title: Fine-needle aspiration of thyroid nodules with macrocalcification.
abstract: BACKGROUND
  The presence of microcalcification is highly suggestive of malignancy; however, the association of macrocalcification with cancer remains unclear and controversial. The purpose of this study was to evaluate the diagnostic yield and accuracy of ultrasound (US)-guided fine-needle aspiration (FNA) of thyroid nodules with macrocalcifications and to investigate the association between macrocalcification subtype and malignancy risk.
  
  
  METHODS
  We retrospectively reviewed sonographic findings and pathologic results of thyroid nodules with macrocalcification in patients who underwent US-guided FNA in our hospital from January 2009 through December 2010. Inclusion criteria were as follows: (i) malignant or benign nodules confirmed on histologic examination of surgical specimens after US-guided FNA and (ii) nodules not histologically confirmed that were subjected to FNA at least twice and follow-up US examinations for 2 years. Thyroid nodules with macrocalcification were classified into four groups: smooth total (eggshell) calcification, smooth partial calcification, irregular calcification, and nodular calcification. The diagnostic yield of FNA for thyroid nodules with macrocalcification was determined by cytology. Sensitivity, specificity, and diagnostic accuracy of preoperative FNA cytology were calculated and compared with those of histologic examination of surgical specimens.
  
  
  RESULTS
  There were 188 nodules with macrocalcification in 167 patients; of these, 95 were benign, 80 were malignant, and 13 were nondiagnostic. The diagnostic yield of FNA for thyroid nodules with macrocalcification was 93.08%. Sensitivity, specificity, positive predictive value, and negative predictive value were 98.51%, 90.91%, 95.65%, and 96.77%, respectively. The false-positive value and false-negative value were 9.09% and 1.49%, respectively. The diagnostic accuracy was 96%. There was no statistically significant difference in the association between macrocalcification subtype and malignancy risk (p > 0.05).
  
  
  CONCLUSIONS
  Macrocalcification associated with thyroid nodules is not a reliable criterion for malignancy. FNA of thyroid nodules with macrocalcification had a high diagnostic yield and a reliable accuracy. Consistency between cytology and histology was almost perfect. Therefore, FNA is a good screening method for malignancy of thyroid nodules with macrocalcification.
authors: 1 Department of Radiology, Chungbuk National University , Cheongju, Korea.
authors: Jisun
authors: J
authors: Lee
authors: Seung Young
authors: SY
authors: Lee
authors: Sang-Hoon
authors: SH
authors: Cha
authors: Bum Sang
authors: BS
authors: Cho
authors: Min Ho
authors: MH
authors: Kang
authors: Ok-Jun
authors: OJ
authors: Lee
mesh_terms: D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000145:classification / Q000000981:diagnostic imaging / Q000473:pathology*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D056910:Republic of Korea; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D016606:Thyroid Nodule / Q000145:classification / Q000000981:diagnostic imaging / Q000473:pathology*; D055815:Young Adult