Although most nodules are benign lesions, the detection of nodules still brings a great psychological and psychological burden to people, and they are even willing to take the risk of suffering pain to have them surgically removed, which is the main reason for the current over-treatment of thyroid nodules.
So what should we do for nodules detected by ultrasound (BI-RADS grade 4)? Fine needle aspiration (FNA) and cytology of the thyroid gland is the most sensitive and inexpensive way to determine the nature of thyroid nodules and whether to operate. After history taking, physical examination, TSH
After history taking, physical examination, TSH testing, and ultrasonography, the choice of FNA is based on nodule size, clinical and ultrasound signs. The ATA recommends the following indications for FNA of thyroid nodules: nodules with a maximum diameter of ≥1.0 cm on ultrasound, with ultrasound findings suggestive of high or moderate suspicion of malignancy nodules with a maximum diameter of ≥1.5 cm on ultrasound, with ultrasound findings suggestive of low suspicion of malignancy nodules with a maximum diameter of ≥2.0 cm on ultrasound, with ultrasound findings suggestive of high or moderate suspicion of malignancy For nodules ≥ 2 cm in diameter with no suspicious signs, and nodules ≥ 1 cm with suspicious ultrasound signs, FNA is required. However, for thyroid nodules < 1 cm in diameter, if clinical or ultrasound suspicious signs are present, FNA should be performed.
Further studies are needed to determine whether FNA can help improve the outcome of treatment for small nodules because it is more difficult to puncture the nodules, and the nature of the nodules cannot be determined even after sequencing technology or whole genome sequencing is completed. For nodules >4 cm in diameter
For nodules >4 cm in diameter, we believe that puncture is of little significance because nodules >4 cm in diameter, regardless of their benignity or malignancy, are inherently indicative of surgery. In conclusion, for nodules of indeterminate quality, clinical work-up is generally either a matter of continued close observation or diagnostic surgery.
The guidelines recommend molecular examination to further determine the nature of the nodule after combining clinical and imaging features and fully communicating the pros and cons with the patient. If the patient does not want to accept the torment of uncertainty during follow-up observation, he or she can also choose diagnostic surgery according to his or her personal wishes.