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1.Screening
1.1.Inclusion criteria

Informed consent

Yes

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

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

2023-07-07

Telephone

15655283309

Sex

Female

Birthday

1979-06-07

Registration number

1001575565

2.2.Preoperative examination

Solid component of sheet-like strong echo (%)

-

Strong echo within nodule

punctate

acoustic halo

hypoecho

border

angled

edge

unclear

echo

hyperecho

Solid component (%)

15

Upper and lower diameter

47 mm

Anteroposterior diameter

19 mm

Coagulation function

Yes

transverse diameter

38 mm

Routine blood test

Yes

Location of target thyroid nodule

left 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

3.Intraoperative indications
3.1.Time of aspiration

End time

15:04

Start time

14:55

Date of aspiration

2023-07-14

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

Injection of SonoVue during FNA

No

Ratio of enhancement

10

No enhancement

No

Dosage of SonoVue

2

3.3.Progression of operation

Machine

GE logiq E9

Sample capacity

a little

Grittiness

No

Quality of nodule

Soft

Pressure

- ml

Use of negative pressure

No

Aspiration times

4

FNA approach

isthmus approach

Aspiration needle

25G

Patient compliance

good

Dosage of local anaesthesics

4 ml

other local anaesthesics

-

Local anesthesia

2% lidocaine

3.4.Intraoperative instant complication

Analgesic

No

methods

VAS score

-

extend of hematoma (once after FNA)

Painful

No

visible for bleeding by CDFI

Allergic to contrast agent

No

location

Aspiration related acute hypersensitivity reaction

No

whether the voice recovers when the patient leaves

Horner syndrome

No

methods

Vagal nerve syndrome

No

vocal cord mobility assessment by ultrasound

Voice change

No

appearance

Haemorrhage

No

extend of hematoma (before patient departure)

Painful when leave interventional room

No

visible hemorrhage by CDFI 30 minutes after FNA

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