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Thyroid Nodules with Isolated Macrocalcifications: Malignancy Risk of Isolated Macrocalcifications and Postoperative Risk Stratification of Malignant Tumors Manifesting as Isolated Macrocalcifications

  • Received : 2019.07.13
  • Accepted : 2020.01.19
  • Published : 2020.05.01

Abstract

Objective: To determine the malignancy risk of isolated macrocalcifications (a calcified nodule with complete posterior acoustic shadowing) detected on ultrasonography (US) and to evaluate the postoperative American Thyroid Association (ATA) risk stratification of malignant tumors manifesting as isolated macrocalcifications. Materials and Methods: A total of 3852 thyroid nodules (≥ 1 cm) of 3061 consecutive patients who had undergone biopsy between January 2011 and June 2018 were included in this study. We assessed the prevalence, malignancy rate, and size distribution of isolated macrocalcifications and evaluated the histopathologic features and postoperative ATA risk stratification of malignant tumors manifesting as isolated macrocalcifications. Results: Isolated macrocalcifications were found in 38 (1.2%) of the 3061 patients. Final diagnosis was established in 30 (78.9%) nodules; seven malignant tumors were diagnosed as papillary thyroid carcinomas (PTCs). The malignancy rate of the isolated macrocalcifications was 23.3% in the 30 nodules with final diagnoses and 18.4% in all nodules. Among the six surgically-treated malignant tumors, five (83.3%) had an extrathyroidal extension (ETE) (minor ETE 1, gross ETE 4), and two (33.3%) had macroscopic lymph node metastasis. Four (66.7%) malignant tumors were categorized as high-risk tumors, one as an intermediate-risk tumor, and one as a low-risk tumor using the ATA risk stratification. Histopathologically, out of the six malignant tumors, ossifications were noted in four (66.7%) and predominant calcifications in two (33.3%). Conclusion: The US pattern of isolated macrocalcifications (≥ 1 cm) showed an intermediate malignancy risk (at least 18.4%). All malignant tumors were PTCs, and most showed an aggressive behavior and a high or intermediate postoperative ATA risk.

Keywords

Acknowledgement

This research was supported by the Medical Research Promotion Program through the GangNeung Asan Hospital funded by the Asan Foundation (2018-C03).

