PAPILLON COURSE on THYROID ULTRASOUND

Section 2 The nodular goiter

Part 9 TIRADS
Lectures

 

Table 2 EU-TIRADS 2 category

Two special cystic nodules are included in this group. The purely cystic nodules and the spongiform cysts.
The EU-TIRADS suggests classifying a nodule as purely cystic if it has neither solid part nor wall thickening. And one more consideration of the protocol: size does not matter. On the one hand, there are very few cystic lesions which fulfill these criteria, on the other hand, very large number of thyroids have tiny cystic areas which are indeed not nodules but dilated macrofollicles.
EU-TIRADS defines spongiform nodule if tiny cystic spaces involve the entire nodule and these cystic areas are separated by isoechoic septa. It is extremely rare to come across a nodule that fully meets these criteria. It is not uncommon for a nodule to have spongiform parts, but for this lesion to cover the whole and not contain a solid part, well these last two conditions have almost no nodules to satisfy. Those cystic nodules which do not fully meet the criteria for EU TIRADS 2 nodules, should be also put into EU TIRADS 3 subgroup.

Benign cystic nodule (cytology and wash-out) - case 2175

Transverse scan
Longitudinal scan

This lesion is almost completely cystic nodule. It is not evident whether the solid-looking areas (arrows) at the inner wall of the cyst correspond indeed to solid thyroid tissue or are clots. Since the lesion has completely disappeared after aspiration, this should be clearly considered a purely cyst.
   
Benign cystic nodule - case 2086
Transverse scan
Longitudinal scan

This is an almost completely cystic lesion, however it does not meet the criteria of a pure cyst. The wall thickening (yellow arrows) is ambiguous but there is a tiny solid-appearing area in the dorsal wall (red arrows). In systems which do not use the term 'almost completely cystic lesion', this nodule should be categorized as a peripheral-type cyst.

   
   

Benign cystic nodule (cytology and wash-out) - case 2177

Transverse scan
Longitudinal scan

According to the EU-TIRADS, this lesion cannot be regarded as a purely cystic nodule due to the presence of wall-thickening (yellow arrows). The EU-TIRADS defines this lesion as an EU-TIRADS 3 nodule.

   
Papillary carcinoma (histology) - case 1457
Before the aspiration
After the aspiration

This case draws attention to why aspiration may also make sense in seemingly pure cysts, moreover it advocates the strict definition of pure cyst of the EU-ITRADS. The solid area containing microcalcifications (marked with red arrows) became visible only after the aspiration of fluid. Nevertheless, a very thin solid part could be found at the ventral wall even before the aspiration.

   

Benign cystic nodule (ultrasound diagnosis) - case 28
Transverse scan
Longitudinal scan

This lesion is very close to the spongiform sphere defined by EU_TIRADS. Nevertheless, the non-cystic part of the nodule involves not only fibrous septa but also a minimal solid portion, as well. Note the posterior acoustic enhancement in the dorsal wall of the small cystic areas. These causes no concern if this optical artifact is linear (arrows), however granular figures might be misinterpreted as microcalcifications (arrowhead).

   
Benign nodular hyperplasia - case 2103

The extent of spongiform areas exceeds 50%, but not the entire nodule is spongiform. Therefore, it depends on the definition whether this nodule should be held as spongiform or not. Since, according to the ETA, only a nodule with fully spongiform parts can be classified as a spongiform lesion, this cannot be considered as such.
   
   
   
   
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