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1.Screening
1.1.Inclusion criteria

nodule with high insufficient rate

high cystic nodule

US assessment accords with FNA criteria recommended by C-TIRADS

Yes
/
No

Thyroid US indicates thyroid nodule.

Yes

Age ≥ 18 years old

Yes

Informed consent

Yes

1.2.Exclusion criteria

Patients unable to cooperate for FNA or CEUS

No

Active infectious focus on cervical skin

No

Pregnancy

No

Severe abnormality of coagulation function

No

Severe abnormality of heart function or lung function

No

Refuse to CEUS

No

Allergic to lidocaine or SonoVue

No

2.Preoperative indications
2.1.General information

Date for signing informed consent

2023-05-16

Telephone

13680834755

Sex

Female

Birthday

1986-09-19

Registration number

0004327136

2.2.Preoperative examination

Anteroposterior diameter

14 mm

Coagulation function

Yes

transverse diameter

17 mm

Routine blood test

Yes

Location of target thyroid nodule

right lobe

VCs function evaluated by TLUSG

bilateral VCs moved symmetrically

Ultrasonic diagnose

甲状腺良性结节

Rank of C-TIRADS

3

Score of C-TIRADS

0

Rank of ACR TI-RADS

2

Score of ACR TI-RADS

2

Solid component of sheet-like strong echo (%)

-

Strong echo within nodule

No

acoustic halo

No

border

regular

edge

clear

echo

iso-echo

Solid component (%)

10

Upper and lower diameter

15 mm

3.Intraoperative indications
3.1.Time of aspiration

End time

18:01

Start time

17:53

Date of aspiration

2023-05-16

3.2.Contrast-enhance indication (CEUS-FNA group)

Injection of SonoVue during FNA

No

Ratio of enhancement

0

No enhancement

Yes

Dosage of SonoVue

2

3.3.Progression of operation

Use of negative pressure

No

Aspiration times

4

FNA approach

lateral approach

Aspiration needle

25G

Patient compliance

good

Dosage of local anaesthesics

2.5 ml

other local anaesthesics

-

Local anesthesia

2% lidocaine

Machine

GE logiq E9

Sample capacity

a little

Grittiness

No

Quality of nodule

Soft

Pressure

- ml

3.4.Intraoperative instant complication

visible for bleeding by CDFI

location

Aspiration related acute hypersensitivity reaction

No

Horner syndrome

No

Vagal nerve syndrome

No

Voice change

No

Haemorrhage

No

Painful when leave interventional room

No

Analgesic

No

whether the voice recovers when the patient leaves

VAS score

3

methods

Painful

Yes

vocal cord mobility assessment by ultrasound

Allergic to contrast agent

No

appearance

extend of hematoma (before patient departure)

visible hemorrhage by CDFI 30 minutes after FNA

methods

extend of hematoma (once after FNA)

4.Follow-up one week after aspiration
4.1.Postoperative cytopathology

Whether sample capacity is enough

Pathological number

Cytopathology classification

Number of observable follicular epithelial cell clusters in specimen

4.15.Physical Sbility Examination
5.Adverse events
1.Adverse events

Record of adverse events

6.Follow-up 2
7.Follow-up 3
8.Management system of participants
9.Speciman management system
10.Data management system
11.ADR/ADE management system
12.Madicine management system
13.Instruments management system
14.SOPs
14.1.Treatment SOP
14.2.Nursing SOP
14.3.Specimen collection SOP
15.Research team
15.1.Institutions
15.2.Researchers
16.Design, Methods
16.1.Calculation of sample size