Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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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

  • Hye Yun Gwon (Department of Radiology, GangNeung Asan Hospital) ;
  • Dong Gyu Na (Department of Radiology, GangNeung Asan Hospital) ;
  • Byeong-Joo Noh (Department of Pathology, GangNeung Asan Hospital) ;
  • Wooyul Paik (Department of Radiology, GangNeung Asan Hospital) ;
  • So Jin Yoon (Department of Radiology, GangNeung Asan Hospital) ;
  • Soo-Jung Choi (Department of Radiology, GangNeung Asan Hospital) ;
  • Dong Rock Shin (Department of Radiology, GangNeung Asan Hospital)
  • Received : 2019.07.13
  • Accepted : 2020.01.19
  • Published : 2020.05.01
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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).

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