How do I read an ultrasound report of a thyroid nodule?

by Specialist

What does an ultrasound report of a thyroid nodule include?

Usually, an ultrasound diagnostic report will include the following sections:

  • 1 to 2 typical ultrasound images;

  • A paragraph describing the characteristics of the lesion;

  • The sonographer’s opinion as to whether the thyroid nodule is “predisposed” to be benign or malignant.

However, ultrasound diagnosis is somewhat subjective, and the same nodule may be described differently by different physicians, and conclusions may vary widely.

If some doctors prefer “malignant” and others prefer “benign” for the same lesion, how should we interpret this? Is there a uniform standard?

How does the ultrasound diagnosis look and how do we follow up?

In order to minimize physician judgment, we need to have a more accurate diagnosis.

In order to minimize the variability caused by physician subjectivity, some hospital ultrasound departments use a standardized classification called the “TI-RADS” reporting system (Thyroid Imaging Reporting and Data System). This is called the “TI-RADS” reporting system (Thyroid Imaging Reporting and Data System).

After combining the various ultrasound presentations of thyroid nodules, the doctor gives a score between 0 and 6 according to the table below. The different scores have different meanings and imply different responses.

1

2

            Table 1. Thyroid nodules TI-RADS score and meaning
TI-RADS score Meaning

0

 Unable to assess, further examination required
“Negative”, i.e. no nodules found, no further workup needed
Benign nodules, predominantly cystic or solid, with regular morphology and clear borders, or with typical benign nodule features. No further examination is needed, clinical observation is sufficient
3 Probably benign (generally less than 5% malignant) with no typical malignant features. Review in 6 to 12 months is recommended
4

Probably malignant, with one or more features of a malignant nodule, which can be subdivided into 4A, 4B, and 4C, with a progressively higher probability of malignancy.

Patients with a “score of 4” usually require close follow-up (every 3 months) or further evaluation, including ultrasound-guided fine-needle aspiration biopsy, and may require surgical treatment
5

Highly suspicious of malignancy (80% to 90% probability), requiring further evaluation (e.g., fine needle aspiration) or surgery
6 Thyroid cancer that has been confirmed by fine-needle aspiration

These are the things you should look for when you “read” an ultrasound report

After you see your ultrasonographer’s TI-RADS diagnosis, there are a few other things to look for:

  1.  The probability of malignancy corresponding to different TI-RADS scores is not absolute, but only a general principle.

    1.  The probability of malignancy for different TI-RADS scores is not absolute, but is a general principle.
    2. Ultrasound, although highly valuable, cannot provide a “final verdict” and can only be used as a reference by physicians.
    3. For the management of your thyroid nodule, your doctor will need to take into account your age, medical history, nodule size, symptoms, and relevant test results. You should not “interpret” the report on your own, but consult a medical professional.

    .

    Co-written by Dr. Naisi Huang, Cancer Hospital, Fudan University