Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Malignancy Risk Stratification of Thyroid Nodules with Macrocalcification and Rim Calcification Based on Ultrasound Patterns

  • Hwa Seon Shin (Department of Radiology, Gyeongsang National University Hospital) ;
  • Dong Gyu Na (Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Wooyul Paik (Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • So Jin Yoon (Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Hye Yun Gwon (Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Byeong-Joo Noh (Department of Pathology, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Won Jun Kim (Department of Endoclinology, Gangneung Asan Hospital, University of Ulsan College of Medicine)
  • Received : 2020.03.30
  • Accepted : 2020.11.03
  • Published : 2021.04.01
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Abstract

Objective: To determine the association of macrocalcification and rim calcification with malignancy and to stratify the malignancy risk of thyroid nodules with macrocalcification and rim calcification based on ultrasound (US) patterns. Materials and Methods: The study included a total of 3603 consecutive nodules (≥ 1 cm) with final diagnoses. The associations of macrocalcification and rim calcification with malignancy and malignancy risk of the nodules were assessed overall and in subgroups based on the US patterns of the nodules. The malignancy risk of the thyroid nodules was categorized as high (> 50%), intermediate (upper-intermediate: > 30%, ≤ 50%; lower-intermediate: > 10%, ≤ 30%), and low (≤ 10%). Results: Macrocalcification was independently associated with malignancy in all nodules and solid hypoechoic (SH) nodules (p < 0.001). Rim calcification was not associated with malignancy in all nodules (p = 0.802); however, it was independently associated with malignancy in partially cystic or isoechoic and hyperechoic (PCIH) nodules (p = 0.010). The malignancy risks of nodules with macrocalcification were classified as upper-intermediate and high in SH nodules, and as low and lower-intermediate in PCIH nodules based on suspicious US features. The malignancy risks of nodules with rim calcification were stratified as low and lower-intermediate based on suspicious US features. Conclusion: Macrocalcification increased the malignancy risk in all and SH nodules with or without suspicious US features, with low to high malignancy risks depending on the US patterns. Rim calcification increased the malignancy risk in PCIH nodules, with low and lower-intermediate malignancy risks based on suspicious US features. However, the role of rim calcification in risk stratification of thyroid nodules remains uncertain.

Keywords

Acknowledgement

This research was supported by Medical Research Promotion Program through the Gangneung Asan Hospital funded by the Asan Foundation (2020IC001).

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