Table 2.

Preoperative features that may indicate noninvasive follicular thyroid neoplasm with papillary‐like nuclear features diagnosis and are permissive of offering hemithyroidectomy initially

I. Physical examination characteristics

1. No lymph node metastasis

2. No fixation

3. No voice abnormalities

4. No vocal cord paralysis

II. Ultrasound characteristics (see also Table 2)

1. Low and intermediate nodule findings: isoechoic or hypoechoic, oval to round, sharp regular margin, hypoechoic rim

2. Not taller than wide

3. No microcalcifications

4. No contralateral lobe nodules

5. No extrathyroidal extension

6. No posterior abutment

7. No lymph node metastasis

8. No fixation

9. No vocal cord paralysis

III. Cytology characteristics (see also Table 1)

Bethesda III, IV, or V with:

+ Follicular pattern

+ Hypercellular

+ Microfollicular architecture

+ Sheet‐like architecture

‐ No papillae

‐ No psammomatous calcifications

‐ No prominent nuclear pseudoinclusions

‐ No prominent nuclear grooves

‐ No necrosis or mitoses

IV. Molecular characteristics

1. May have RAS, THADA fusion, or PAX8‐PARG

2. Should not have BRAF, RET fusion, TERT promoter, or other high‐grade mutation

V. Patient/endocrine characteristics

1. Willing to have second surgery if needed

2. Medically fit for possible second anesthesia

3. Endocrinologist in agreement with initial lobectomy surgery