PAPILLON COURSE on THYROID ULTRASOUND
Case of the Month
November 2021 - case 2 - evaluation
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Summary and comments
45 participants have answered the questions.
1. What is the subtype of the nodule in the LEFT lobe?
Distribution of answers
Answer Percentage No This is a dominantly solid nodule. 97.78 % 44 This is a dominantly cystic nodule. 2.22 % 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
Answer Percentage No Microcalcifications 22.22 % 10 Back wall cystic figures 37.78 % 17 Comet tail artifacts 28.89 % 13 Macrocalcifications 11.11 % 5 Expert comment
I think most or all of the hyperechoic dots and lines in the nodule all correspond to back wall figures. It's worth reviewing the video several times in slow motion: almost all hyperechoic figures are dorsal to cystic areas.
3. Does the nodule in the LEFT lobe have microcalcifications?
Distribution of answers
Answer Percentage No Yes. 31.11 % 14 No. 28.89 % 13 Doubtful. 40 % 18 Expert comment
My answer would be 'No'. There are a few conglomerates of hyperechoic figures, e.g. at 0.47-0:08 seconds. It is a reasonable assumption that these are also back wall figures. Nevertheless, I can accept that these are doubtful figures.
4. How to classify the nodule in the LEFT lobe according to EU-TIRADS?
Distribution of answers
Answer Percentage No EU-TIRADS 1 0 % 0 EU-TIRADS 2 4.44 % 2 EU-TIRADS 3 13.33 % 6 EU-TIRADS 4 48.89 % 22 EU-TIRADS 5 33.33 % 15 Expert comment
Those who thought there were microcalcifications in the nodule had to classify the nodule as EU-TIRADS 5. The other responders should classify the nodule as an EU-TIRADS 4 lesion because no other suspicious signs can be considered, and the nodule is minimally/moderately hypoechoic.
5. Based on the suggestions of the EU-TIRADS system, is FNA indicated?
Distribution of answers
Answer Percentage No Yes. 88.89 % 40 No. 11.11 % 5 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.
