Peripheral Thyroid Nodule Calcifications on Sonography: Evaluation of Malignant Potential
Harshawn S. Malhi1, Erik Velez1, Brittany Kazmierski1, Mittul Gulati1 ... Show all
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Citation: American Journal of Roentgenology: 1-4. 10.2214/AJR.18.20799
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ABSTRACT :
OBJECTIVE. The purpose of this study is to assess the association of thyroid cancer with sonographic features of peripheral calcifications.
MATERIALS AND METHODS. We retrospectively reviewed patients who had a total of 97 thyroid nodules with peripheral calcifications who underwent ultrasound-guided fine-needle aspiration from 2008 to 2018. Three board-certified radiologists evaluated the nodules for features of peripheral calcifications: the percentage of the nodule involved by peripheral calcifications, whether the calcifications were continuous or discontinuous, the visibility of internal components of the nodule, and the presence of extrusion of soft tissue beyond the calcifications. The correlation of peripheral calcification parameters with the rate of thyroid nodule malignancy was evaluated. In addition, the interobserver agreement between readers was assessed with Cohen kappa coefficient.
RESULTS. Of the 97 nodules with peripheral calcifications, 27% (n = 26) were found to be malignant on biopsy. The continuity of peripheral calcifications, visibility of internal components, and extrusion of soft tissue beyond the calcification rim showed no significant association with benign or malignant nodules. Readers had good agreement on peripheral calcification continuity (κ = 0.63; 95% CI, 0.53–0.73) and moderate agreement on internal component visibility (κ = 0.43; 95% CI, 0.35–0.51) and percentage of the nodule involved by rim calcifications (κ = 0.52; 95% CI, 0.44–0.59). There was fair agreement for extranodular soft-tissue extrusion (κ = 0.32, 95% CI, 0.24–0.39).
CONCLUSION. Peripheral rim calcifications are highly associated with malignancy. However, specific peripheral rim calcification features do not aid in distinguishing benign from malignant nodules, which may in part be caused by high interobserver variability.
Keywords: ACR TI-RADS, malignancy, thyroid calcifications, thyroid nodules, ultrasound
References
Previous section
1. Guth S, Theune U, Aberle J, Galach A, Bamberger CM. Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur J Clin Invest 2009; 39:699–706 [Crossref] [Medline] [Google Scholar]
2. Singh Ospina N, Brito JP, Maraka S, et al. Diagnostic accuracy of ultrasound-guided fine needle aspiration biopsy for thyroid malignancy: systematic review and meta-analysis. Endocrine 2016; 53:651–661 [Crossref] [Medline] [Google Scholar]
3. Burman KD, Wartofsky L. CLINICAL PRACTICE: thyroid nodules. N Engl J Med 2015; 373:2347–2356 [Crossref] [Medline] [Google Scholar]
4. Ito Y, Uruno T, Nakano K, et al. An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid 2003; 13:381–387 [Crossref] [Medline] [Google Scholar]
5. Tessler FN, Middleton WD, Grant EG, et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): white paper of the ACR TI-RADS Committee. J Am Coll Radiol 2017; 14:587–595 [Crossref] [Medline] [Google Scholar]
6. Grant EG, Tessler FN, Hoang JK, et al. Thyroid ultrasound reporting lexicon: white paper of the ACR Thyroid Imaging, Reporting and Data System (TIRADS) Committee. J Am Coll Radiol 2015; 12(12 Pt A):1272–1279 [Crossref] [Medline] [Google Scholar]
7. Arpaci D, Ozdemir D, Cuhaci N, et al. Evaluation of cytopathological findings in thyroid nodules with macrocalcification: macrocalcification is not innocent as it seems. Arq Bras Endocrinol Metabol 2014; 58:939–945 [Crossref] [Medline] [Google Scholar]
8. Kwak JY, Han KH, Yoon JH, et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology 2011; 260:892–899 [Crossref] [Medline] [Google Scholar]
9. Moon HJ, Sung JM, Kim EK, Yoon JH, Youk JH, Kwak JY. Diagnostic performance of gray-scale US and elastography in solid thyroid nodules. Radiology 2012; 262:1002–1013 [Crossref] [Medline] [Google Scholar]
10. Kim MJ, Kim EK, Kwak JY, et al. Differentiation of thyroid nodules with macrocalcifications: role of suspicious sonographic findings. J Ultrasound Med 2008; 27:1179–1184 [Crossref] [Medline] [Google Scholar]
11. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26:1–133 [Crossref] [Medline] [Google Scholar]
12. Labourier E, Shifrin A, Busseniers AE, et al. Molecular testing for miRNA, mRNA, and DNA on fine-needle aspiration improves the preoperative diagnosis of thyroid nodules with indeterminate cytology. J Clin Endocrinol Metab 2015; 100:2743–2750 [Crossref] [Medline] [Google Scholar]
