In terms of surgery, the primary issue to be addressed in patients with thyroid nodules is the determination of the benignity or malignancy of the nodule. For patients with a confirmed diagnosis and high suspicion of thyroid nodules, blood TSH (thyroid stimulating hormone) levels and ultrasound of the thyroid and cervical lymph nodes are often required at the initial consultation.
According to the NCCN Thyroid Cancer Guidelines 2013 edition, tethered needle aspiration biopsy is considered for patients with the following thyroid nodules.
1. Patients with normal or increased blood TSH levels.
2. Patients with reduced TSH levels but with I131 uptake tests suggesting cold or warm nodules (usually hot nodules with decreased TSH levels are overwhelmingly benign nodules, so fine needle aspiration is not considered for now).
The NCCN guidelines recommend the following criteria for fine needle aspiration biopsy.
1, solid nodules: suspicious ultrasound presentation >1cm, no suspicious ultrasound presentation >1.5cm.
2. Cystic nodules: suspicious ultrasound >1.5-2.0 cm.
No suspicious ultrasound performance >2.0cm.
3.Spongy nodule: >2.0cm.
4.Simple cystic nodules: puncture biopsy is usually not required.
5.Suspicious lymph nodes on ultrasound often need to be biopsied together with suspicious nodes.
So which ultrasound descriptions are highly suggestive of malignant nodes? As a rule, nodes with the following characteristics are suspicious for malignant nodes.
1. hypoechoic.
2, Irregular morphology.
3, poorly defined borders.
4, multiple internal microcalcifications.
5. an aspect ratio greater than 1. 6 In terms of surgery, the primary issue to be addressed in patients with thyroid nodules is the determination of the benignity or malignancy of the nodule. For patients with confirmed and highly suspected thyroid nodules, the initial diagnosis often requires testing of blood TSH (thyroid-stimulating hormone) levels and ultrasound of the thyroid and cervical lymph nodes.
According to the NCCN Thyroid Cancer Guidelines 2013 edition, tethered needle aspiration biopsy is considered for patients with the following thyroid nodules.
1. Patients with normal or increased blood TSH levels.
2. Patients with reduced TSH levels but with I131 uptake tests suggesting cold or warm nodules (usually hot nodules with decreased TSH levels are overwhelmingly benign nodules, so fine needle aspiration is not considered for now).
The NCCN guidelines recommend the following criteria for fine needle aspiration biopsy.
1, solid nodules: suspicious ultrasound presentation >1cm, no suspicious ultrasound presentation >1.5cm.
2. Cystic nodules: suspicious ultrasound >1.5-2.0 cm. No suspicious ultrasound performance >2.0cm.
3.Spongy nodule: >2.0cm.
4.Simple cystic nodules: puncture biopsy is usually not required.
5.Suspicious lymph nodes on ultrasound often need to be biopsied together with suspicious nodes.
So which ultrasound descriptions are highly suggestive of malignant nodes? As a rule, nodes with the following characteristics are suspicious for malignant nodes.
1. hypoechoic.
2, Irregular morphology.
3, poorly defined borders.
4, multiple internal microcalcifications.
5, aspect ratio greater than 1.
6, rich internal blood flow.
The fine needle aspiration biopsy criteria mentioned in the above guidelines are applicable to the general population. For patients with high-risk clinical factors, it is often necessary for the physician to narrow the above criteria according to the actual situation. In other words, thyroid nodules in the high-risk population often need to be considered for aggressive aspiration biopsy, even if they do not meet the guidelines’ criteria. Those with radiation exposure in childhood and adolescence, those with previous thyroid cancer with resection of the affected thyroid and isthmus, those with previous history of familial adenomatous polyposis (FAP), Carney syndrome, Cowden syndrome, MEN2, and other diseases closely related to thyroid cancer, those with first-degree relatives with thyroid cancer, and those with PET-CT suggestive of high uptake foci are all considered high-risk groups.
Internal blood flow is abundant.
The fine needle aspiration biopsy criteria mentioned in the above guidelines are applicable to the general population. For patients with high-risk clinical factors, it is often necessary for physicians to narrow the above criteria according to the actual situation. In other words, thyroid nodules in the high-risk population often need to be considered for aggressive aspiration biopsy even if they do not meet the criteria in the guidelines. Those who have been exposed to radiation in childhood and adolescence, those who have had previous thyroid cancer with excision of the affected thyroid gland and isthmus, those who have a history of familial adenomatous polyposis (FAP), Carney syndrome, Cowden syndrome, MEN2, and other diseases closely related to thyroid cancer, those who have a first-degree relative with thyroid cancer, and those with PET-CT indicating high uptake foci are all considered high-risk groups.