Summary and comments
44 participants have answered the questions.
1. Does the thyroid have pathological nodule?
Distribution of answers
Choice
Percentage
No
The RIGHT lobe has, the left lobe has not.
4.5%
2
The LEFT lobe has, right lobe has not.
27.3%
12
Both lobes have nodules.
43.2%
19
The thyroid does not have nodules.
25.0%
11
Expert comment
If we do not take the patient' history into account, then we can consider one or the other lesion as a nodule. Even in this case, I would consider it more fortunate to use the term 'nodule-like lesion' or 'discrete lesion', as what we see is a typical example of a subtotally resected thyroid gland.
However, taking into account the outcome of histology and the not very long time that has elapsed since surgery, the likelihood of true nodule is very low.
2. Which statement is most likely to be true regarding the judgement of echogenic figures?
Distribution of answers
Choice
Percentage
No
These are microcalcifications.
6.8%
3
These are presentations of connective tissue.
45.5%
20
These are back wall figures.
47.8%
21
These are comet-tail artifacts.
0%
0
Expert comment
I agree with most of the participants, these figures correspond either to connective tissue or connective tissue. The distinction between these two opportunities has minimal if any relevance. In my opinion, these figures are a bit more likely presentations of connective tissue.
The synchronous presence of similarly bright echogenic lines and granules and the higher proportion of the former makes microcalcification unlikely.
3. Would you perform FNA?
Distribution of answers
Choice
Percentage
No
Yes, from both lobes.
22.7%
10
Yes, from the right lobe.
4.5%
2
Yes, from the left lobe.
25.0%
11
No.
47.7%
21
Expert comment
The distribution of answers represents the distribution of answers to the first question. I agree, if someone considers any of these lesions as true nodules, then FNA is indicated.
As is clear from the commentary to question 1, I do not consider any of the lesions to be a real nodule. Nevertheless, based on my daily practice, I would take a sample of the lesion on the left. This is simply because, as can be seen from the answers to each question, some researchers consider this to be a nodule, and it is likely that the patient will later be evaluated by colleague who considers this lesion as an EU TIRADS 5 nodule. In this case, it is important that a reassuring cytological result is obtained from the lesion.
4. If you would consider the lesion in the left lobe as nodule, how to categorize it according to EU-TIRADS?
Distribution of answers
Choice
Percentage
No
EU-TIRADS 3
6.8%
3
EU-TIRADS 4
34.1%
15
EU-TIRADS 5
59.1%
26
Expert comment
I apologize because it was not clear which discrete lesion my question was about. The lesions in the right lobe are moderately hypoechoic, while the left one is deeply hypoechoic. No other suspicious signs were found in any of the lesions. Accordingly, if the lesion were to be considered as nodules, they would be EU TIRADS 4 nodules in the right lobe, while the lesion in the left lobe would be EU-TIRADS 5.
