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1、[A8]Thyroidsonography■RECOMMENDATION6Thyroidsonographywithsurveyofthecervicallymphnodesshouldbeperformedinallpatientswithknownorsuspectedthyroidnodules.(Strongrecommendation,High-qualityevidence)Diagnosticthyroid/neckUSshouldbeperformedinallpatientswithasuspectedthyroidnodule,nodulargoiter,orr
2、adiographicabnormalitysuggestingathyroidnoduleincidentallydetectedonanotherimagingstudy(e.g.,computedtomography(CT)ormagneticresonanceimaging(MRI)orthyroidaluptakeon18FDG-PETscan)ThyroidUScananswerthefollowingquestions:Istheretrulyanodulethatcorrespondstoanidentifiedabnormality?Howlargeistheno
3、dule?Whatisthenodule’spatternofultrasoundimagingcharacteristics?Issuspiciouscervicallymphadenopathypresent?Isthenodulegreaterthan50%cystic?Isthenodulelocatedposteriorlyinthethyroidgland?TheselasttwofeaturesmightdecreasetheaccuracyofFNAbiopsyperformedwithpalpation(63;64).Ultrasoundshouldevaluat
4、ethefollowing:thyroidparenchyma(homogeneousorheterogeneous)andglandsize;size,location,andsonographiccharacteristicsofanynodule(s);thepresenceorabsenceofanysuspiciouscervicallymphnodesinthecentralorlateralcompartments.Theultrasoundreportshouldconveynodulesize(in3dimensions)andlocation(e.g.right
5、upperlobe)andadescriptionofthenodule’ssonographicfeaturesincluding:composition(solid,cysticproportion,orspongiform),echogenicity,margins,presenceandtypeofcalcifications,andshapeiftallerthanwide,andvascularity.Thepatternofsonographicfeaturesassociatedwithanoduleconfersariskofmalignancy,andcombi
6、nedwithnodulesize,guidesFNAdecision-making(65;66)(seeRecommendation8).InthesubsetofpatientswithlowserumTSHlevelswhohaveundergoneradionuclidethyroidscintigraphysuggestingnodularity,ultrasoundshouldalsobeperformedtoevaluateboththepresenceofnodulesconcordantwiththehyperfunctioningareasonthescan,w
7、hichdonotrequireFNA,aswellasothernonfunctioningnodulesthatmeetsonographiccriteriaforFNA.■RECOMMENDATION8ThyroidnodulediagnosticFNAisrecommendedfor(Figure2,Table6):A)Nodules>1cmingreatestdimensionwithhighsuspicionsonographicpattern(Stron
