K-TIRADS Calculator for Thyroid Nodules

1구성Composition

2에코Echo

3의심 소견Suspicious

4특수 범주Special

Step 1. 구성 (Composition)Step 1. Composition

결절의 초음파 구성을 선택하세요. (Select ultrasound composition of the nodule.)Select the ultrasound composition of the nodule.

Step 2. 에코발생도 (Echogenicity)Step 2. Echogenicity

정상 갑상선 실질과 비교하세요. (Compare to normal thyroid parenchyma.)Compare to normal thyroid parenchyma.

Step 3. 의심스러운 초음파 소견 (Suspicious US Features)Step 3. Suspicious US Features

해당되는 소견을 모두 선택하세요. 없으면 다음 단계로 진행하세요. (Select all that apply.)Select all that apply. If none, proceed to the next step.

점상 에코성 초점 (PEF)Punctate echogenic foci (PEF) / microcalcifications ≤ 1 mm in solid component

비평행 방향Nonparallel orientation (taller-than-wide on transverse)

불규칙한 변연Irregular margin (spiculated / microlobulated)

Step 4. 특수 범주 (Special Categories)Step 4. Special Categories

해당되는 항목이 있으면 선택하세요. (Check if applicable.)Check if applicable.

완전 석회화 결절Entirely calcified nodule

광범위 실질 PEF (이산 결절 없음)Extensive parenchymal PEF without discrete nodule (diffuse sclerosing variant)

미만성 침윤성 병변Diffusely infiltrative lesion (metastasis / lymphoma)

낭내 에코성 초점 + 혜성꼬리 인공물Intracystic echogenic foci with comet-tail artifact (→ benign colloid)

※ Entirely calcified nodule이 아닌 macrocalcification(>1 mm) 또는 rim calcification은 단독으로 K-TIRADS 등급을 변경하지 않습니다. 결절의 구성·에코·의심 소견에 따라 분류하세요. ※ Macrocalcification (>1 mm) or rim calcification, when not entirely calcified, does not change the K-TIRADS grade by itself. Classify based on composition, echogenicity, and suspicious features.

관리 권고 (Management Recommendation)Management Recommendation

결절 크기 (Nodule size):Nodule size: mm

특수 생검 적응증 (Special Biopsy Indications)Special Biopsy Indications

크기에 관계없이 생검이 권고되는 경우 (Biopsy indicated regardless of size):Biopsy indicated regardless of size:

림프절 전이 의심 (Suspected lymph node metastasis)Suspected lymph node metastasis 인접 구조물 침범 의심 (Suspected invasion — trachea, larynx, RLN, vessels)Suspected invasion of adjacent structures (trachea, larynx, RLN, vessels) 원격 전이 의심 (Suspected distant metastasis)Suspected distant metastasis 갑상선 수질암 의심 (Suspected medullary thyroid cancer)Suspected medullary thyroid cancer

추적 관찰 일정 (Follow-up Schedule)Follow-up Schedule

판독문 (Report)Report

결절 위치 (Location)Nodule Location

추가 소견 (Additional Findings)Additional Findings

경부 림프절: 이상 소견 없음 (No suspicious cervical lymphadenopathy)No suspicious cervical lymphadenopathy 양측 침샘: 이상 소견 없음 (No remarkable salivary gland abnormality)No remarkable salivary gland abnormality

기타 소견 (Other findings)Other findings

면책 조항 (Disclaimer): 이 계산기는 2021 K-TIRADS 가이드라인에 기반하며, 교육 및 임상 의사결정 지원 목적으로만 사용됩니다. 최종 임상 결정은 자격을 갖춘 의료 전문가가 내려야 합니다.
This calculator is based on 2021 K-TIRADS guidelines and is intended for educational and clinical decision support only. Final clinical decisions should be made by qualified medical professionals.

