The association of papillary thyroid cancer with microcalcification in thyroidnodules with indeterminate cytology based on fine-needle aspiration biopsy

Abstract

Background/aim: Microcalcifications are generally accepted as highly specific for thyroid malignancy, especially for papillary thyroid carcinoma (PTC). The aim of this study was to determine the significance of microcalcification within nodules that were classified as being of "indeterminate cytology" (IC) according to fine-needle aspiration biopsy. Materials and methods:Patients who underwent thyroidectomy between January 2010 and 2013 were included in the study. Nodules identified as "atypia/follicular lesion of undetermined significance", "follicular neoplasm/suspicious for follicular neoplasm", or "suspicious for malignancy" were categorized as IC. Patients were subcategorized depending on the presence of microcalcification (Group 1) or its absence (Group 2). The relationship between microcalcification and PTC was evaluated in the IC group retrospectively.Results: Indeterminate cytology was detected in 135 (28.5%) of 473 patients. Microcalcification was detected in 27 (20%) of 135 nodules and classified as Group 1, while the remaining 108 (80%) patients were classified as Group 2. According to the final pathology results, PTC was diagnosed in 13 of 27 (48.1%) patients in Group 1 and 29 of 108 (26.8%) patients in Group 2. A statistically significant relation between microcalcification and malignancy was determined in the IC group (P < 0.05). Conclusion:Surgery might be considered primarily for patients harboring nodule(s) with IC accompanied by microcalcification due to increased risk of PTC.

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].…”

A Proposal to Stratify the Intermediate-Risk Thyroid Nodules According to the AACE/ACE/AME Guidelines with Ultrasound Features

“…Nodules without macro-calcification were 1.896 times more dangerous than nodules with macro-calcification in our study ( OR : 1.921; 95% CIs:1.085–3.402). Many studies showed that micro-calcification was independently associated with malignancy 7 , 9 , 10 . However, there were fewer studies on macro-calcification in TNs.…”

Value of differential diagnosis of contrast‑enhanced ultrasound in benign and malignant thyroid nodules with microcalcification

“…The main component of microcalcification is calcium oxalate crystal (11). The major mechanism of microcalcification formation is as follows (12,13): i) thrombus is formed in the fibrovascular core of thyroid nodules, which develops into infarction, or necrosis of metastatic tumor cell nests in the lymph vessels occurs and triggers calcium deposit in dead tumor cells, thus forming gravel-like microcalcification. ii) The normal tumor cells in the thyroid nodules can release metabolic products and lead to dystrophic calcification of tumor cells, but such a calcification has no association with the apoptosis and necrosis of the tumor cells.…”