SUMMARY
1. What is the dominant echogenicity of the nodule in the right lobe?
Two answers preferred that the lesion is minimally/moderately hypoechoic while one responder judged the nodule as deeply hypoechoic. In my opinion, both answers can be correct.
2. How to judge the borders of the largest nodule in the RIGHT lobe?
All three possible answers - the borders are sharp and regular, the borders are irregular, lobulated and the borders are partly sharp, partly ill-defined - received one vote. I mean that the borders are not blurred. The judgement whether the borders are irregular or lobulated depends on the currently lacking definition. No guideline gives an exact measure which the undulation should exceed to judge as irregular. I judge the undulation of the borders in this case as non-pathological. Therefore, I prefer the first answer.
3. What types of intranodular echogenic figures does the nodule present?
All responders stated that the nodule has back wall cystic figures. I agree. One colleague stated that the nodule has microcalcifications, too.
At the time of the examiantion, I interpreted part of the intranodular echogenic figures as microcalcifications. However, by reviewing the case later, I changed my mind. I think we would overestimate our options if we made a clear commitment in this case. In any case, re-evaluating the case, I would be more cautious: in the case of intranodular echogenic granules, in addition to the back wall figures, microcalcifications should also be considered. It means that by classifying the nodule according to EU-TIRADS, I would not say that the nodule has unequivocal microcalcifications.
4. What statement is correct?
All agreed that the nodule has perinodular blood flow but not halo. I think this is obvious.
5. How to categorize the nodule according to the EU-TIRADS?
Two colleagues classified the nodule as a Category 4 (intermediate risk) while a third responder did as a Category 5 (high risk). All colleagues applied correctly the rules of EU-TIRADS. The classification depends on how to judge the echogenicity (and borders) of the nodule.
I would classify the lesion as a Category 4 one, however, I would and indeed did perform FNA depsite the suggestions of ETA which does not recommend FNA in intermediate group if the lesion is smaller than 15 mm.