저작권 고지 (License Notice): 본 콘텐츠는 다음 자료를 기반으로 작성되었으며, Creative Commons Attribution-NonCommercial (CC BY-NC) 라이선스 하에 비영리 목적으로 사용됩니다.
Disclaimer: This calculator is based on 2021 K-TIRADS guidelines and is intended for educational and clinical decision support only. Final clinical decisions should be made by qualified medical professionals.

License Notice: This content is based on the following publications and is used for non-commercial purposes under Creative Commons Attribution-NonCommercial (CC BY-NC) license.
• Ha EJ et al. Korean J Radiol 2021;22:2094-2123 — © 2021 The Korean Society of Radiology. Licensed under CC BY-NC 4.0
• Jung SL. Korean J Med 2022;97:292-302 — © 2022 The Korean Association of Internal Medicine. Licensed under CC BY-NC 3.0

FNA 후 관리 (Post-FNA Management)Post-FNA Management

FNA 세포검사 결과와 K-TIRADS 분류에 따른 관리 권고 (Based on Table 5, 2021 K-TIRADS)Management recommendations based on FNA cytology result and K-TIRADS classification (Table 5, 2021 K-TIRADS)

FNA 결과 (Result)FNA Result	K-TIRADS 2–3	K-TIRADS 4	K-TIRADS 5
비진단적 (Nondiagnostic)Nondiagnostic	반복 FNA 또는 추적 관찰 Repeat FNA or follow-upRepeat FNA or follow-up	반복 FNA 또는 CNB Repeat FNA or CNBRepeat FNA or CNB	반복 FNA 또는 CNB Repeat FNA or CNBRepeat FNA or CNB
양성 (Benign)Benign	K-TIRADS에 따른 추적 Follow-up per K-TIRADSFollow-up per K-TIRADS	K-TIRADS에 따른 추적 Follow-up per K-TIRADSFollow-up per K-TIRADS	1년 이내 반복 FNA/CNB Repeat FNA or CNB within 1 yearRepeat FNA or CNB within 1 year
비정형 (AUS/FLUS)AUS/FLUS	반복 FNA Repeat FNARepeat FNA	반복 FNA 또는 CNB Repeat FNA or CNBRepeat FNA or CNB	반복 FNA/CNB 또는 진단적 수술 Repeat FNA/CNB or diagnostic surgeryRepeat FNA/CNB or diagnostic surgery
여포 종양 / 의심 (FN/SFN)FN/SFN	진단적 수술 또는 분자검사 Diagnostic surgery or molecular testingDiagnostic surgery or molecular testing	진단적 수술 또는 분자검사 Diagnostic surgery or molecular testingDiagnostic surgery or molecular testing	진단적 수술 Diagnostic surgeryDiagnostic surgery
악성 의심 (Suspicious for malignancy)Suspicious for malignancy	수술 SurgerySurgery	수술 SurgerySurgery	수술 SurgerySurgery
악성 (Malignant)Malignant	수술 SurgerySurgery	수술 SurgerySurgery	수술 SurgerySurgery

CNB = 중심부 바늘 생검 (Core needle biopsy). FNA 반복은 1~3개월 후 시행 권장.CNB = Core needle biopsy. Repeat FNA recommended after 1–3 months.

AUS/FLUS = 의의불명의 비정형 / 여포 병변 (Atypia/Follicular lesion of undetermined significance).AUS/FLUS = Atypia of undetermined significance / Follicular lesion of undetermined significance.

FN/SFN = 여포 종양 / 여포 종양 의심 (Follicular neoplasm / Suspicious for follicular neoplasm).FN/SFN = Follicular neoplasm / Suspicious for follicular neoplasm.

참고문헌 (Reference):Reference: Ha EJ et al. 2021 Korean Thyroid Imaging Reporting and Data System and Imaging-Based Management of Thyroid Nodules. Korean J Radiol 2021;22:2094-2123.

