Now a mainstay in the diagnosis of thyroid nodules, ultrasonography provides a high pretest probability of cancer when certain characteristics exist in a nodule, namely a solid or partly cystic nodule with irregular and blurred margins, mixed hypoechoic isoechoic areas and microcalcifications, and intranodular vascular pattern . Malignant cervical lymph nodes have a characteristic pattern, appearing round, without a hilar area and containing intranodu-lar vascular flow. A Solbiati index (SI = ratio of largest to smallest diameter) of about one and a complex echoic pattern or irregular hypere-choic small intranodular structures and irregular diffuse intranodular blood flow are the best indicators of malignancy in a lymph node , which often provides information that alters the surgical approach . These features are reviewed in detail in Chapter 26 by Dr Richardson.
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