Rodrigo Arrangoiz MS, MD, FACS, FSSO

01/11/2026

Thyroid Awareness Month

Understanding TI-RADS & ATA Risk Categories

Not all thyroid nodules are the same. Ultrasound risk stratification helps determine which nodules need biopsy and which can be safely monitored.

🔍 What are TI-RADS and ATA?
• ACR TI-RADS and ATA ultrasound patterns are validated, evidence-based systems
• They estimate the risk of thyroid cancer based on ultrasound features
• They help avoid unnecessary biopsies and surgeries

📊 What ultrasound features matter?

Risk stratification is based on:
• Composition (solid vs cystic)
• Echogenicity (hypoechoic nodules carry higher risk)
• Margins (irregular margins increase risk)
• Calcifications (especially microcalcifications)
• Shape (taller-than-wide nodules are more suspicious)

Each feature contributes to a risk category, which then guides:
✔️ Need for biopsy
✔️ Size threshold for biopsy
✔️ Follow-up interval

🧪 What does this mean for patients?
• Low-risk nodules → observation with ultrasound
• Intermediate-risk nodules → biopsy at specific sizes
• High-risk nodules → earlier biopsy and closer follow-up

🦋 This approach is personalized, safe, and evidence-based.

⸻

👨‍⚕️ Dr. Rodrigo Arrangoiz, MD
Surgical Oncologist – Thyroid, Head & Neck, Breast
Mount Sinai Medical Center

📌 Take-home message:
Ultrasound risk stratification ensures the right care for the right patient, avoiding both under- and overtreatment.

📚 References
• Tessler FN et al. ACR TI-RADS. Radiology
• Haugen BR et al. ATA Guidelines for Thyroid Nodules. Thyroid
• Russ G et al. EU-TI-RADS. European Journal of Endocrinology

01/11/2026

Thyroid Awareness Month - Understanding TI-RADS & ATA Risk Categories

Not all thyroid nodules are the same. Ultrasound risk stratification helps determine which nodules need biopsy and which can be safely observed. 🔍 What are TI-RADS and ATA? ACR TI-RADS and ATA ultr…

01/09/2026

Early Breast Cancer New Information from San Antonio Breast Cancer Conference 2025

Adjuvant endocrine therapy is evolving: Oral SERD in early HR+ / HER2− disease: lidERA (giredestrant vs standard endocrine therapy): What it tested: Adjuvant giredestrant (oral SERD) vs standa…

01/09/2026

Finishing a strong first full week of 2026 with 65 patients in clinic and 13 operative cases

01/08/2026

Destiny - Breast 02 Trial

Is a randomized phase III trial: That established trastuzumab deruxtecan (T-DXd) as the preferred therapy for patients with HER2-positive metastatic breast cancer: Previously treated with trastuzum…

01/07/2026

Thyroid Awareness Month - Why Thyroid Ultrasound Is the Most Important Test

When a thyroid nodule is suspected or discovered, high-resolution thyroid ultrasound is the single most important diagnostic study. 🔍 What does a thyroid ultrasound tell us? Ultrasound allows us to…

01/07/2026

Thyroid Awareness Month – Day 4

Why Thyroid Ultrasound Is the Most Important Test

When a thyroid nodule is suspected or discovered, high-resolution thyroid ultrasound is the single most important diagnostic study.

🔍 What does a thyroid ultrasound tell us?

Ultrasound allows us to evaluate:
• Size and exact location of the nodule
• Composition (solid, cystic, or mixed)
• Margins (smooth vs irregular)
• Echogenicity and calcifications
• Vascularity (with Doppler imaging)
• Cervical lymph nodes

➡️ These features are far more predictive of cancer risk than symptoms or blood tests.

📊 Risk stratification matters

Using ultrasound findings, nodules are categorized with validated systems such as:
• ATA risk patterns
• ACR TI-RADS

These systems help determine:
✔️ Which nodules need biopsy
✔️ Which nodules can be safely observed
✔️ Appropriate follow-up intervals

🧪 Important clarification
• Blood tests do not diagnose thyroid cancer
• CT scans and MRIs are NOT first-line tests for thyroid nodules
• Ultrasound provides real-time, radiation-free, highly accurate evaluation

🦋 Why this matters for patients

Proper ultrasound evaluation:
• Prevents unnecessary biopsies and surgeries
• Ensures early diagnosis of clinically significant thyroid cancer
• Guides personalized management

⸻

👨‍⚕️ Rodrigo Arrangoiz, MD
Surgical Oncologist – Thyroid, Head & Neck, Breast
Mount Sinai Medical Center

📌 Take-home message:
Not all ultrasounds are equal.
Expert, high-resolution thyroid ultrasound makes all the difference.