References

  1. Ha EJ, Lim HK, Yoon JH, Baek JH, Do KH, Choi M, et al. Primary imaging test and appropriate biopsy methods for thyroid nodules: guidelines by Korean Society of Radiology and National Evidence-based Healthcare Collaborating Agency. Korean J Radiol 2018;19:623-631 https://doi.org/10.3348/kjr.2018.19.4.623
  2. Brito JP, Gionfriddo MR, Al Nofal A, Boehmer KR, Leppin AL, Reading C, et al. The accuracy of thyroid nodule ultrasound to predict thyroid cancer: systematic review and meta-analysis. J Clin Endocrinol Metab 2014;99:1253-1263 https://doi.org/10.1210/jc.2013-2928
  3. Campanella P, Ianni F, Rota CA, Corsello SM, Pontecorvi A. Quantification of cancer risk of each clinical and ultrasonographic suspicious feature of thyroid nodules: a systematic review and meta-analysis. Eur J Endocrinol 2014;170:203-211 https://doi.org/10.1530/EJE-13-0995
  4. Remonti LR, Kramer CK, Leitao CB, Pinto LC, Gross JL. Thyroid ultrasound features and risk of carcinoma: a systematic review and meta-analysis of observational studies. Thyroid 2015;25:538-550 https://doi.org/10.1089/thy.2014.0353
  5. Na DG, Baek JH, Sung JY, Kim JH, Kim JK, Choi YJ, et al. Thyroid Imaging Reporting and Data System risk stratification of thyroid nodules: categorization based on solidity and echogenicity. Thyroid 2016;26:562-572 https://doi.org/10.1089/thy.2015.0460
  6. Frates MC, Benson CB, Doubilet PM, Kunreuther E, Contreras M, Cibas ES, et al. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. J Clin Endocrinol Metab 2006;91:3411-3417 https://doi.org/10.1210/jc.2006-0690
  7. Moon WJ, Jung SL, Lee JH, Na DG, Baek JH, Lee YH, et al. Benign and malignant thyroid nodules: US differentiation--multicenter retrospective study. Radiology 2008;247:762-770 https://doi.org/10.1148/radiol.2473070944
  8. Lu Z, Mu Y, Zhu H, Luo Y, Kong Q, Dou J, et al. Clinical value of using ultrasound to assess calcification patterns in thyroid nodules. World J Surg 2011;35:122-127 https://doi.org/10.1007/s00268-010-0827-3
  9. Na DG, Kim DS, Kim SJ, Ryoo JW, Jung SL. Thyroid nodules with isolated macrocalcification: malignancy risk and diagnostic efficacy of fine-needle aspiration and core needle biopsy. Ultrasonography 2016;35:212-219 https://doi.org/10.14366/usg.15074
  10. Russ G. Risk stratification of thyroid nodules on ultrasonography with the French TI-RADS: description and reflections. Ultrasonography 2016;35:25-38 https://doi.org/10.14366/usg.15027
  11. Shin JH, Baek JH, Chung J, Ha EJ, Kim JH, Lee YH, et al. Ultrasonography diagnosis and imaging-based management of thyroid nodules: revised Korean Society of Thyroid Radiology consensus statement and recommendations. Korean J Radiol 2016;17:370-395 https://doi.org/10.3348/kjr.2016.17.3.370
  12. Yoon SJ, Na DG, Gwon HY, Paik W, Kim WJ, Song JS, et al. Similarities and differences between Thyroid Imaging Reporting and Data Systems. AJR Am J Roentgenol 2019;213:W76-W84 https://doi.org/10.2214/AJR.18.20510
  13. Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, Teefey SA, et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): white paper of the ACR TI-RADS Committee. J Am Coll Radiol 2017;14:587-595 https://doi.org/10.1016/j.jacr.2017.01.046
  14. Middleton WD, Teefey SA, Reading CC, Langer JE, Beland MD, Szabunio MM, et al. Comparison of performance characteristics of American College of Radiology TI-RADS, Korean Society of Thyroid Radiology TIRADS, and American Thyroid Association guidelines. AJR Am J Roentgenol 2018;210:1148-1154 https://doi.org/10.2214/AJR.17.18822
  15. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016;26:1-133 https://doi.org/10.1089/thy.2015.0020
  16. Russ G, Bonnema SJ, Erdogan MF, Durante C, Ngu R, Leenhardt L. European Thyroid Association guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: the EU-TIRADS. Eur Thyroid J 2017;6:225-237 https://doi.org/10.1159/000478927
  17. Na DG, Baek JH, Jung SL, Kim JH, Sung JY, Kim KS, et al. Core needle biopsy of the thyroid: 2016 consensus statement and recommendations from Korean Society of Thyroid Radiology. Korean J Radiol 2017;18:217-237 https://doi.org/10.3348/kjr.2017.18.1.217
  18. Cibas ES, Ali SZ. The Bethesda system for reporting thyroid cytopathology. Thyroid 2009;19:1159-1165 https://doi.org/10.1089/thy.2009.0274
  19. Jung CK, Min HS, Park HJ, Song DE, Kim JH, Park SY, et al. Pathology reporting of thyroid core needle biopsy: a proposal of the Korean Endocrine Pathology Thyroid Core Needle Biopsy Study Group. J Pathol Transl Med 2015;49:288-299 https://doi.org/10.4132/jptm.2015.06.04
  20. Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, et al. AJCC cancer staging manual, 8th ed. New York: Springer International Publishing, 2017:873-890
  21. Bai Y, Zhou G, Nakamura M, Ozaki T, Mori I, Taniguchi E, et al. Survival impact of psammoma body, stromal calcification, and bone formation in papillary thyroid carcinoma. Mod Pathol 2009;22:887-894 https://doi.org/10.1038/modpathol.2009.38
  22. Takeda M, Mikami T, Numata Y, Okamoto M, Okayasu I. Papillary thyroid carcinoma with heterotopic ossification is a special subtype with extensive progression. Am J Clin Pathol 2013;139:587-598 https://doi.org/10.1309/AJCPQZQN50HKIAHA
  23. Aurora N, Hashmi I, Misra S, Aydin N. A rare presentation: a case report of osseous metaplasia and mature bone formation in a follicular adenoma of the thyroid. Int J Surg Case Rep 2017;37:83-86 https://doi.org/10.1016/j.ijscr.2017.06.031