title: Thyroid nodules with isolated macrocalcification: malignancy risk and diagnostic efficacy of fine-needle aspiration and core needle biopsy.
abstract: OBJECTIVE
  This study was performed to determine the malignancy risk of thyroid nodules with isolated macrocalcification and to evaluate the diagnostic efficacy of fine-needle aspiration (FNA) and core needle biopsy (CNB).
  
  
  METHODS
  From May 2008 to December 2014, a total of 44 patients with isolated macrocalcifications were enrolled from 4,081 consecutive patients who underwent FNA or CNB at a single institution. We assessed the malignancy risk of nodules with isolated macrocalcification. We compared the diagnostic results between FNA and CNB, and the diagnostic efficacy of each procedure was evaluated by the rate of inconclusive results. We compared the diagnostic performance for malignancy between FNA and CNB with a criterion of malignant or atypia/follicular lesion of undetermined significance (indeterminate) diagnostic results. We investigated whether the ultrasonographic feature of isolated macrocalcification was predictive of malignancy.
  
  
  RESULTS
  The malignancy risk of nodules with isolated macrocalcification was 16.1% in 31 nodules with final diagnoses and 11.4% in all nodules. CNB demonstrated a significantly lower rate of nondiagnostic and inconclusive results than FNA (7.7% vs. 53.8%, P=0.002 and 15.4% vs. 57.7%, P=0.003, respectively) in 26 nodules that underwent both FNA and CNB. CNB showed a marginally higher diagnostic performance for identifying malignancy than FNA (P=0.067). The ultrasonographic features of the anterior margin of isolated macrocalcification were not predictive of malignancy (P>0.999).
  
  
  CONCLUSIONS
  Thyroid nodules with isolated macrocalcification had a low to intermediate malignancy risk and should not be considered benign nodules. CNB showed a higher diagnostic efficacy than FNA in these nodules.
authors.affiliation: Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea.
authors.forename: Dong Gyu
authors.identifier: 0000-0001-6422-1652
authors.initials: DG
authors.lastname: Na
authors.affiliation: Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea.|Department of Radiology, Incheon Medical Center, Incheon, Korea.
authors.forename: Dae Sik
authors.identifier: 0000-0001-8424-8561
authors.initials: DS
authors.lastname: Kim
authors.affiliation: Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea.|Department of Radiology, New Korea Hospital, Gimpo, Korea.
authors.forename: Soo Jin
authors.identifier: 0000-0001-8233-1388
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jae Wook
authors.identifier: 0000-0003-4695-6246
authors.initials: JW
authors.lastname: Ryoo
authors.affiliation: Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: So Lyung
authors.identifier: 0000-0002-3267-8399
authors.initials: SL
authors.lastname: Jung
keywords: Biopsy, fine-needle; Biopsy, large-core needle; Diagnosis; Thyroid nodule; Ultrasonography
references.citation: J Clin Endocrinol Metab. 2014 Apr;99(4):1253-63
references.pmid: 24276450
references.citation: Korean J Radiol. 2015 Mar-Apr;16(2):391-401
references.pmid: 25741201
references.citation: Eur J Endocrinol. 2014 Apr 10;170(5):R203-11
references.pmid: 24536085
references.citation: Thyroid. 2009 Nov;19(11):1159-65
references.pmid: 19888858
references.citation: Thyroid. 2015 May;25(5):538-50
references.pmid: 25747526
references.citation: Yonsei Med J. 2014 Mar;55(2):339-44
references.pmid: 24532501
references.citation: Thyroid. 2015 Jun;25(6):657-64
references.pmid: 25851539
references.citation: Eur Radiol. 2012 Jul;22(7):1564-72
references.pmid: 22415411
references.citation: Eur Thyroid J. 2015 Sep;4(3):189-96
references.pmid: 26558236
references.citation: J Ultrasound Med. 2008 Oct;27(10 ):1425-30
references.pmid: 18809952
references.citation: Ultrasonography. 2016 Jan;35(1):25-38
references.pmid: 26324117
references.citation: J Ultrasound Med. 2007 Oct;26(10 ):1349-55; quiz 1356-7
references.pmid: 17901138
references.citation: Eur Radiol. 2015 Jul;25(7):2153-62
references.pmid: 25680723
references.citation: Eur J Endocrinol. 2013 Apr 15;168(5):649-55
references.pmid: 23416955
references.citation: World J Surg. 2011 Jan;35(1):122-7
references.pmid: 21042914
references.citation: J Pathol Transl Med. 2015 Jul;49(4):288-99
references.pmid: 26081825
references.citation: Radiology. 2008 Jun;247(3):762-70
references.pmid: 18403624