Section 2 The nodular goiter

Part 3 The echogenicity of the nodule



One of the immediate impressions we get from a discrete lesion is the echogenicity. This is the most important of the ultrasound characteristics because the echogenicity has the most significant impact on the grouping of the nodules according to the various TIRADS.

As in most ultrasound characteristics, the main issue it that we have no biological standard which the echogenicity can be compared to. Similarly to other features, the interobserver variation in the judgement of the nodule' echogenicity is substantial. If we dig deep into this topic, and we will, we found some really disturbing concerns. It affects lack of basic definitions in the literature, significantly different handling of certain types of nodules, including heterogeneous ones and lesions in Hashimoto's thyroiditis.
Nevertheless, we try to give the reader a guideline in order to be able to handle different interpretations in their daily work.

This course is composed of several parts. It is advised follow the order of the parts.

  1. Introductory course briefly describes the various types of nodules according to their echogenicity, discusses the echogenicity of the nodules in relation to various forms of thyroid cancer and their role in the different TIRADS.

  2. Manual serves as a guidance for the reader. The manual can be downloaded in pdf format.

  3. Lectures present the different forms in detail and give an approach to differential diagnostic. This is one of the most time-consuming parts of the topic.

  4. Case study is composed of dozens of cases most of them presents beside 5 to 15 ultrasound images ultrasound videos, as well.

  5. Videolibrary serves the goal of testing the skills by analyzing videos.

  6. If you visit the Exam, you can test your skills. The unspoken purpose of these tests is to get the students to watch and analyze as many videos as possible.


Case study of the topic

A 47-year-old woman requested a follow-up examination. She has been diagnosed with a thyroid nodule for 12 years. At the first examination, FNA was not performed because the nodule did not show any suspicious signs and had a maximal diameter of 14 mm. On ultrasound a dominantly iso/hyperechoic nodule was found which showed halo sign. The nodule has increased in volume by more than 8-fold for 12 years. Cytology resulted in follicular tumor. Histopathology disclosed follicular cancer. On the post-therapy scan, two metastatic foci were found in the lung.

Although this case study points to a rare problem but in the last decade we pretend as this problem would not exist: how to diagnose follicular cancer in time if we rely on ultrasound characteristics specific on papillary cancer.