The ultrasound "U" classification of thyroid nodules has been developed by the British Thyroid Association (BTA) as part of their 2014 guidelines on the management of thyroid cancer 1.
It allows for stratifying thyroid nodules as benign, suspicious or malignant based on ultrasound appearances termed U1-U5. This is used to streamline further investigation and management.
- no nodules
- hyperechoic or isoechoic with a halo
- cystic change with ring down artifact (colloid)
- microcystic or spongiform appearance
- peripheral egg-shell calcification
- peripheral vascularity
- solid homogenous markedly hyperechoic nodule with halo (follicular lesions)
- hypoechoic with equivocal echogenic foci or cystic change
- mixed or central vascularity
- solid hypoechoic (compared with thyroid)
- solid very hypoechoic (compared with strap muscles)
- hypoechoic with disrupted peripheral calcification
- lobulated outline
- solid hypoechoic with a lobulated or irregular outline and microcalcification
- solid hypoechoic with a lobulated or irregular outline and globular calcification
- intranodular vascularity
- taller than wide axially (AP>ML)
- characteristic associated lymphadenopathy
Size does not have a role in this grading system.
Treatment and prognosis
U2 nodules do not require fine needle aspiration (FNA) or follow-up imaging in the absence of concerning clinical features.
U3 - U5 nodules require FNA with further management based on resultant cytology, radiology and clinical findings. Many units have a low threshold for performing diagnostic hemithyroidectomies for nodules that are both radiologically- and cytologically-suspicious.
- 1. Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G, Gilbert J, Harrison B, Johnson SJ, Giles TE, Moss L, Lewington V, Newbold K, Taylor J, Thakker RV, Watkinson J, Williams GR. Guidelines for the management of thyroid cancer. Clinical endocrinology. 81 Suppl 1: 1-122. doi:10.1111/cen.12515 - Pubmed
- 2. Xie C, Cox P, Taylor N, LaPorte S. Ultrasonography of thyroid nodules: a pictorial review. Insights into imaging. 7 (1): 77-86. doi:10.1007/s13244-015-0446-5 - Pubmed
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