EFSUMB Guidelines on Multiparametric Ultrasound Thyroid Nodule Evaluation: PART II

Area of Science:

• Radiology
• Oncology
• Endocrinology

Background:

• Thyroid nodules are common, but malignancy rates are low (4-6.5%), leading to frequent invasive diagnostic procedures.
• Current diagnostic methods for thyroid nodules can be costly, time-consuming, and result in overtreatment.
• Technological advancements in ultrasound, including multiparametric ultrasound (MPUS) features, offer improved characterization capabilities.

Purpose of the Study:

• To provide a guideline for the recognition and use of new multiparametric ultrasound features in thyroid nodule evaluation.
• To minimize unnecessary diagnostic interventions and guide appropriate treatments for thyroid nodules.
• To stimulate the routine clinical practice adoption of MPUS for thyroid nodule assessment.

Main Methods:

• Review of published literature on multiparametric ultrasound for thyroid nodules.
• Expert consensus from the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB).
• Analysis of MPUS applications in specific scenarios: indeterminate nodules, multinodular goiter, extrathyroidal extension, and lymph node staging.

Main Results:

• MPUS, incorporating features like Microvascular flow imaging, Elastosonography, contrast-enhanced ultrasound (CEUS), and artificial intelligence (AI), enhances thyroid nodule characterization.
• MPUS aids in guiding thyroid biopsy/aspiration and staging cervical lymph nodes.
• Recommendations are provided based on evidence levels and expert consensus for various thyroid nodule scenarios.

Conclusions:

• Multiparametric ultrasound evaluation is essential for accurate thyroid nodule characterization, differentiating benign from malignant cases.
• Implementing MPUS in routine practice can significantly reduce unnecessary invasive procedures and overtreatment.
• This guideline aims to standardize the use of MPUS, improving diagnostic accuracy and patient management for thyroid nodules.