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Thyroid nodules: risk stratification for malignancy with ultrasound and guided biopsy

机译：甲状腺结节：超声和活检引导下恶性肿瘤的危险分层

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Replacing palpating fingers with an ultrasound (US) probe has resulted in an epidemic of thyroid nodules. Despite the high prevalence of thyroid nodules in the general population, thyroid malignancy is rare. Although no imaging modality can accurately predict the nature of every nodule, high-resolution US is the most sensitive, easily available and cost-effective diagnostic test available to detect thyroid nodules, measure their dimensions and identify their structure. The presence of calcifications, irregular spiculated outline, hypoechogenicity in a solid nodule, chaotic intranodular vascularity and an elongated shape are well-known US features of malignancy in thyroid nodules. Cervical lymph node metastasis and extrathyroidal extension of a thyroid nodule are highly specific for malignancy but seen infrequently. Spongiform nodules, purely or predominantly cystic nodules, nodules with well-defined hypoechoic halo and echogenic as well as isoechoic nodules are usually benign. None of the US characteristics have 100% accuracy in detecting or excluding malignancy. Fine-needle biopsy is currently the best triage test for pre-operative evaluation of a thyroid nodule. There is no significant difference in the risk for malignancy between palpable and non-palpable nodules and size is not a reliable indicator for their malignant potential. The best tool for risk stratification for malignancy in thyroid nodules is US and guided biopsy of nodules with suspicious imaging features. This is especially relevant in patients with multinodular goitre.
机译：用超声（US）探头代替触诊手指已导致甲状腺结节流行。尽管在普通人群中甲状腺结节患病率很高，但甲状腺恶性肿瘤很少见。尽管没有影像学方法可以准确预测每个结节的性质，但高分辨率US是最敏感，最容易获得且具有成本效益的诊断测试，可用于检测甲状腺结节，测量其大小并确定其结构。在美国，甲状腺结节恶性肿瘤的特征是钙化，不规则的针状轮廓，实性结节的低回声性，结节内血管混乱和形状变长。宫颈淋巴结转移和甲状腺结节的甲状腺外扩展对恶性肿瘤具有高度特异性，但很少见。海绵状结节，纯或主要是囊性结节，具有明确的低回声晕和回声的结节以及等回声结节通常是良性的。美国的任何特征在检测或排除恶性肿瘤方面均没有100％的准确性。目前，细针穿刺活检是对甲状腺结节进行术前评估的最佳分类检查方法。可触及结节与不可触及结节的恶性风险无显着差异，大小也不是其潜在恶性的可靠指标。甲状腺结节恶性肿瘤风险分层的最佳工具是超声检查和具有可疑影像学特征的结节活检。这对于多结节性甲状腺肿患者尤其重要。

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