SUMMARY
1. Does the right lobe have pathological nodule?
I have to apologize because the question and the possible answer were incoherent. Therefore, it has no sense to evaluate the answers.
2. What is echogenicity has the largest lesion in the left lobe?
Nine colleagues favored that the lesions is iso/hyperechoic nodule while 3 responders judged the nodule as minimally/moderately hypoechoic. Essentially, all of the answers were correct because ompared with the extranodular area, the echogenicity of the lesion was iso/hyperechoic, while compared with a healthy thyroid, the lesion would be classified as a minimally/moderately hypoechoic nodule.
3. How to classify the largest lesion in the LEFT lobe according to the EU-TIRADS?
The answers were as follows: Category 2 (benign) 2, Category 3 (low risk) 9, Category 4 (intermediate risk) 1, Category 5 (high risk) 0. The judgement is closely related to the previous answer. If we judge the lesion as iso/hyperechoic than the lesions is a Category 3, low-risk nodule. If we judge the nodule as minimally/moderately hypoechoic than he the lesion should be classified as a Category 4, intermediate one.
EU-TIRADS 2 (benign) EU-TIRADS 3 (intermediate) EU-TIRADS 4 (high risk) Iso/hyperechoic Minimally/moderately hypoechoi c The cells highlighted with yellow are the correct answers. An iso/hyperechoic nodule lacking suspicious ultrasound signs must be classified as an intermediate risk EU-TIRADS 3, while a minimally/moderately hypoechoic nodule lacking suspicious ultrasound signsshould categorized as an intermediate risk, EU-TIRADS 4 nodule. Only pure cysts and entirely spongiform nodules belong to EU-TIRADS 2 subgroup.
4. According to the EU-TIRADS, should this nodule be evaluated by cytology?
The answers are again closely related to a previous question, this time to the classification of nodule according to EU-TIRADS.
EU-TIRADS 2 (benign) EU-TIRADS 3 (intermediate) EU-TIRADS 4 (high risk) FNA indicated FNA NOT indicated The cells highlighted with yellow are the correct answers. The nodule was 20 mm in maximal diameter. According to the EU-TIRADS, a category 3 nodule requires FNA if the largest diameter exceeds >20 mm. Naturally, in this case the 3, theroretically false answers can be accepted, too.
5. Did you personally indicate FNA in this lesion?
Seven colleagues would indicate FNA while 5 did not. Personally, I agree with those who suggested FNA. The nodule presented halo sign and perinodular blood flow, i.e. both possible ultrasound signs of a capsule. Moreover, this was a solitary nodule. Taking these circumstances into account, the nodule is very likely a follicular tumor. Considering the size of the lesion, if it would be the malignant form of follicular neoplasia, the 2 cm is the critical size: In follicular tumors, 2 cm is the limit at which the incidence of distant metastases increases significantly.
Indeed, this lesion proved to be a follicular cancer.
The complete case study is presented here.
