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1.Screening
1.1.Inclusion criteria

Informed consent

Yes

nodule with high insufficient rate

suspected degenerative nodule

US assessment accords with FNA criteria recommended by C-TIRADS

Yes
/
No

Thyroid US indicates thyroid nodule.

Yes

Age ≥ 18 years old

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

Birthday

1983-05-02

Registration number

1000047745

Date for signing informed consent

2023-06-06

Telephone

13570421523

Sex

Female

2.2.Preoperative examination

Rank of ACR TI-RADS

5

Score of ACR TI-RADS

10

Solid component of sheet-like strong echo (%)

-

Strong echo within nodule

No

acoustic halo

No

border

angled

edge

unclear

echo

extremely hypoecho

Solid component (%)

100

Upper and lower diameter

8 mm

Anteroposterior diameter

12 mm

Coagulation function

Yes

transverse diameter

9 mm

Routine blood test

Yes

Location of target thyroid nodule

right lobe

VCs function evaluated by TLUSG

bilateral VCs moved symmetrically

Ultrasonic diagnose

退变结节与肿瘤鉴别

Rank of C-TIRADS

4c

Score of C-TIRADS

4

3.Intraoperative indications
3.1.Time of aspiration

End time

16:24

Start time

16:13

Date of aspiration

2023-06-06

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

Injection of SonoVue during FNA

No

Ratio of enhancement

50

No enhancement

No

Dosage of SonoVue

2

3.3.Progression of operation

other local anaesthesics

-

Local anesthesia

2% lidocaine

Machine

GE logiq E9

Sample capacity

medium

Grittiness

Suspected

Quality of nodule

solid

Pressure

- ml

Use of negative pressure

No

Aspiration times

4

FNA approach

lateral approach

Aspiration needle

Italy 23G

Patient compliance

good

Dosage of local anaesthesics

4 ml

3.4.Intraoperative instant complication

methods

Haemorrhage

No

extend of hematoma (once after FNA)

Painful when leave interventional room

No

visible for bleeding by CDFI

Analgesic

No

location

VAS score

2

Painful

Yes

Allergic to contrast agent

No

whether the voice recovers when the patient leaves

methods

vocal cord mobility assessment by ultrasound

Aspiration related acute hypersensitivity reaction

No

appearance

Horner syndrome

No

extend of hematoma (before patient departure)

Vagal nerve syndrome

No

visible hemorrhage by CDFI 30 minutes after FNA

Voice change

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