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1.Screening
1.1.Inclusion criteria

Age ≥ 18 years old

Yes

Informed consent

Yes

nodule with high insufficient rate

nodule with macrocalcification

US assessment accords with FNA criteria recommended by C-TIRADS

Yes
/
No

Thyroid US indicates thyroid nodule.

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

2023-05-31

Telephone

18803776677

Sex

Female

Birthday

1968-04-30

Registration number

0002983346

2.2.Preoperative examination

Ultrasonic diagnose

甲状腺癌

Rank of C-TIRADS

4c

Score of C-TIRADS

4

Rank of ACR TI-RADS

5

Score of ACR TI-RADS

13

Solid component of sheet-like strong echo (%)

20

Strong echo within nodule

Sheet-like

acoustic halo

No

border

unable to determine

edge

unclear

echo

hypoecho

Solid component (%)

100

Upper and lower diameter

15 mm

Anteroposterior diameter

12 mm

Coagulation function

Yes

transverse diameter

11 mm

Routine blood test

Yes

Location of target thyroid nodule

left lobe

VCs function evaluated by TLUSG

bilateral VCs moved symmetrically

3.Intraoperative indications
3.1.Time of aspiration

End time

16:38

Start time

16:28

Date of aspiration

2023-05-31

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

Injection of SonoVue during FNA

No

Ratio of enhancement

5

No enhancement

No

Dosage of SonoVue

2

3.3.Progression of operation

Aspiration needle

Italy 23G

Patient compliance

good

Dosage of local anaesthesics

3 ml

other local anaesthesics

-

Local anesthesia

2% lidocaine

Machine

GE logiq E9

Sample capacity

a little

Grittiness

Yes

Quality of nodule

solid

Pressure

- ml

Use of negative pressure

No

Aspiration times

4

FNA approach

isthmus approach

3.4.Intraoperative instant complication

methods

Horner syndrome

No

extend of hematoma (once after FNA)

Vagal nerve syndrome

No

visible for bleeding by CDFI

Voice change

No

location

Haemorrhage

No

Painful when leave interventional room

No

Analgesic

No

VAS score

-

Painful

No

Allergic to contrast agent

No

whether the voice recovers when the patient leaves

methods

vocal cord mobility assessment by ultrasound

appearance

extend of hematoma (before patient departure)

visible hemorrhage by CDFI 30 minutes after FNA

Aspiration related acute hypersensitivity reaction

No

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

Cytopathology classification

Number of observable follicular epithelial cell clusters in specimen

Whether sample capacity is enough

Pathological number

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