The pattern and significance of the calcifications of papillary thyroid microcarcinoma presented in preoperative neck ultrasonography

Abstract

PurposeTo analyze the incidence and patterns of calcification of papillary thyroid microcarcinoma (PTMC) on neck ultrasonography (NUS) and assess the clinical implications of calcification, especially for neck node metastasis.MethodsThe clinical data of 379 patients with PTMC who underwent thyroidectomy between January and December 2011 were retrospectively analyzed. PTMC lesions were classified into four subgroups according to their calcification patterns on preoperative NUS: microcalcification, macrocalcification, rim calcification, and noncalcification. The clinicopathologic characteristics were compared between the patients with and without calcification, and among the four subgroups.ResultsCalcifications were detected on NUS in 203 patients (53.5%) and central neck node metastasis was observed in 119 patients (31.3%). Calcification was associated with larger tumor size (0.68 cm vs. 0.54 cm), higher rate of lymph node metastasis (38.6% vs. 23.2%) and higher lymph node ratio (0.11 vs. 0.06) compared to noncalcification (All P < 0.05). In addition, the extent of calcification correlated with lesion size (0.67 cm vs. 0.69 cm vs. 0.85 cm). Further, the likelihood of lymph node metastasis also correlated with the extent of calcification in the order of non-, micro- and macrocalcification (23.3%, 36.8%, and 44.1%, respectively). The calcification rate was higher in patients with lymph node metastasis than those without it (65.5% vs.47.7%) (All P < 0.05).ConclusionPTMC patients positive for calcification on NUS had a higher rate of lymph node metastasis, and a higher lymph node ratio compared to noncalcification patients. Calcification patterns should be assessed carefully in patients with PTMC by preoperative NUS.

Clinicopathological features for predicting central and lateral lymph node metastasis in papillary thyroid microcarcinoma: Analysis of 66 cases that underwent central and lateral lymph node dissection

“…Extrathyroid invasion, multifocality and calcification are all valuable high-risk factors of lymph metastasis of PTMC (43–45). PTMC with these pathological characters exhibit more aggressive biological behavior (42).…”

“…Shindo et al (44) and Chow et al (48) reported that neck lymph node metastasis was significantly correlated with tumor multifocality. Multiple microcalcifications were recognized as an important feature of malignancy, and PTMC with calcification was detected with a large size and higher lymph node ratio compared with non-calcified lesions (45). Unfortunately, these options remain controversial (34,38).…”

Pathological characteristics of low-risk papillary thyroid microcarcinoma with progression during active surveillance

“…Indeed, we found that intraglandular dissemination and psammoma bodies in normal thyroid tissue occurred more frequently in cases with than in those without nodal metastasis. Both types of lesion may be detected ultrasonographically [25,26]. Small low-echoic lesions with an irregular margin surrounding PTMC are a marker of intraglandular dissemination.…”

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

“…The clinical significance of calcification and the molecular mechanism that is responsible for calcification in PTC is still uncertain (2). The rapid proliferation of cancer cells may lead to necrosis, resulting in calcium deposits (16). Histopathologically, calcifications can be seen as psammoma bodies and dystrophic calcifications, or psammoma bodies and stromal calcifications (2).…”