Evaluation of cytopathological findings in thyroid nodules with macrocalcification: macrocalcification is not innocent as it seems

Abstract

Objective: Microcalcification is strongly correlated with papillary thyroid cancer. It is not clear whether macrocalcification is associated with malignancy. In this study, we aimed to assess the result of fine needle aspiration biopsies (FNAB) of thyroid nodules with macrocalcifications. Subjects and methods: We retrospectively evaluated 269 patients (907 nodules). Macrocalcifications were classified as eggshell and parenchymal macrocalcification. FNAB results were divided into four groups: benign, malignant, suspicious for malignancy, and non-diagnostic. Results: There were 79.9% female and 20.1% male and mean age was 56.9 years. Macrocalcification was detected in 46.3% nodules and 53.7% nodules had no macrocalcification. Parenchymal and eggshell macrocalcification were observed in 40.5% and 5.8% nodules, respectively. Cytologically, malignant and suspicious for malignancy rates were higher in nodules with macrocalcification compared to nodules without macrocalcification (p = 0.004 and p = 0.003, respectively). Benign and non-diagnostic cytology results were similar in two groups (p > 0.05). Nodules with eggshell calcification had higher rate of suspicious for malignancy and nodules with parenchymal macrocalcification had higher rates of malignant and suspicious for malignancy compared to those without macrocalcification (p = 0.01, p = 0.003 and p = 0.007, respectively). Conclusions: Our findings suggest that macrocalcifications are not always benign and are not associated with increased nondiagnostic FNAB results. Macrocalcification, particularly the parenchymal type should be taken into consideration. Arq Bras Endocrinol Metab. 2014;58(9):939-45 Keywords Thyroid nodule; macrocalcification; malignancy; suspicious of malignancy RESUMO Objetivo: A microcalcificação está fortemente correlacionada com o câncer papilar de tiroide. Não está claro se a macrocalcificação também está associada com malignidade. Neste estudo, nosso objetivo foi avaliar o resultado da biópsia de aspiração por agulha fina (FNAB) de nó-dulos tiroidianos com macrocalcificações. Sujeitos e métodos: Avaliamos retrospectivamente 269 pacientes (907 nódulos). As macrocalcificações foram classificadas como periféricas (casca de ovo) ou parenquimatosas (interna). Os resultados da FNAB foram divididos em quatro grupos citológicos: benignos, com malignidade, suspeita de malignidade e não diagnósticos. Resultados: Das amostras, 79,9% foram coletadas de mulheres e 20,1% de homens, e a idade média foi de 56,9 anos. A macrocalcificação foi detectada em 46,3% dos nódulos, e em 53,7% dos nódulos não havia macrocalcificação. A macrocalcificação parenquimatosa e periférica foi observada em 40,5% e 5,8% dos nódulos, respectivamente. Em termos citológicos, a malignidade e suspeita de malignidade foram mais comuns em nódulos com macrocalcificação em comparação com nódulos sem macrocalcificação (p = 0,004 e p = 0,003, respectivamente). Resultados benignos e não diagnósticos da citologia foram similares em ambos os grupos (p > 0,05). Os nódulos com calci...

Clinical, Laboratory, Ultrasound and FNB aspects of thyroid nodules with calcifications

“…Standard US examination showed that 57% of the malignant lesions were hypoechoic, in agreement with literature reports [23,31]. The presence of calcifi cation in the TN studied here increased with age but was not associated with a characteristic signal of the presence of malignancy [32][33][34][35] However, neither study was later confi rmed [36,37].…”

Using Artificial Intelligence to Revise ACR TI-RADS Risk Stratification of Thyroid Nodules: Diagnostic Accuracy and Utility

“…This modification highlights ongoing uncertainty regarding the clinical importance of macrocalcifications (16)(17)(18). Some studies (19) suggest that they confer a higher degree of risk than originally thought, whereas other studies (8) suggest that this feature is less suspicious than are punctate echogenic foci or peripheral calcifications. Although the allocation of zero points does not imply zero risk, this suggests that macrocalcifications are less suspicious than are punctate echogenic foci or peripheral calcifications based on our data.…”

ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee

“…Evidence in the literature regarding their association with increased malignancy risk is mixed, especially in nodules lacking other malignant features [12,[49][50][51]. Given published data that show a weakly positive relationship with malignancy [52], macrocalcifications are assigned one point, recognizing that the risk is increased if the nodule also contains moderately or highly suspicious features that warrant additional points.…”