Thyroid Nodules with Macrocalcification: Sonographic Findings Predictive of Malignancy

Abstract

PurposeTo analyze which sonographic features of thyroid nodules with macrocalcifications were predictable of thyroid malignancy.Materials and MethodsWe reviewed sonographic findings of 854 macrocalcified thyroid nodules in patients who underwent fine needle aspiration biopsy between December 2009 and January 2011. There were 171 non-diagnostic aspirations, 34 nodules with category 3, 4, 5 based on Bethesda system, which were not confirmed by surgery, and these nodules were excluded from the analysis. Sonographic characteristics of the macrocalcifications including its thickness, interruption, and existence of soft tissue rim outside the macrocalcification were analyzed. Other sonographic characteristics of nodules such as shape, margin, composition, echo pattern, vascularity, and underlying parenchymal echogenicity were also evaluated. The correlation of sonographic features with cytopathologic results and the diagnostic performance of sonographic features for the prediction of malignancy were analyzed.ResultsAmong 649 nodules, 179 (27.6%) nodules were malignant and 470 (72.4%) nodules were benign. Among the features of the macrocalcification, interruption, irregular thickness, or the presence of soft tissue outside calcification rim were associated with malignancy (p<0.001). A high sensitivity and negative predictive values for the prediction of malignancy was found in sonographic characteristics of irregular thickness (92.2% and 91.0%, respectively) and the presence of soft tissue (88.5% and 88.8%, respectively).ConclusionSonographic characteristics of macrocalcification such as interruption, irregular thickness and the presence of soft tissue rim were associated with malignancy in thyroid nodules with macrocalcifications.

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

“…However, presence of macrocalcification was not associated with increased risk of malignancy in FNAB compared to nodules without macrocalcification. These results are contrary to our (29). In that study, the rates of nondiagnostic and suspicious for malignancy cytologies were similar with our findings.…”

Ultrasound-Guided Fine Needle Aspiration of Thyroid Nodules: A Consensus Statement by the Korean Society of Thyroid Radiology

“…For example, certain US features such as cystic dominancy, macrocalcification, size less than 5-10 mm, or hypoechogenicity, have been reported to increase the likelihood of nondiagnostic sampling despite highly variable nondiagnostic rates between studies (13, 14, 15, 16, 18, 19, 20, 21, 23, 39, 62, 63, 64). Particularly, cystic dominancy and intranodular macrocalcification were reported to be independent findings that increase the possibility of nondiagnostic results, even when experienced operators performed US-FNA (13).…”

The utility of thyroid ultrasonography in the management of thyroid nodules

“…It should be noted that the interpretation of microcalcifications on images can be confused with the presence of echogenic foci secondary to colloid, and this may have decreased the specificity. 22 No marker had both sensitivity and specificity exceeding 63%, and consequently the positive likelihood ratio varied between 0.8 and approximately 3.0 in the presence of individual markers. Of the reports that included any 2 criteria, including microcalcifications, echogenicity, ir regular margins or solidity, the combined positive likelihood ratio increased to 5.2.…”