SUMMARY
1. What is the subtype of the larger nodule?
This is clearly a dominantly solid nodule, and the answers were consistent.
2. What is the subtype of the larger nodule in relation to the solid component?
According to the half of the responders (3 out of 6), this is a peripheral type cyst, while 2 of 6 responders were of the opinion that this is a central type cyst. In fact, it depends on whether we judge the type of cyst before or after aspiration. In the former case, the cyst should be regarded as peripheral while in the latter, the lesion should be regarded as central type. This problem is not mentioned in the literature. In my opinion, the real situation is better reflected in the post-aspiration state. In this case, the compressive effect of the liquid ceases, and thus the solid part compressed until then becomes visible.
One responders stated that this is a spongifrom type cyst. I think that's the wrong answer. To do this, the cystic areas separated by fibrous septa should have reached at least 50%.
3. Does the larger nodule have microcalcifications?
With the exception of one respondent, no one thought the lesion contained microcalcifications. I myself agree with the majority. Although we see hyperechogenic granulations, they occur together with linear figures, and most of them are clearly related to the ventral cystic areas; therefore, these are back wall figures caused by posterior enhancement.
4. Does the larger nodule have back wall cystic figures?
Half of the respondents clearly answered yes, the other half said no clear answer could be given. I think the former are right. Judging the back wall figure is often complicated by the fact that the ventral cystic area is very small, this was still the case.
5. Does the larger nodule have comet tail artifacts?
Of the six respondents, 4 say yes, while two say no. I think the answer is a resounding yes. An echogenic figure within a cystic part is difficult to evaluate differently. See the video between 0:15 and 0:19.
6. How to judge the borders of the larger nodule?
It is clear, that the borders were regular before while became irregular after the aspiration. With the exception of one respondent, the colleagues judge the borders before aspiration. I agree with the majority. It is obvious that the fluid is able to deform the solid tissue. However, the significance of this is quite different than if it is done by a solid area that can even be malignant.
The complete case study is presented here.
