PAPILLON COURSE on THYROID ULTRASOUND

 

Case of the Month

December 2024 - case 1 - evaluation

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Summary and comments

37 colleagues have replied to the survey.

 

1. How would you consider the echogenicity of the nodule?

Distribution of answers

1 Iso/hyperechoic

10 Minimally/moderately hypoechoic

26 Very hypoechoic

Expert comment

I would regard the nodule as very hypoechoic. The echogenicity of the nodule is identical to that of the strap muscle (see 0.15 in video) and according to the 2023 guideline, it means that we should classify as very hypoechoic.

2. What intranodular echogenic figures does the nodule have?

Distribution of answers

12 Back wall figures

4 Comet tail artifacts

26 Obvious forms of microcalcifications

19 Punctate echogenic foci which can be microcalcifications

Expert comment

Some linear forms are dorsal to tiny cystic areas (see the two uppermost linear figures at 0:16 in the clip), therefore back wall figures are present. I was not able to find any comet tail artifacts. I won't describe any figures as obvious microcalcifications. The suspicious forms are integral parts of macrocalcification.

3. What suspicious characteristics does the nodule have?

Distribution of answers

25 Deep hypoechogenicity

23 Irregular borders

15 Irregular shape

26 Obvious forms of microcalcifications

1 None of them.

Expert comment

Regarding echogenicity and microcalcifications, see the previous comments. The borders are lobulated (see the medial undulation at 0:39 in the video). The judgement on shape is very difficult or even impossible. Due to the acoustic shadowing, the dorsal border of the nodule is not evident. In such cases, I won't classify the nodule as presenting irregular shape.

4. How would you classify the nodule according to EU-TIRADS?

Distribution of answers

2 This is an EU-TIRADS 3 lesion.

1 This is an EU-TIRADS 4 lesion.

34 This is an EU-TIRADS 5 lesion.

Expert comment

Based on the answer to question 1 and 3, all but 3 colleagues have correctly applied the EU TIRADS rules. One colleague stated that the nodule is minimally hypoechoic and has no suspicious features. Such a nodule should be regarded as EU TIRADS 4, but the colleague classified wrongly as EU TIRADS 3. Two other colleagues who have found suspicious characteristics classified the nodule as TIRADS 4 instead of TIRADS 5.

5. What is the suggestion of the ETA in this nodule?

Distribution of answers

1 FNA not indicated.

37 FNA should be performed.

Expert comment

Based on the answer to question 4 and the size of the nodule, all colleagues have correctly applied the EU TIRADS rules.

 

 

 

 

 

 

 

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