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1.Screening
1.1.Inclusion criteria

Age ≥ 18 years old

Yes

Thyroid US indicates thyroid nodule.

Yes

US assessment accords with FNA criteria recommended by C-TIRADS

Yes
/
No

nodule with high insufficient rate

nodule with macrocalcification

Informed consent

Yes

1.2.Exclusion criteria

Allergic to lidocaine or SonoVue

No

Refuse to CEUS

No

Severe abnormality of heart function or lung function

No

Severe abnormality of coagulation function

No

Pregnancy

No

Active infectious focus on cervical skin

No

Patients unable to cooperate for FNA or CEUS

No

2.Preoperative indications
2.1.General information

Registration number

0000055276

Birthday

1979-01-16

Sex

Female

Telephone

13527866855

Date for signing informed consent

2023-05-17

2.2.Preoperative examination

Location of target thyroid nodule

right lobe

transverse diameter

8 mm

Anteroposterior diameter

7 mm

Upper and lower diameter

11 mm

Solid component (%)

100

echo

hypoecho

edge

clear

border

regular

acoustic halo

No

Strong echo within nodule

punctate
/
Sheet-like

Solid component of sheet-like strong echo (%)

100

Score of ACR TI-RADS

9

Rank of ACR TI-RADS

5

Score of C-TIRADS

2

Rank of C-TIRADS

4b

Ultrasonic diagnose

不除外甲状腺癌

VCs function evaluated by TLUSG

bilateral VCs moved symmetrically

Routine blood test

Yes

Coagulation function

Yes

3.Intraoperative indications
3.1.Time of aspiration

Date of aspiration

2023-05-17

Start time

16:43

End time

16:51

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

Dosage of SonoVue

-

No enhancement

Ratio of enhancement

-

Injection of SonoVue during FNA

3.3.Progression of operation

Machine

GE logiq E9

Local anesthesia

2% lidocaine

other local anaesthesics

-

Dosage of local anaesthesics

3 ml

Patient compliance

good

Aspiration needle

Italy 25G

FNA approach

isthmus approach

Aspiration times

4

Use of negative pressure

No

Pressure

- ml

Quality of nodule

solid

Grittiness

Yes

Sample capacity

a little

3.4.Intraoperative instant complication

Allergic to contrast agent

No

Painful

No

VAS score

-

Analgesic

No

Painful when leave interventional room

No

Haemorrhage

No

Voice change

No

Vagal nerve syndrome

No

Horner syndrome

No

Aspiration related acute hypersensitivity reaction

No

location

visible for bleeding by CDFI

extend of hematoma (once after FNA)

methods

visible hemorrhage by CDFI 30 minutes after FNA

extend of hematoma (before patient departure)

appearance

vocal cord mobility assessment by ultrasound

methods

whether the voice recovers when the patient leaves

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

Pathological number

Whether sample capacity is enough

Number of observable follicular epithelial cell clusters in specimen

Cytopathology classification

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