Table 5.

Features That Warrant Percutaneous Fine-Needle Aspiration Biopsy of a “Solitary” Nodule or a “Special” Nodule in A Goiter

1.

Clinical Features

a.

History of head and neck irradiation in youth

b.

Family history of medullary (or signs & symptoms) or less so papillary thyroid cancer

c.

Unusual firmness without calcification

d.

Growth of nodule especially during suppressive therapy

e.

Lymphadenopathy

2.

Ultrasonic Features (at least two “suspicious” ultrasound features)

a.

Hypoechoic nodules with one or more of the following

i.

Irregular margins

ii.

Enhanced intranodular vascular spots (central vascularity)

iii.

Microcalcifications (punctate calcifications)

iv.

Blurred margins

v.

Taller-than-wide nodule shape

vi.

Enlargement of a nodule when compared to prior examination

b.

Lymphadenopathy (palpable or ultrasonographic)

3.

In a goiter, biopsy the nodule that has “suspicious” ultrasonographic features rather than the largest nodule.

4.

The size or number of nodules in a gland does not correlate with risk factors

From: Ultrasonography of the Thyroid

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