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Grading
| Grade | Lesion Characteristics |
|---|---|
| Grade 0 | Thyroiditis, simple goiter, unclear surgery history, incomplete ultrasound examination, requiring combination with other tests |
| Grade 1 | Normal thyroid or diffuse hyperplastic thyroid, cystic nodules with crystals (no further follow-up needed if less than 5mm) |
| Grade 2 | Benign nodules, simple cysts, stable postoperative changes and adenomas or cystadenomas with no changes during long-term follow-up, postoperative scar changes, etc. Includes predominantly cystic nodules, honeycomb pattern and ring calcification (malignancy risk < 2%) |
| Grade 3 | Mostly benign, malignancy risk 2-5%. Ultrasound findings: lesions are round or oval, well-defined edges, predominantly solid with heterogeneous echoes, eggshell or coarse calcifications, high likelihood of adenoma/cystadenoma, with one malignant feature such as hypoechoic area or calcification |
| Grade 4 | Suspicious malignant nodules: 5-95%, including papillary carcinoma, medullary carcinoma, malignant transformation of adenoma |
| 4a (5-45%) with 2 ultrasound malignant signs | |
| 4b (45-75%) with 3 ultrasound malignant signs | |
| 4c (75-94%) with 4 ultrasound malignant signs | |
| Grade 5 | Highly suspicious of malignancy |
| Grade 6 | Pathologically confirmed malignant lesion |
Malignant Ultrasound Signs of Thyroid Nodules
- Irregular shape
- Blurred boundaries with invasive growth
- Solid hypoechoic
- Posterior echo attenuation
- Incomplete halo, narrow band hypoechoic area
- Invasion of thyroid capsule, showing interruption of strong echo capsule, with longitudinal to transverse ratio >1
- Sand-like calcifications: microcalcifications or clustered distribution, with or without posterior acoustic shadowing, no comet-tail artifact
- Cervical lymph node metastasis
- CDFI: irregular distribution, visible penetrating blood flow, multi-polar blood flow, peripheral ring vessels less than half of the lesion
- VE (elastography) score 3-4
- CEUS: heterogeneous enhancement, low enhancement, centripetal enhancement predominates, unclear boundary, irregular shape
Basic Observation Methods for Thyroid Diagnosis
- Shape: regular / irregular
- Boundary: clear / unclear
- Internal echo: very low echo / low echo / moderate strong echo
- Calcification: present / absent
- Calcification type: small calcification / large calcification / mixed-sized calcification
- Presence or absence of lymph node metastasis
- Longitudinal to transverse ratio
- CDFI examination: scarce or abundant
- VE:
- Score 1: lesion overall displays green
- Score 2: lesion mostly displays green
- Score 3: lesion displays roughly equal proportions of green and blue
- Score 4: lesion mostly blue with minor green inside
Scores 1-2: benign; 3-4: malignant
- CEUS: provides microvascular information
Thyroid Nodule Ultrasound Morphological Signs
Normal thyroid: rapid uniform - marked enhancement
Adenoma: uniform ring-shaped high enhancement, clear boundary after enhancement, regular shape
Papillary carcinoma: diverse appearances, mostly iso-enhancement
Medullary carcinoma: heterogeneous, centripetal low enhancement, unclear boundary after enhancement, irregular shape