28-year-old Ms. Lian is from Shanxi. She is thyroid nodule found in June last year. At that time, she felt a foreign body when she was eating. She always felt something blocking her neck when she swallowed. Later, she went to the hospital for examination and found that it was a thyroid nodule. But the result of the examination at that time was that the nodules were benign and the size was not very large. The doctor told the girl that she could have a regular follow-up examination and would not need to undergo treatment for the time being.
Later, as time went on, Ms. Lian felt more and more uncomfortable in her neck. Recently, her neck swelling and her voice became a little hoarse. So she went to the hospital for a review and found that the nodule has grown a lot and has signs of diffuse lesions. The largest nodule on the right is already 8mm, and they are all cystic solid nodules with slightly lower echoes. Local doctors recommend that surgical removal be performed directly to prevent the nodules from developing in a bad direction.
When she heard that she was going to be surgically removed, even the lady was a little panicked. Considering that she was still young and didn’t want to take medicine for life, she came to Beijing directly with her family. When I met Ms. Lian, Ms. Lian’s face was not very good. I checked Ms. Lian again to determine whether the properties of the nodules are benign and can be ablated by microwaves. I told Ms. Lian that ablation is minimally invasive and does not require thyroid to be cut open like an excision surgery. In fact, in addition to ultrasound examination, to determine the benign and malignant nature of the nodule is fine needle aspiration.
1, ultrasound examination
Ultrasound examination distinguishes the benign and malignant lesions by observing the morphology and structure of the nodule and blood supply, and the diagnosis of cystic lesions is very reliable. According to incomplete statistics, when there is calcification in the thyroid nodule, about 40% of patients have thyroid cancer . Due to its non-invasive, convenient and fast advantages, ultrasound is the first choice for the examination of thyroid nodules in clinical practice, but it has a certain missed diagnosis rate. For highly suspicious patients, further biopsy is needed.
2. Puncture cytology test
When ultrasound indicates that malignant or nodules are >1cm, patients will be recommended to undergo thyroid fine needle aspiration cytology test. This is the most accurate method to identify benign and malignant thyroid nodules at present. However, due to the characteristics of the nodules, about 20% of the nodules are still difficult to judge benign and malignant, and some patients with "false negative" are also "false negative".
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