Ultrasound Features
Select one option per category (except Echogenic Foci — select all that apply)
1. Composition Select one
Cystic or almost completely cystic 0
Spongiform 0
Mixed cystic and solid 1
Solid or almost completely solid 2
Spongiform = predominantly (>50%) small cystic spaces. No further points added for other categories.
2. Echogenicity Select one
Anechoic 0
Hyperechoic or isoechoic 1
Hypoechoic 2
Very hypoechoic (more than strap muscles) 3
Compare echogenicity to adjacent thyroid parenchyma (hypo/iso/hyper) or strap muscles (very hypoechoic)
3. Shape Select one
Wider-than-tall 0
Taller-than-wide 3
Assessed on transverse/axial image. AP dimension > transverse = taller-than-wide.
4. Margin Select one
Smooth 0
Ill-defined 0
Lobulated or irregular 2
Extrathyroidal extension 3
Ill-defined margins are considered benign (0 pts). Lobulated/irregular/spiculated = 2 pts.
5. Echogenic Foci Select ALL that apply
Punctate foci = psammomatous calcifications, strong predictor of papillary thyroid carcinoma
Nodule Maximum Diameter mm
Largest dimension in any plane — determines FNA/follow-up threshold