Relative risk of cancer in sonographically detected thyroid nodules with calcifications

Abstract

ABSTRACT:Purpose. The aim of this prospective study was to evaluate the significance of sonographically detected thyroid calcifications in the diagnosis of thyroid cancer.Methods. One hundred eighty-eight patients with thyroid disease, including 37 with thyroid cancer, were included in the study. Each patient underwent preoperative, high-resolution sonography to evaluate the thyroid gland for the presence of calcifications.Results. The highest incidence of calcification was found in thyroid cancer (54%), followed by multinodular goiter (40%), solitary nodular goiter (14%), and follicular adenomas (12%). The incidence of cancer was significantly higher in calcified nodules (29%) than in noncalcified nodules in the entire group (14%) (p = 0.019), with a relative risk of 2.5. In the group of solitary thyroid nodules, the incidence of cancer in the calcified nodules (55%) was higher than in the nodules without calcification (23%) (p = 0.016). Multiple noncalcified thyroid nodules harbored cancer in only 5% of cases. Compared with multiple noncalcified thyroid nodules, the solitary calcified nodules demonstrated a relative risk of 22.8. In both the solitary and multiple nodules, the relative risk in the presence of calcification was about the same, around 4. Patients younger than 40 years with calcified nodules constituted a high-risk group, with a relative risk of 3.8 versus 2.5 in patients older than 40 years with calcified nodules.Conclusions. The detection of thyroid calcifications by sonography is diagnostically valuable, especially in cases involving a solitary nodule or a young person. The presence of calcifications in these cases should raise the suspicion of malignancy. The low incidence of cancer in patients with multiple noncalcified thyroid nodules suggests that a more conservative approach may be appropriate in such cases.

Relationship between patterns of calcification in thyroid nodules and histopathologic findings

“…3 The percentage of each type of calcification in malignant and benign nodules ule is one of the most important US findings in distinguishing malignant from benign nodules. Several reports have noted that calcification seems to be more common in malignant than benign thyroid nodules [7][8][9][10][11]. The incidence of calcification is 26-54% in malignant and 8-32% in benign lesions.…”

Impact of nodular size on the predictive values of gray-scale, color-Doppler ultrasound, and sonoelastography for assessment of thyroid nodules

“…Microcalcification is one of the most specific features of thyroid malignancy with a specificity of 71.0%-98.8% (Kakkos et al, 2000;Khoo et al, 2002;Kim et al, 2002;Papini et al, 2002;Reading et al, 2005;Cappelli et al, 2006;Hoang et al, 2007;Moon W.J. et al, 2008;Ahn et al, 2010).…”

High Prevalence of Carcinoma in Ultrasonography-guided Fine Needle Aspiration Cytology of Thyroid Nodules

“…In our study, the sonographic characteristics that correlated with malignancy included: solid, hypoechoic, ill-defined margin, and the presence of microcalcifications. Our findings are consistent with previous studies [4,8,9,18,19]. For rim calcification, other studies did not show a relationship to malignancy [8,9].…”