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1.Screening
1.1.Inclusion criteria

Thyroid US indicates thyroid nodule.

Yes

Age ≥ 18 years old

Yes

Informed consent

Yes

nodule with high insufficient rate

suspected degenerative nodule

US assessment accords with FNA criteria recommended by C-TIRADS

Yes
/
No

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

13600451330

Sex

Female

Birthday

1979-02-07

Registration number

0000479692

2.2.Preoperative examination

Location of target thyroid nodule

left lobe

VCs function evaluated by TLUSG

bilateral VCs moved symmetrically

Ultrasonic diagnose

可疑退变结节

Rank of C-TIRADS

4b

Score of C-TIRADS

2

Rank of ACR TI-RADS

5

Score of ACR TI-RADS

7

Solid component of sheet-like strong echo (%)

90

Strong echo within nodule

Sheet-like

acoustic halo

hypoecho

border

lobulated

edge

clear

echo

hypoecho

Solid component (%)

100

Upper and lower diameter

14 mm

Anteroposterior diameter

11 mm

Coagulation function

Yes

transverse diameter

15 mm

Routine blood test

Yes

3.Intraoperative indications
3.1.Time of aspiration

End time

15:04

Start time

14:59

Date of aspiration

2023-05-31

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

Injection of SonoVue during FNA

Ratio of enhancement

-

No enhancement

Dosage of SonoVue

-

3.3.Progression of operation

FNA approach

lateral approach

Aspiration needle

Italy 23G

Patient compliance

good

Dosage of local anaesthesics

4 ml

other local anaesthesics

-

Local anesthesia

2% lidocaine

Machine

other machine

Sample capacity

a little

Grittiness

No

Quality of nodule

Soft

Pressure

- ml

Use of negative pressure

No

Aspiration times

4

3.4.Intraoperative instant complication

Aspiration related acute hypersensitivity reaction

No

Horner syndrome

No

whether the voice recovers when the patient leaves

Vagal nerve syndrome

No

methods

Voice change

No

vocal cord mobility assessment by ultrasound

Haemorrhage

No

appearance

Painful when leave interventional room

No

extend of hematoma (before patient departure)

Analgesic

No

visible hemorrhage by CDFI 30 minutes after FNA

VAS score

3

methods

Painful

Yes

extend of hematoma (once after FNA)

Allergic to contrast agent

No

visible for bleeding by CDFI

location

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