In medical examination reports, the words thyroid nodules can often be found. What does this mean, is it cancer? Many people are very concerned and even anxious because of it. First of all, please don’t be nervous, thyroid nodules are very common, 20%-76% of people can detect thyroid nodules in ultrasound examination, only 5%-15% of nodules are malignant, you can make a simple analysis with the following points. 1. Ultrasound signs of benign nodules: ① pure cystic nodules; ② nodules with multiple small vesicles occupying more than 50% of the nodule volume and showing spongy changes, 99.7% are benign. The following ultrasound signs suggest that thyroid cancer is more likely: 1) solid hypoechoic nodules; 2) rich blood supply in the nodules (under normal TSH); 3) irregular nodule shape and margin, halo absence; 4) microcalcifications, pinpoint-like diffuse distribution or clusters of calcifications; 5) abnormal ultrasound images of cervical lymph nodes, such as round lymph nodes, irregular or blurred borders, uneven internal echogenicity, calcifications, dermal medulla, etc. The lymph nodes are round, with irregular or blurred borders, uneven internal echogenicity, internal calcification, poorly demarcated dermal medulla, disappearance of lymphatic portals or cystic changes. In particular, no single ultrasound feature is unique to benign or malignant thyroid nodules, and a comprehensive analysis is needed to identify them. In order to better assess the risk level of nodules, the TI-RADS thyroid nodule classification criteria were proposed internationally in 2009, and Kwak further proposed a more practical classification method by using the five ultrasound sonographic features of solid nodules, hypoechoic or very hypoechoic, irregular borders, microcalcifications, and aspect ratio >1 as criteria for the assessment of malignant thyroid nodules, with reference to the BI-RADS
The following classification was established with reference to the BI-RADS malignancy risk level classification system, which is the most used classification: TI-RADS category 1: negative (without any abnormality) (malignancy rate 0); TI-RADS category 2: confirmed benign lesion (malignancy rate 0); TI-RADS category 3: ( no suspicious ultrasound presentation) (malignancy rate 1.7%); TI-RADS category 4: 4a ( 1 suspicious ultrasound presentation) (malignancy rate 3.3%), 4b (2 suspicious ultrasound presentations) (malignancy rate 9.2%), 4c (3 or 4 suspicious ultrasound presentations) (malignancy rate 44.4-72.4%); TI-RADS category 5: (5 suspicious ultrasound presentations) (malignancy rate 87.5%). It should be reminded that the ability of ultrasonography to identify benign and malignant thyroid nodules is related to the clinical experience of the ultrasonographer. If in doubt, repeat the ultrasonography, and the final result should be determined by the clinician after comprehensive analysis.