Summary and comments
62 participants have answered the questions.
1. How to classify the largest nodule in the left lobe?
Distribution of answers
Choice
%
No
Dominantly solid, iso/hyperechoic
0.0
0
Dominantly solid, minimally/moderately hypoechoic
16.1
10
Dominantly solid, deeply hypoechoic Dominantly cystic, iso/hyperechoic Dominantly cystic, minimally/moderately hypoechoic Dominantly cystic, deeply hypoechoic
9.7
6
Expert comment
The echogenicity of the solid part of the nodule is very close to that of the strap muscle, so both the 2nd and 3rd answers can be accepted.
2. What echogenic figure or figures has the largest nodule in the LEFT lobe?
Distribution of answers
Choice
%
No
Microcalcifications
33.9
21
Back wall cystic figures
53.2
33
Comet tail artifacts
12.9
8
None of them 0.0
0
Expert comment
The presence of back wall figures is obvious (see e.g., the dorsal part of the nodule from 0:51 to 0.55 sec). Some echogenic figures can be microcalcifications and this possibility cannot be excluded. If I had to choose between yes and no, I would say no to the presence of microcalcification.
3. How to classify the nodule in the RIGHT lobe according to EU-TIRADS?
Distribution of answers
Choice
%
No
EU-TIRADS 3
1.6
1
EU-TIRADS 4
14.5
9
EU-TIRADS 5
83.9
52
Expert comment
If someone found the nodule to be deeply hypoechoic and or found microcalcification in the nodule, they had to be classified in EU-TIRADS Category 5. Most colleagues in this group (52 of 57) gave correct answer.
4. Is FNA indicated from the nodule in the RIGHT lobe according to EU-TIRADS?
Distribution of answers
Choice
%
No
Yes
98.4
61
No
1.6
1
Expert comment
All colleagues who considered the nodule as an EU-TIRADS 5 lesion would correctly indicate FNA. There were 4 others who considered the nodule as an EU-TIRADS 4 lesion but raised the suspicion of extrathyroidal spread and indicated also FNA. They were also right.
5. What is your opinion about the possibility of extrathyroidal extension (ETE) of the nodule?
Distribution of answers
Choice
%
No
There is a very small chance of ETE.
8.1
5
There is a significant chance of minimal ETE. There is a significant chance of gross ETE. Expert comment
I would choose the second answer. Indeed, the lesion did not spread extrathyroidal.
6. What statement is the most appropriate regarding the mass signed with yellow arrow in the video?
Distribution of answers
Choice
%
No
This is probably a lymph node which is very suspicious as it is very close to the thyroid tumor.
25.8
16
This is unlikely a lymph node as it has no vascularity on Doppler mode.
1.6
1
This is probably a lymph node which is suspicious as it does not present regular hilum.
72.6
45
Expert comment
This node does not have regular hilum and has a bit heterogeneous pattern. It means that there is a certain extent but of suspicion. It proved to be a reactive-type, benign node on histopathology.
7. What would you suggest as a next step?
Distribution of answers
Choice
%
No
Total thyroidectomy and bilateral lymph node dissection.
27.4
17
Total thyroidectomy and left lymph node dissection.
59.7
37
Left lobectomy and left lymph node dissection. Left lobectomy.
0.0
0
Expert comment
I indicated total thyroidectomy and left lymph node dissection and the surgeon agreed with me. The tumor proved to be a T1bN0 tumor, no metastatic lymph nodes were found. It means that those who would choose the third opportunity may have made a better decision than the majority for that patient.
