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Orientation
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- “taller-than-wide” shape on transverse and longitudinal planes, in contrast to all other shapes;
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Doppler
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- the presence of increased irregular chaotic central blood flows; this group includes also hypoechoic lesions when accompanied by a total absence of blood flow; in contrast to the peripheral, subcapsular blood flow (suggesting benign lesions);
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Echogenicity
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- hypoechogenicity, defined as “darker” than normal thyroid echogenicity, and described as similar to the echogenicity of muscles surrounding the gland, especially sternocleidomastoid muscles;
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Halo
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- uneven thickness of halo (outer shell that surrounds the lesion) or absence of halo, in contrast to thin halo, regularly surrounding the lesion;
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Echostructure (composition)
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- solid lesions, also mixed lesions with cystic portion not exceeding 10% of the volume, in contrast to mixed lesions with cystic parts greater than 10% of total volume, as well as to lesions with solely cystic composition;
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Largeness (size)
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- the size of lesion greater than 3 cm in diameter, in contrast to smaller lesions;
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Margin
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- poorly defined and irregular, sometimes infiltrated border, in contrast to a well-differentiated regular margin;
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Augmentation
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- the enlargement of lesion by at least 20% in two dimensions, i.e. at least 50% by volume (for the lesion in diameter of less than 10 mm - minimum 2 mm in two dimensions) in a period of time shorter than 1.5 years [2, 3];
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Lymph node invasion
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- the presence of lymph nodes, suspicious in US evaluation and of the size larger than 5-8 mm in the smallest dimension [3].
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