SUMMARY
1. How to judge the intranodular echogenic figures in the largest nodule of the RIGHT lobe?
According to all respondents, the nodule obviously has back wall figures while the presence of microcalcifications is doubtful. I agree with the colleagues.
2. What is the echogenicity of the largest nodule in the RIGHT lobe?
The nodule has both minimally/moderately and deeply hypoechoic areas. By definition, such a nodule cannot be classified as heterogeneous because the latter must contain both iso/ hyperechogenic and hypoechogenic parts. Therefore, three colleagues I think were wrong. They stated that this is a heterogeneous nodule composed of minimally/moderately and deeply hypoechoic parts. The fourth colleague says the nodule is deeply hypoechoic. May be, she has right, however on my opinion, minimally/moderately hypoechoic parts prevail over deeply hypoechoic, therefore I would classify this nodule as minimally/moderately hypoechoic. Nevertheless, the proportion of these is very similar.
3. How to classify the largest lesion in the RIGHT lobe according to the EU-TIRADS?
The distribution of answers were as follows: Category 3 (low risk) 1, Category 4 (intermediate) 1, Category 5 (high risk) 2. A hypoechoic nodule belongs either to intermediate or high risk subgroup. Which of these it belongs to depends on whether we consider the nodule to have suspicious characteristics. As a rule, only obvious presentation of microcalcifications can be considered as a suspicious finding. All colleagues agreed that the nodule lacks obvious microcalcifications. Therefore, the classification depends on the judgement of echogenicity. If we consider it deeply hypoechoic, the nodule should be put into category 5 (high risk), if we consider the lesion as minimally/moderately hypoechoic, the nodule should be classified as a category 4 (intermediate risk) nodule.
4. According to the EU-TIRADS, should the largest nodule in the RIGHT lobe be evaluated by FNA?
All respondents correctly applied the EU-TIRADS rules.
5. Did you personally indicate FNA in this lesion?
All colleagues would perform aspiration cytology, I agree.
6. How to judge the intranodular echogenic figures in the largest nodule of the LEFT lobe?
According to all respondents, both back-wall figures and microcalcifications are present. I agree.
7. What is the echogenicity of the largest nodule in the LEFT lobe?
All colleagues said that this is a minimally/moderately hypoechoic nodule. Agree.
8. How to classify the largest nodule in the LEFT lobe according to EU-TIRADS?
All put the lesion into Category 5 (high risk) subgroup, and it seems evident that they were right.
9. How to describe the discrete cystic lesions in the LEFT lobe?
I agree with those three colleagues who said that the cystic areas are findings normally occurring in a thyroid and not cystic nodules.
For details of the case study click here.