갑상선외 침범 (ETE) 초음파 기준Extrathyroidal Extension (ETE) — Ultrasound Criteria

Extrathyroidal Extension — Ultrasound Criteria ReferenceReference for ultrasound-based assessment of extrathyroidal extension

미세 갑상선외 침범 (Minor ETE)Minor ETE (Microscopic Extrathyroidal Extension)

전외측 (Anterolateral)Anterolateral: 갑상선 피막의 파괴 또는 불연속 (Capsular disruption or discontinuity)Capsular disruption or discontinuity; 피막 외 연조직으로의 종양 돌출 (Tumor protrusion beyond capsule into perithyroidal soft tissue)Tumor protrusion beyond capsule into perithyroidal soft tissue
후방 (Posterior)Posterior: 갑상선 후방 경계를 넘어선 돌출 (Protrusion beyond the posterior thyroid margin)Protrusion beyond the posterior thyroid margin; 후방 피막과의 접촉 길이 > 결절 둘레의 25% (Contact length with posterior capsule > 25% of nodule circumference)Contact length with posterior capsule > 25% of nodule circumference

현성 갑상선외 침범 (Gross ETE)Gross ETE (Macroscopic Extrathyroidal Extension)

경대근 침범 (Strap muscle invasion)Strap muscle invasion: 경대근의 종양에 의한 대체 또는 침범 (Replacement or invasion of strap muscle by tumor)Replacement or invasion of strap muscle by tumor; 근육과의 불규칙한 경계면 소실 (Loss of echogenic fascial plane between nodule and muscle)Loss of echogenic fascial plane between nodule and muscle
반회후두신경 침범 (RLN invasion)Recurrent laryngeal nerve (RLN) invasion: 기관식도구(tracheoesophageal groove)로의 종양 돌출 (Tumor protrusion into TEG)Tumor protrusion into tracheoesophageal groove (TEG); 성대 마비 동반 시 강력히 의심 (Strongly suspected with vocal cord paralysis)Strongly suspected with vocal cord paralysis
기관 침범 (Tracheal invasion)Tracheal invasion: 종양과 기관 연골 사이의 둔각(obtuse angle) 형성 (Obtuse angle between tumor and tracheal cartilage)Obtuse angle between tumor and tracheal cartilage; 기관 연골의 변형 또는 파괴 (Deformity or destruction of tracheal cartilage)Deformity or destruction of tracheal cartilage; 기관 내강으로의 종양 돌출 (Tumor protrusion into tracheal lumen)Tumor protrusion into tracheal lumen
식도 침범 (Esophageal invasion)Esophageal invasion: 식도벽과의 경계면 소실 (Loss of fat plane between nodule and esophagus)Loss of fat plane between nodule and esophagus; 식도벽의 비대 또는 변형 (Thickening or deformity of esophageal wall)Thickening or deformity of esophageal wall
혈관 침범 (Vascular invasion)Vascular invasion: 경동맥 또는 내경정맥에 대한 > 180° 접촉 (Contact with carotid artery or IJV > 180°)Contact with carotid artery or IJV > 180°; 혈관벽의 불규칙성 또는 혈전 (Irregular vessel wall or intraluminal thrombus)Irregular vessel wall or intraluminal thrombus

ETE 평가 시 주의사항 (Key Considerations)Key Considerations for ETE Assessment

임상적 의의 (Clinical Significance)Clinical Significance: 미세 ETE: 예후에 미치는 영향이 상대적으로 적음 (Minor ETE: relatively limited prognostic impact)Minor ETE: relatively limited prognostic impact; 현성 ETE: 재발율 증가, 수술 범위 결정에 중요 (Gross ETE: affects recurrence risk and surgical planning)Gross ETE: affects recurrence risk and surgical planning
초음파 한계 (US Limitations)Ultrasound Limitations: 미세 ETE의 초음파 민감도는 제한적 (Sensitivity for minor ETE is limited)Sensitivity for minor ETE is limited on ultrasound; 현성 ETE 의심 시 CT/MRI 추가 평가 권장 (CT/MRI recommended when gross ETE suspected)CT/MRI recommended when gross ETE is suspected

참고문헌 (References):References:
1. Ha EJ et al. 2021 Korean Thyroid Imaging Reporting and Data System. Korean J Radiol 2021;22:2094-2123.
2. Jung SL. 2021 K-TIRADS and Imaging-Based Management of Thyroid Nodules. Korean J Med 2022;97:292-302.