📚 References
• Haugen BR et al. ATA Guidelines for Thyroid Nodules. Thyroid
• Tessler FN et al. ACR TI-RADS. Radiology
• Russ G et al. EU-TI-RADS. European Journal of Endocrinology

01/07/2026

01/07/2026

01/07/2026

Thyroid Awareness Month – Who Is at Risk for Thyroid Nodules?

Thyroid Awareness Month – Day 3 Who Is at Risk for Thyroid Nodules? Thyroid nodules can occur in anyone, but certain factors make them more likely. 👥 Common Risk Factors Age: Nodules beco…

01/07/2026

Thyroid Awareness Month – Day 3

Who Is at Risk for Thyroid Nodules?

Thyroid nodules can occur in anyone, but certain factors make them more likely.

👥 Common Risk Factors
• Age: Nodules become more common as we get older
• Female s*x: Women develop thyroid nodules 3–4 times more often than men
• Iodine imbalance: Both deficiency and excess can play a role
• Family history: Thyroid nodules or thyroid cancer in first-degree relatives
• Autoimmune thyroid disease: Hashimoto’s thyroiditis increases nodule prevalence

☢️ Higher-Risk Situations
• Radiation exposure to the head and neck, especially during childhood
• Prior radiation therapy for acne, tonsils, or cancer (historical treatments)
• Certain genetic syndromes (rare, but important)

🧠 Important clarification

Having risk factors does not mean a thyroid nodule is cancer.
➡️ Even in higher-risk individuals, most nodules are benign.

🔍 What matters most?

Risk factors help guide how closely we evaluate, but ultrasound findings ultimately determine:
• Cancer risk
• Need for biopsy
• Follow-up strategy

📌 Key point for patients:
A thyroid nodule should never be ignored — but it should also never cause unnecessary fear. Proper, evidence-based evaluation is the answer.

⸻

👨‍⚕️ Rodrigo Arrangoiz, MD
Surgical Oncologist – Thyroid, Head & Neck, Breast
Mount Sinai Medical Center

📚 References
• Haugen BR et al. ATA Guidelines for Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid
• Guth S et al. Very high prevalence of thyroid nodules. Thyroid
• Gharib H et al. Evaluation and Management of Thyroid Nodules. Endocrine Practice

01/06/2026

A Targeted Approach to Post-Mastectomy Pain and Persistent Pain Following Breast Cancer Treatment
Chang PJ, Asher A, Smith SR. Cancers. 2021;13(20):5191

Post-mastectomy pain syndrome (PMPS) remains an underrecognized yet highly impactful complication of breast cancer treatment, affecting up to 20–60% of patients and often persisting for years after surgery.

This comprehensive review reframes PMPS as a multifactorial neuropathic pain condition, emphasizing the importance of mechanism-based diagnosis and targeted intervention, rather than a one-size-fits-all approach.

🔑 Key Insights

🧠 Pathophysiology Matters
• PMPS is primarily driven by nerve injury (intercostobrachial nerve, medial/lateral pectoral nerves, intercostal nerves).
• Contributors include surgical trauma, radiation-induced fibrosis, chemotherapy-related neuropathy, and central sensitization.

📍 Pain Is Regional, Not Generic
• Pain commonly localizes to the chest wall, axilla, shoulder, and upper arm.
• Recognizing the anatomic pain generator is critical to effective treatment.

🎯 Targeted, Multimodal Management
The authors advocate for a stepwise, personalized strategy, including:
• Peripheral nerve blocks (intercostobrachial, paravertebral, PECS blocks)
• Neuromodulation techniques
• Physical therapy and desensitization
• Pharmacologic agents (gabapentinoids, TCAs, SNRIs)
• Psychological support for centralized pain components

🔪 Surgical Prevention Starts in the OR
• Meticulous nerve identification and preservation
• Thoughtful axillary dissection
• Early postoperative pain control may reduce chronic pain transition

📊 Why This Matters
• Persistent pain significantly affects quality of life, functional recovery, body image, and survivorship outcomes
• Early identification and intervention can prevent chronic disability

💡 Take-Home Message

PMPS should be approached as a distinct, treatable neuropathic condition, not an inevitable consequence of breast cancer surgery. A targeted, anatomy-driven strategy—integrating surgeons, anesthesiologists, pain specialists, and rehabilitation teams—offers the best opportunity to improve long-term outcomes for breast cancer survivors.