Cysts, Polyps, Tumors… Detected in Physical Exams: Are They Serious? This Article Has the Answers

As 2023 is drawing to a close, many readers have been battling pathogens such as mycoplasma and influenza viruses while also carrying the burden of abnormalities found in physical examinations, such as nodules, cysts, tumors, calcifications, polyps, and stones.

Today, let’s discuss those “impressive” descriptions on the physical examination report. How should we deal with these puzzling and headache-inducing little things?

Image source: bonjin-mame

 Nodules

Ultrasonography findings of nodules are very common. Remember one thing first, look at the results given by the “classification system”, that is, the TI-RADS classification for thyroid and the BI-RADS classification for breast. (In addition to nodules, cysts and calcifications will also be needed later.)

The TI-RADS classification is a comprehensive scoring based on the nodule conditions seen under ultrasound, including the composition, echo, boundary, size, aspect ratio, calcification, etc., of thyroid nodules. It takes into account all the descriptions you are worried about.

According to the score, it is divided into 5 categories. Different classifications mean different risks.

Class 1, Class 2: Considered benign changes.

Class 3: Considered highly likely to be benign.

Class 4: Considered to have a certain risk, but it does not mean there is definitely a problem. If the nodule is ≥1.5cm, usually a further puncture assessment by the thyroid surgery department is needed. (However, size is not the only factor to judge the risk, it needs to be analyzed based on the specific situation of the nodule)

Class 5: Considered to have a high possibility of malignancy, and it is recommended to further assess by the thyroid surgery department.

Let’s “practice” with a real case:

First find TI-RADS, this thyroid nodule is Class 3; then look at the size, 3.8*2.2mm (Note: it’s mm, not cm), which is a typical benign thyroid nodule, and color Doppler ultrasound follow-up is sufficient.

This classification is used to standardize mammography and breast ultrasound examinations, which helps us guide subsequent decisions based on the classification, and it is divided into 6 classes in total.

Class 1, Class 2: Considered benign changes.

Class 3: Considered highly likely to be benign, with a possibility of malignant lesions being less than 2%, and generally recommended for re-examination every 6 months.

Class 4: Further divided into 4A, 4B, 4C.

Class 5: Indicates that the lesions have typical risk features, with a suspicion of malignancy greater than 95%, and a higher possibility of malignancy, which also requires biopsy to confirm.

Class 6: Breast cancer has been confirmed pathologically.

In addition, there is a less common BI-RADS Class 0, which means that the existing image information is not sufficient to draw a conclusion, and other imaging assessments are needed.

From the above explanation, it can be seen that follow-up re-examination is mainly for Class 3 and below, and Class 4 and above require further assessment by a breast specialist based on the specific situation.

Let’s “practice” with a real case:

This patient’s right breast nodule is classified as Class 3, which is highly likely to be benign, and follow-up color Doppler ultrasound is sufficient.

Chest X-rays or chest CT scans, both of these physical examination items can detect pulmonary nodules, but their interpretation requires a comprehensive judgment based on the overall situation of the nodule and the individual’s risk level, cannot be simply summarized.

Friends who have found pulmonary nodules can read these 2 articles:

Pulmonary Nodules Found in Physical Examination, Should I Worry?

Pulmonary Nodules Found in Physical Examination, Could It Be a Tumor?

Cysts

Cysts are also a very common diagnosis in ultrasound reports of various organs, including liver cysts, kidney cysts, breast cysts, thyroid cysts, prostate cysts, etc.

Cysts and tumors are only one word different, which can easily cause unnecessary anxiety.

Breast cysts and thyroid cysts are usually simple cysts, that is, benign lesions with clear boundaries and anechoic seen under ultrasound. In the classification system mentioned earlier, they are usually Class 1 or Class 2 (considered benign changes), such as:

• Bilateral breast cysts, BI-RADS Class 2

• Bilateral lobe cysts of the thyroid, TI-RADS Class 2

However, some complex breast cysts may be Class 3 (considered highly likely to be benign lesions), usually with follow-up re-examination being the main approach. Rare compound breast cysts may be classified higher, or may have certain risks, and need to be analyzed based on specific situations.

Simple liver cysts and kidney cysts, that is, cystic structures containing clear fluid, usually do not require intervention.

However, if the cyst has symptoms (usually seen in larger cysts), such as abdominal pain caused by compression of surrounding organs, nausea after eating, waist pain, etc., then specialist consultation is needed to determine whether intervention is necessary.

Polycystic liver and polycystic kidney are also conditions that can appear in ultrasound examinations. These cystic lesions may be different from simple cysts, and some may be related to autosomal inheritance.

Autosomal dominant polycystic kidney disease often occurs with liver and pancreatic cysts, and may also have other complications, such as aneurysms. Because this type of disease may cause kidney damage, it is necessary to specialist assessment, identify patients at high risk of chronic kidney damage, and undergo specific treatment. Polycystic liver often coexists with polycystic kidney.

• Asymptomatic liver hemangioma patients do not need treatment.

• If >5cm and growing, an enhanced MRI follow-up examination is needed 6-12 months later. Lesions that continue to grow require specialist assessment of whether surgical intervention is needed.

• Specialist needs to carefully investigate the correlation between symptoms and liver hemangiomas, and decide whether intervention is needed based on the specific situation.

Gallbladder polyps are common ultrasound findings, mostly protruding lesions of the gallbladder wall, usually asymptomatic. The management of gallbladder polyps is closely related to size.

Polyps 6-9mm, if asymptomatic, undergo ultrasound monitoring once every 6 months in the first year; if the polyp size is stable, then monitor once a year thereafter.

Polyps ≥10mm, or those with gallbladder stones or a history of biliary colic, need to visit the hepatobiliary surgery department for assessment.

Stones

Gallbladder stones and kidney stones are the two most common types of stones.

Gallbladder stones:

Kidney stones (formation is mostly related to dietary habits, underlying diseases, and metabolic status):

Well, class is over! This issue is quite “dry” and may be difficult to “digest”.

These are some of the more common types of ultrasound examination results. If your doubts are not resolved, the most direct method is to consult a doctor for a professional interpretation of the physical examination report. You can choose to see a doctor in person or consult online (for example, Zhuozheng online report interpretation).

| Review Expert

| Content Team

Medical Editor / Sun    

Disclaimer: The purpose of the article is to provide general health information. For personal medical issues, please consult a doctor. To reprint the article, please contact: medicine@distinctclinic.com.