13. Cibas ES, Ali SZ. The 2017 Bethesda System for reporting thyroid cytopathology. Thyroid 2017; 27:1341–1346 [Crossref] [Medline] [Google Scholar]
14. Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Fam Med 2005; 37:360–363 [Medline] [Google Scholar]
15. Frates MC, Benson CB, Doubilet PM, et al. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. J Clin Endocrinol Metab 2006; 91:3411–3417 [Crossref] [Medline] [Google Scholar]
16. Yoon DY, Lee JW, Chang SK, et al. Peripheral calcification in thyroid nodules: ultrasonographic features and prediction of malignancy. J Ultrasound Med 2007; 26:1349–1355; quiz, 1356–1357 [Crossref] [Medline] [Google Scholar]
17. Hoang JK, Lee WK, Lee M, Johnson D, Farrell S. US features of thyroid malignancy: pearls and pitfalls. RadioGraphics 2007; 27:847–860; discussion, 861–865 [Crossref] [Medline] [Google Scholar]
18. Park YJ, Kim JA, Son EJ, et al. Thyroid nodules with macrocalcification: sonographic findings predictive of malignancy. Yonsei Med J 2014; 55:339–344 [Crossref] [Medline] [Google Scholar]
19. Kim BM, Kim MJ, Kim EK, et al. Sonographic differentiation of thyroid nodules with eggshell calcifications. J Ultrasound Med 2008; 27:1425–1430 [Crossref] [Medline] [Google Scholar]
20. Kim DS, Kim JH, Na DG, et al. Sonographic features of follicular variant papillary thyroid carcinomas in comparison with conventional papillary thyroid carcinomas. J Ultrasound Med 2009; 28:1685–1692 [Crossref] [Medline] [Google Scholar]
21. Hoang JK, Middleton WD, Farjat AE, et al. Interobserver variability of sonographic features used in the American College of Radiology Thyroid Imaging Reporting and Data System. AJR 2018; 211:162–167 [Abstract] [Google Scholar]
22. Cáp J, Ryska A, Rehorková P, Hovorková E, Kerekes Z, Pohnetalová D. Sensitivity and specificity of the fine needle aspiration biopsy of the thyroid: clinical point of view. Clin Endocrinol (Oxf) 1999; 51:509–515 [Crossref] [Medline] [Google Scholar]
23. Choi SH, Han KH, Yoon JH, et al. Factors affecting inadequate sampling of ultrasound-guided fine-needle aspiration biopsy of thyroid nodules. Clin Endocrinol (Oxf) 2011; 74:776–782 [Crossref] [Medline] [Google Scholar]
Address correspondence to H. S. Malhi (Harshawn.malhi@med.usc.edu).
Read More: https://www.ajronline.org/doi/abs/10.2214/AJR.18.20799
Harshawn S. Malhi1, Erik Velez1, Brittany Kazmierski1, Mittul Gulati1 ... Show all
Share Share
+ Affiliation:
Citation: American Journal of Roentgenology: 1-4. 10.2214/AJR.18.20799
AbstractFull TextReferencesPDFPDF PlusAdd to FavoritesPermissionsDownload Citation
ABSTRACT :
OBJECTIVE. The purpose of this study is to assess the association of thyroid cancer with sonographic features of peripheral calcifications.
MATERIALS AND METHODS. We retrospectively reviewed patients who had a total of 97 thyroid nodules with peripheral calcifications who underwent ultrasound-guided fine-needle aspiration from 2008 to 2018. Three board-certified radiologists evaluated the nodules for features of peripheral calcifications: the percentage of the nodule involved by peripheral calcifications, whether the calcifications were continuous or discontinuous, the visibility of internal components of the nodule, and the presence of extrusion of soft tissue beyond the calcifications. The correlation of peripheral calcification parameters with the rate of thyroid nodule malignancy was evaluated. In addition, the interobserver agreement between readers was assessed with Cohen kappa coefficient.
RESULTS. Of the 97 nodules with peripheral calcifications, 27% (n = 26) were found to be malignant on biopsy. The continuity of peripheral calcifications, visibility of internal components, and extrusion of soft tissue beyond the calcification rim showed no significant association with benign or malignant nodules. Readers had good agreement on peripheral calcification continuity (κ = 0.63; 95% CI, 0.53–0.73) and moderate agreement on internal component visibility (κ = 0.43; 95% CI, 0.35–0.51) and percentage of the nodule involved by rim calcifications (κ = 0.52; 95% CI, 0.44–0.59). There was fair agreement for extranodular soft-tissue extrusion (κ = 0.32, 95% CI, 0.24–0.39).
CONCLUSION. Peripheral rim calcifications are highly associated with malignancy. However, specific peripheral rim calcification features do not aid in distinguishing benign from malignant nodules, which may in part be caused by high interobserver variability.
