title: Impact of Microcalcifications on Risk of Malignancy in Thyroid Nodules with Indeterminate or Benign Cytology.
abstract: OBJECTIVE
  Adverse sonographic features such as microcalcification may predict increased likelihood of malignant cytology by fine-needle aspiration and, accordingly, increased risk of malignant histology. Our objective was to study the predictive value of microcalcifications and other sonographic features for malignancy among thyroid nodules with benign or indeterminate cytology.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Academic teaching hospital.
  
  
  METHODS
  Patients (N = 769) with 858 thyroid nodules undergoing 1142 ultrasound fine-needle aspirations; 411 cases had surgical correlation.
  
  
  METHODS
  Sonographic features predictive of malignancy were correlated with malignancy as determined by histology. Incidental malignancies occurring outside the index nodule were discounted.
  
  
  RESULTS
  Cytology was inadequate (87 cases), benign (518), indeterminate (210), and malignant (44). In 32 cases, initial benign cytology was upgraded to a higher-risk category after repeat ultrasound fine-needle aspiration. Microcalcification (P = .001) and irregular margins (P = .04) were significantly predictive of malignant cytology. Among surgical cases, microcalcification (P < .001) and irregular margins (P = .04) were significantly predictive of malignant histology; 170 patients with initial benign cytology and 161 with indeterminate cytology underwent surgery. Microcalcification was significantly associated with malignancy among cases with indeterminate cytology (P = .04) but not among cases with benign cytology (P = .23); however, only 13 of 33 cases with benign cytology and microcalcifications underwent surgery.
  
  
  CONCLUSIONS
  Presence of microcalcification increases the risk of malignancy in thyroid nodules with indeterminate cytology and may thus aid in selection of cases for surgery.
authors.affiliation: Department of Otolaryngology, South Infirmary University Hospital, Cork, Ireland.
authors.forename: Catherine
authors.initials: C
authors.lastname: Brophy
authors.affiliation: Department of Otolaryngology, South Infirmary University Hospital, Cork, Ireland.
authors.forename: James
authors.initials: J
authors.lastname: Stewart
authors.affiliation: Department of Radiology, South Infirmary University Hospital, Cork, Ireland.
authors.forename: Neil
authors.initials: N
authors.lastname: O'Donovan
authors.affiliation: Department of Pathology, Cork University Hospital, Cork, Ireland.
authors.forename: Julie
authors.initials: J
authors.lastname: McCarthy
authors.affiliation: Department of Endocrinology, South Infirmary University Hospital, Cork, Ireland.
authors.forename: Matthew
authors.initials: M
authors.lastname: Murphy
authors.affiliation: Department of Otolaryngology, South Infirmary University Hospital, Cork, Ireland sheahan.patrick@sivuh.ie.
authors.forename: Patrick
authors.initials: P
authors.lastname: Sheahan
mesh_terms: D002114:Calcinosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D012189:Retrospective Studies; D012307:Risk Factors; D013959:Thyroid Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D016606:Thyroid Nodule / Q000000981:diagnostic imaging / Q000473:pathology*; D014463:Ultrasonography
keywords: cytology; fine needle aspiration; microcalcifications; thyroid nodule; ultrasound