EFSUMB Guidelines on Multiparametric Ultrasound Thyroid Nodule Evaluation: PART II.
Authors
Affiliations (24)
Affiliations (24)
- 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 Strausberg/Wriezen, Strausberg, Germany.
- Brandenburg Institute for Clinical Ultrasound (BICUS), Brandenburg Institute for Clinical Ultrasound at Medical University Brandenburg, Neuruppin, Germany.
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.
- Radiology, Hadassah, Jerusalem, Israel.
- Radiology, Northeastern Ohio Medical University, youngstown, United States.
- Department of Imaging and Interventional Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom of Great Britain and Northern Ireland.
- Radiology, University of Washington Department of Biology, Seattle, United States.
- Dept. of Translational and Precision Medicine, "Sapienza" University of Rome, ROME, Italy.
- Department of Radiology, "Sapienza" University of Rome, Cassino, Italy.
- Dept. 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.
- Radiology, Ege University School of Medicine, 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.
- Thyroid Unit, Clinic for Endocrinology and Diabetology, Repubblica e Cantone Ticino Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, 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.