Clinical References

2021 K-TIRADS 가이드라인의 근거가 되는 주요 참고문헌 및 원문 자료Key references and source materials for the 2021 K-TIRADS guidelines

1. 2021 K-TIRADS Consensus Statement (Primary Guideline)

Ha EJ, Chung SR, Na DG, et al. 2021 Korean thyroid imaging reporting and data system and imaging-based management of thyroid nodules: Korean Society of Thyroid Radiology consensus statement and recommendations. Korean J Radiol 2021;22:2094-2123.
https://doi.org/10.3348/kjr.2021.0713

2. 2021 K-TIRADS Review Article

Jung SL. 2021 Korean Thyroid Imaging Reporting and Data System (2021-K-TIRADS) and imaging-based management of thyroid nodules. Korean J Med 2022;97:292-302.
https://doi.org/10.3904/kjm.2022.97.5.292

3. 2016 KSThR Revised Guidelines

Shin JH, Baek JH, Chung J, et al. Ultrasonography diagnosis and imaging-based management of thyroid nodules: revised Korean Society of Thyroid Radiology consensus statement and recommendations. Korean J Radiol 2016;17:370-395.
https://doi.org/10.3348/kjr.2016.17.3.370

4. Original KSThR Guidelines (2011)

Moon WJ, Baek JH, Jung SL, et al. Ultrasonography and the ultrasound-based management of thyroid nodules: consensus statement and recommendations. Korean J Radiol 2011;12:1-14.
https://doi.org/10.3348/kjr.2011.12.1.1

5. Multicenter Validation Study

Chung SR, Ahn HS, Choi YJ, et al. Diagnostic performance of the modified Korean thyroid imaging reporting and data system for thyroid malignancy: a multicenter validation study. Korean J Radiol 2021;22:1579-1586.
https://doi.org/10.3348/kjr.2020.1498

6. Diagnostic Performance Comparison

Ha EJ, Na DG, Baek JH, Sung JY, Kim JH, Kang SY. US fine-needle aspiration biopsy for thyroid malignancy: diagnostic performance of seven society guidelines applied to 2000 thyroid nodules. Radiology 2018;287:893-900.
https://doi.org/10.1148/radiol.2018171592

7. Hypoechogenicity Risk Stratification

Lee JY, Na DG, Yoon SJ, et al. Ultrasound malignancy risk stratification of thyroid nodules based on the degree of hypoechogenicity and echotexture. Eur Radiol 2020;30:1653-1663.
https://doi.org/10.1007/s00330-019-06527-8

Official KSThR Resources

대한갑상선영상의학회 (Korean Society of Thyroid Radiology) — K-TIRADS 가이드라인 및 임상 자료Korean Society of Thyroid Radiology — K-TIRADS guidelines and clinical resources
https://www.thyroidimaging.kr

Korean Journal of Radiology: 2021 K-TIRADS 전문 (Full-text open access)Korean Journal of Radiology: 2021 K-TIRADS full-text (open access)
View Full Article at KJR Online

면책 조항 (Disclaimer): 본 참고문헌 목록은 교육 및 임상 의사결정 지원 목적으로만 제공됩니다. 모든 자료의 저작권은 해당 저자 및 출판사에 있습니다.
These references are provided for educational and clinical decision support purposes only. All copyrights belong to the respective authors and publishers. Disclaimer: These references are provided for educational and clinical decision support purposes only. All copyrights belong to the respective authors and publishers.