title: Thyroid nodules with macrocalcification: sonographic findings predictive of malignancy.
abstract: OBJECTIVE
  To analyze which sonographic features of thyroid nodules with macrocalcifications were predictable of thyroid malignancy.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Among 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).
  
  
  CONCLUSIONS
  Sonographic characteristics of macrocalcification such as interruption, irregular thickness and the presence of soft tissue rim were associated with malignancy in thyroid nodules with macrocalcifications.
authors.affiliation: Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea. chrismd@hanmail.net.
authors.forename: Yun Joo
authors.initials: YJ
authors.lastname: Park
authors.forename: Jeong-Ah
authors.initials: JA
authors.lastname: Kim
authors.forename: Eun Ju
authors.initials: EJ
authors.lastname: Son
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Youk
authors.forename: Eun-Kyung
authors.initials: EK
authors.lastname: Kim
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Kwak
authors.forename: Cheong Soo
authors.initials: CS
authors.lastname: Park
mesh_terms: D000328:Adult; D044963:Biopsy, Fine-Needle; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000473:pathology*; D014463:Ultrasonography
keywords: Sonography; macrocalcification; papillary thyroid cancer