Keywords: ACR TI-RADS, malignancy, thyroid calcifications, thyroid nodules, ultrasound
References
Previous section
1. Guth S, Theune U, Aberle J, Galach A, Bamberger CM. Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur J Clin Invest 2009; 39:699–706 [Crossref] [Medline] [Google Scholar]
2. Singh Ospina N, Brito JP, Maraka S, et al. Diagnostic accuracy of ultrasound-guided fine needle aspiration biopsy for thyroid malignancy: systematic review and meta-analysis. Endocrine 2016; 53:651–661 [Crossref] [Medline] [Google Scholar]
3. Burman KD, Wartofsky L. CLINICAL PRACTICE: thyroid nodules. N Engl J Med 2015; 373:2347–2356 [Crossref] [Medline] [Google Scholar]
4. Ito Y, Uruno T, Nakano K, et al. An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid 2003; 13:381–387 [Crossref] [Medline] [Google Scholar]
5. Tessler FN, Middleton WD, Grant EG, et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): white paper of the ACR TI-RADS Committee. J Am Coll Radiol 2017; 14:587–595 [Crossref] [Medline] [Google Scholar]
6. Grant EG, Tessler FN, Hoang JK, et al. Thyroid ultrasound reporting lexicon: white paper of the ACR Thyroid Imaging, Reporting and Data System (TIRADS) Committee. J Am Coll Radiol 2015; 12(12 Pt A):1272–1279 [Crossref] [Medline] [Google Scholar]
7. Arpaci D, Ozdemir D, Cuhaci N, et al. Evaluation of cytopathological findings in thyroid nodules with macrocalcification: macrocalcification is not innocent as it seems. Arq Bras Endocrinol Metabol 2014; 58:939–945 [Crossref] [Medline] [Google Scholar]
8. Kwak JY, Han KH, Yoon JH, et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology 2011; 260:892–899 [Crossref] [Medline] [Google Scholar]
9. Moon HJ, Sung JM, Kim EK, Yoon JH, Youk JH, Kwak JY. Diagnostic performance of gray-scale US and elastography in solid thyroid nodules. Radiology 2012; 262:1002–1013 [Crossref] [Medline] [Google Scholar]
10. Kim MJ, Kim EK, Kwak JY, et al. Differentiation of thyroid nodules with macrocalcifications: role of suspicious sonographic findings. J Ultrasound Med 2008; 27:1179–1184 [Crossref] [Medline] [Google Scholar]
11. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26:1–133 [Crossref] [Medline] [Google Scholar]
12. Labourier E, Shifrin A, Busseniers AE, et al. Molecular testing for miRNA, mRNA, and DNA on fine-needle aspiration improves the preoperative diagnosis of thyroid nodules with indeterminate cytology. J Clin Endocrinol Metab 2015; 100:2743–2750 [Crossref] [Medline] [Google Scholar]
13. Cibas ES, Ali SZ. The 2017 Bethesda System for reporting thyroid cytopathology. Thyroid 2017; 27:1341–1346 [Crossref] [Medline] [Google Scholar]
14. Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Fam Med 2005; 37:360–363 [Medline] [Google Scholar]
15. Frates MC, Benson CB, Doubilet PM, et al. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. J Clin Endocrinol Metab 2006; 91:3411–3417 [Crossref] [Medline] [Google Scholar]
16. Yoon DY, Lee JW, Chang SK, et al. Peripheral calcification in thyroid nodules: ultrasonographic features and prediction of malignancy. J Ultrasound Med 2007; 26:1349–1355; quiz, 1356–1357 [Crossref] [Medline] [Google Scholar]
17. Hoang JK, Lee WK, Lee M, Johnson D, Farrell S. US features of thyroid malignancy: pearls and pitfalls. RadioGraphics 2007; 27:847–860; discussion, 861–865 [Crossref] [Medline] [Google Scholar]
18. Park YJ, Kim JA, Son EJ, et al. Thyroid nodules with macrocalcification: sonographic findings predictive of malignancy. Yonsei Med J 2014; 55:339–344 [Crossref] [Medline] [Google Scholar]
19. Kim BM, Kim MJ, Kim EK, et al. Sonographic differentiation of thyroid nodules with eggshell calcifications. J Ultrasound Med 2008; 27:1425–1430 [Crossref] [Medline] [Google Scholar]
20. Kim DS, Kim JH, Na DG, et al. Sonographic features of follicular variant papillary thyroid carcinomas in comparison with conventional papillary thyroid carcinomas. J Ultrasound Med 2009; 28:1685–1692 [Crossref] [Medline] [Google Scholar]
21. Hoang JK, Middleton WD, Farjat AE, et al. Interobserver variability of sonographic features used in the American College of Radiology Thyroid Imaging Reporting and Data System. AJR 2018; 211:162–167 [Abstract] [Google Scholar]
22. Cáp J, Ryska A, Rehorková P, Hovorková E, Kerekes Z, Pohnetalová D. Sensitivity and specificity of the fine needle aspiration biopsy of the thyroid: clinical point of view. Clin Endocrinol (Oxf) 1999; 51:509–515 [Crossref] [Medline] [Google Scholar]
23. Choi SH, Han KH, Yoon JH, et al. Factors affecting inadequate sampling of ultrasound-guided fine-needle aspiration biopsy of thyroid nodules. Clin Endocrinol (Oxf) 2011; 74:776–782 [Crossref] [Medline] [Google Scholar]
Address correspondence to H. S. Malhi (Harshawn.malhi@med.usc.edu).
Read More: https://www.ajronline.org/doi/abs/10.2214/AJR.18.20799
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