Summary and comments
65 colleagues sent reply. I apologize that the video did not have the left lobe, therefore answering questions 4 and 5 was impossible. Really sorry...
1. How do you classify the lesion in question according to the EU-TIRADS?
6 - EU-TIRADS 1
1 - EU-TIRADS 2
3 - EU-TIRADS 3
5 - EU-TIRADS 4
50 - EU-TIRADS 5
Expert comment. In my opinion, the lesion presents two suspicious signs, first it is taller-than wide, as the diameters indicated (these were written in the case study). Second, the echogenicity of the lesion is almost identical to that of the strap muscle, and according to the 2023 ETA guideline, such lesions should be classified as very or deeply hypoechoic. Moreover, the borders can be regarded as irregular.
The only issue is whether this lesion corresponds to a pathological nodule or not. Color Doppler decided the issue: this discrete lesion is indeed a vessel. So, I would consider this lesion as an EU-TRIADS 1.
2. Is FNA indicated according to the EU-TIRADS classification?
42 - No
5 - Unclear
18 - Yes
Expert comment. If we consider the lesion as a nodule, and it must be regarded as a TIRADS 5 one. In such nodules the EU-TRADS rules permit us to indicate cytology, but by no way they suggest. So, the first two answers are correct.
3. Would you personally indicate FNA?
30 - No
35 - Yes
Expert comment. According to my experience, most colleagues are more aggressive in indicating FNA compared to the TIRADS system. We were taught in college that cancer is the enemy. It's very hard to forget this education when it comes to papillary carcinoma, which is called cancer but actually behaves like a non-malignant tumor.
