PAPILLON COURSE on THYROID ULTRASOUND
Case of the Month
November 2021 - case 1 - evaluation
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Summary and comments
47 participants have answered the questions.
1. What is the subtype of the nodule in the LEFT lobe?
Distribution of answers
Distribution of answers Percentage No This is a dominantly solid nodule. 97.87 % 46 This is a dominantly cystic nodule. 2.13 % 1 Expert comment
The nodule is obviously a dominantly solid nodule.
2. What is the dominant kind of intranodular echogenic figures in the nodule in the LEFT lobe?
Distribution of answers
Distribution of answers Percentage No Microcalcifications 8.51 % 4 Back wall cystic figures 65.96 % 31 Comet tail artifacts 12.77 % 6 Macrocalcifications 12.77 % 6 Expert comment
I agree with the majority, the dominant echogenic figures are back wall figures.
3. Does the nodule in the LEFT lobe have microcalcifications?
Distribution of answers
Distribution of answers Percentage No Yes. 12.77 % 6 No. 51.06 % 24 Doubtful. 36.17 % 17 Expert comment
In my opinion, the bright echogenic granules are also back wall figures. The most (or only) suspicious of them is seen between 0:19 and 0:20 sec in the video. This is a linear form with a rounded thickening in the middle part. This cannot be considered as a clear microcalcification, at most a doubtful form. All other granules are located dorsal to cystic areas.
4. How to classify the nodule in the LEFT lobe according to EU-TIRADS?
Distribution of answers
Distribution of answers Percentage No EU-TIRADS 1 0 % 0 EU-TIRADS 2 8.51 % 4 EU-TIRADS 3 31.91 % 15 EU-TIRADS 4 44.68 % 21 EU-TIRADS 5 14.89 % 7 Expert comment
First, only pure and spongiform cysts belong to EU-TIRADS 2 lesions. This nodule in obviously not a pure cyst. Although the lesion has spongiform areas, according to EU-TIRADS, only entirely spongiform cysts can be classified in category 2.
The nodule is darker than the extranodular tissue but a bit lighter than the strap muscle, i.e. the nodule is moderately hypoechoic. Such nodule cannot be regarded as EU-TIRADS 3 lesion. Out of the 4 suspicious signs, neither deep hypoechogenicity, nor irregular borders nor irregular shape are present. Those who thought the nodule contained microcalcification correctly classified the nodule in EU-TIRADS 5 group. (The other question is whether the globe really contains microcalcification. See point 3.)
All in all, in my opinion is that the nodule is an EU-TIRADS 4 lesion.
5. Based on the suggestions of the EU-TIRADS system, is FNA indicated?
Distribution of answers
Distribution of answers Percentage No Yes. 82.98 % 39 No. 17.02 % 8 Uncertain. 0 % 0 Expert comment
The answer is clearly yes because the lesion is larger than 2 cm when FNAC is indicated in all nodules except for pure and spongiform cysts.
