total or near total thyroidectomy or hemithyroidectomy was performed in patients whose nodules were highly suspicious for malignancy and who had multiple tumors or lymph node (LN) metastasis according to the ATA guideline. Surgery was performed by 4 experienced surgeons at our institution.

Histopathological and cytopathological results from surgery or US-guided FNAB were considered as the reference standard. Nodules with benign or malignant results at surgery or initial US-guided FNAB were considered benign or malignant, respectively.

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