EFSUMB Guidelines on Multiparametric Ultrasound Thyroid Nodule Evaluation: PART I.
Authors
Affiliations (23)
Affiliations (23)
- Department of Radiology, "Sapienza" University of Rome, ROME, Italy.
- Radiology Research laboratory, Riga Stradins University, Riga, Latvia.
- Diagnostic Radiology Institute, Paul Stradins Clinical University Hospital, Riga, Latvia.
- Department General Internal Medicine (DAIM), Hospitals Hirslanden Bern Beau Site, Salem and Permanence, bern, Switzerland.
- Department of Internal Medicine, Krankenhaus Märkisch-Oderland GmbH, Strausberg, Germany.
- Brandenburg Institute for Clinical Ultrasound (BICUS), Brandenburg Medical University, Neuruppin, Germany.
- Department of Biomedical Imaging and Image-Guided Therapy, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
- Department of Radiology, Hadassah University Medical Center, Jerusalem, Israel.
- Radiology, Northeastern Ohio Medical University, youngstown, United States.
- Dept of Imaging, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom of Great Britain and Northern Ireland.
- Radiology, University of Washington Department of Biology, Seattle, United States.
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, ROME, Italy.
- Department of Radiology, "Sapienza" University of Rome, Cassino, Italy.
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy.
- Dept of Imaging, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom of Great Britain and Northern Ireland.
- Department of Ultrasonography, The 2nd Affiliated Hospital Zhejiang University College of Medicine, Hangzhou, China.
- Dept.of Radiology, US Center, Univ. Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia.
- Imaging, Imperial College, London, United Kingdom of Great Britain and Northern Ireland.
- Department of Radiology, Era Radiology Centre, Izmir, Turkey.
- RADIOLOGY, DOKUZ EYLUL UNIVERSITY FACULTY OF MEDICINE, IZMIR, Turkey.
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital, Kobenhavn, Denmark.
- Copenhagen Academy for Medical Education and Simulation, Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark.
- IIMSI, Repubblica e Cantone Ticino Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
Abstract
Thyroid nodules are common incidental findings but only a small proportion of cases are malignant (4-6.5%) or symptomatic. Numerous follow-up examinations and invasive diagnostic procedures, such as fine-needle aspiration, fine-needle biopsies, and thyroidectomies, are performed, leading to potentially costly and time-consuming diagnostic procedures and overtreatment. Most experts and scientific societies (EFSUMB, WFUMB...) encourage the use of multiparametric ultrasound evaluation to improve the thyroid nodule characterization thanks also to the continuous technological developments with different ultrasound software (Microvascular flow imaging, Elastosonography...), contrast media (CEUS) and artificial intelligence (AI). Therefore, the recognition and proper use of new multiparametric ultrasound features of thyroid nodules are essential to minimize unnecessary interventions and guide appropriate treatments, also stimulating their use in routine clinical practice, which is the aim of our guideline. In addition, we analyze the use of MPUS in some emblematic thyroid scenarios such as cytologically indeterminate nodule, multinodular goiter and extrathyroidal extension of the malignant nodule and the usefulness of MPUS as a guide to thyroid biopsy/aspiration and in the staging of cervical lymph nodes. For each question, recommendations based on the level of evidence of the published literature and on the EFSUMB expert group's consensus are given.