[Medical Q&A] What kind of thyroid nodules have the risk of malignancy?

Author: Yang Xiaorong Shanghai Pudong New Area Zhoupu Hospital

Reviewer: Zhang Jinan, Chief Physician, Zhoupu Hospital, Pudong New Area, Shanghai

When the ultrasound report contains the following descriptions of thyroid nodules, the risk of suspected malignancy is 70% to 90%, which should be taken seriously:

(1) Solid hypoechoic or cystic-solid nodules in which the solid component is hypoechoic.

(2) Simultaneous presence of one or more of the following ultrasound features: ① irregular margins (infiltrative, small lobes, or spiculated); ② microcalcifications; ③ aspect ratio > 1; ④ interrupted calcification at the margins, with low echoes protruding outside the calcifications; and ⑤ invasion of the thyroid capsule.

If the above description is present, the thyroid nodule is generally considered to be malignant. At this time, the ultrasound physician will recommend that the patient complete a thyroid fine needle biopsy to further clarify the diagnosis.

Ultrasound-guided thyroid fine needle aspiration biopsy is a minimally invasive procedure that involves extracting a small amount of tissue from a thyroid nodule through a fine needle. Anesthetic drugs are used during the procedure, and the patient feels almost no pain. It is the most sensitive and specific method for preoperative diagnosis of thyroid cancer. If the result is benign, surgery is not necessary; if the result indicates malignancy, it can help the clinician develop an appropriate surgical plan.

A fine needle aspiration biopsy of the thyroid gland may be necessary in the following situations:

(1) Thyroid nodules with a diameter of less than 5 mm, when ultrasound indicates "high-risk thyroid lesions with the presence of pathological lymph nodes or growth outside the thyroid gland".

When the diameter of the thyroid nodule is greater than 10 mm and the clinical manifestations cannot be determined as a benign lesion.

Nodules with a diameter ≥ 20 mm show spongiosis, homogeneous high-intensity echoes, or a cystic nodule area of ​​＞ 50%, or are progressively enlarged.

Patients with a history of thyroid cancer or family history, or with suspicious clinical and imaging manifestations.

If a biopsy confirms a diagnosis of thyroid cancer, further treatment may be needed.