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NCCN Guidelines for Patients



Thyroid Cancer, Version 1.2017



Test results

Guide 4. Ultrasounds results

Type of finding on ultrasound results

Will an FNA biopsy be done?

Solid nodule

• With abnormal features

• Without abnormal features



Yes, when nodule is 1.0 cm or more

Yes, when nodule is 1.5 cm or more

Mixed cystic-solid nodule (fluid & solid part)

• With abnormal features

• Without abnormal features



Yes, with solid part more than 1.0 cm

Yes, with solid part more than 1.5 cm

Spongiform (sponge-like) nodule


Yes, when nodule is 2.0 cm or more

Simple cyst (fluid-filled nodule)


No FNA (only treat cyst as needed)

Suspicious cervical lymph node


Yes, FNA of cervical lymph node with or without

FNA of other thyroid nodule or nodules

The ultrasound will show if the nodule is solid or

liquid. Your doctor can see the size and location.

See Guide 4.

Thyroid nodules that are suspicious

for cancer should be assessed further. Your doctors

will look at certain features of nodules that could be a

sign of cancer. These can include:



Irregular borders



Microcalcifications (small white dots in the




Nodules that are more tall than wide



Increased blood flow to the nodule

If there is a nodule on an imaging test, your doctor

will decide whether or not you will need a biopsy.

An FNA biopsy is used to test thyroid nodules.


Guide 5.

An FNA biopsy can show if a nodule is fluid filled

(cyst). FNA does not always show you if a thyroid

nodule is cancer. More tests may be needed to

confirm a diagnosis of cancer, especially for follicular

and Hürthle cell thyroid cancer.