Different sonographic features of peripheral thyroid nodule calcification and risk of malignancy: a prospective observational study
More details
Hide details
Department of Radiology, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran
Department of Endocrinology, Rohani Hospital, Babol University of Medical Sciences, Babol, Iran
Department of Radiology, Rohani Hospital, Babol University of Medical Sciences, Babol, Iran
Submission date: 2020-10-19
Final revision date: 2021-01-21
Acceptance date: 2021-01-26
Publication date: 2021-06-18
Pol J Radiol, 2021; 86: 366-371
To investigate the association of peripheral calcification, as well as its sonographic features, with thyroid nodule malignancy.

Material and methods:
This study was prospectively conducted during 2015-2020 on patients diagnosed with thyroid nodule undergoing ultrasound-guided fine-needle aspiration in Shahid Beheshti teaching hospital or private offices in Babol, northern Iran. The ultrasonographic characteristics of the nodules, as well as the cytological findings, were recorded. Regression analysis was used to assess the relationship between sonographic results and malignancy. We also used receiver operator characteristics (ROC) analysis to estimate the ability of ultrasound to predict the characteristic features of malignancy, as estimated by the area under the curve (AUC).

A total of 1857 thyroid nodules were finally included, of which 84 were peripherally calcified nodules. There was a significant positive association between the nodule malignancy and peripheral calcification (OR = 2.23, 95% CI: 1.13-4.35). In the nodules with peripheral calcification, significant positive associations were seen between malignancy and lobulated margin (OR = 3.85, 95% CI: 1.02-14.54) and solid composition (OR = 4.05, 95% CI: 0.99-16.53). The ROC analysis indicated that AUC for lobulated margin and solid composition was 63.8% and 66.5%, respectively, in predicting malignant thyroid nodules.

The findings showed that peripheral calcification on sonography can be a potential indicator of malignant thyroid nodules. Also, the presence of lobulated margin and/or solid composition, besides peripheral calcification, can be helpful in better distinguishing malignant from benign nodules.

Karkada M, Costa AF, Imran SA, et al. Incomplete thyroid ultrasound reports for patients with thyroid nodules: implications regarding risk assessment and management. Am Roentgen Ray Soc 2018; 211: 1348-1353.
Shen Y, Liu M, He J, et al. Comparison of different risk-stratification systems for the diagnosis of benign and malignant thyroid nodules. Front Oncol 2019; 9: 378.
Tamhane S, Gharib H. Thyroid nodule update on diagnosis and management. Clin Diabetes Endocrinol 2016; 2: 17.
McQueen AS, Bhatia KS. Thyroid nodule ultrasound: technical advances and future horizons. Insights Imaging 2015; 6: 173-188.
Ha SM, Chung YJ, Ahn HS, et al. Echogenic foci in thyroid nodu­les: diagnostic performance with combination of TIRADS and echogenic foci. BMC Med Imaging 2019; 19: 28.
Jabar ASS, Koteshwara P, Andrade J. Diagnostic reliability of the Thyroid Imaging Reporting and Data System (TI-RADS) in routine practice. Pol J Radiol 2019; 84: e274-e280.
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.
Erdem Toslak I, Martin B, Barkan GA, et al. Patterns of sonogra­phically detectable echogenic foci in pediatric thyroid carcinoma with corresponding histopathology: an observational study. AJNR Am J Neuroradiol 2018; 39: 156-161.
Gwon HY, Na DG, Noh BJ, et al. Thyroid nodules with isolated macrocalcifications: malignancy risk of isolated macrocalcifications and postoperative risk stratification of malignant tumors manifesting as isolated macrocalcifications. Korean J Radiol 2020; 21: 605-613.
Shin JH, Baek JH, Chung J, et al. Ultrasonography diagnosis and imaging-based management of thyroid nodules: revised Korean Society of Thyroid Radiology consensus statement and recommendations. Korean J Radiol 2016; 17: 370-395.
Kim BM, Kim MJ, Kim EK, et al. Sonographic differentiation of thyroid nodules with eggshell calcifications. J Ultrasound Med 2008; 27: 1425-1430.
Park YJ, Kim JA, Son EJ, et al. Thyroid nodules with macrocalcification: sonographic findings predictive of malignancy. Yonsei Med J 2014; 55: 339-344.
Xie C, Cox P, Taylor N, LaPorte S. Ultrasonography of thyroid nodu­les: a pictorial review. Insights Imaging 2016; 7: 77-86.
Lee YH, Kim DW, In HS, et al. Differentiation between benign and malignant solid thyroid nodules using an US classification system. Korean J Radiol 2011; 12: 559-567.
Nabahati M, Moazezi Z, Fartookzadeh S, et al. The comparison of accuracy of ultrasonographic features versus ultrasound-guided fine-needle aspiration cytology in diagnosis of malignant thyroid nodules. J Ultrasound 2019; 22: 315-321.
Siebert SM, Gomez AJ, Liang T, et al. Diagnostic performance of margin features in thyroid nodules in prediction of malignancy. AJR Am J Roentgenol 2018; 210: 860-865.
Remonti LR, Kramer CK, Leitao CB, et al. Thyroid ultrasound features and risk of carcinoma: a systematic review and meta-analysis of observational studies. Thyroid 2015; 25: 538-550.
Popoveniuc G, Jonklaas J. Thyroid nodules. Med Clin North Am 2012; 96: 329-349.
Na DG, Kim JH, Kim DS, Kim SJ. Thyroid nodules with minimal cystic changes have a low risk of malignancy. Ultrasonography 2016; 35: 153-158.
Al-Hakami HA, Alqahtani R, Alahmadi A, et al. Thyroid nodule size and prediction of cancer: a study at tertiary care hospital in Saudi Arabia. Cureus 2020; 12: e7478.
Kamran SC, Marqusee E, Kim MI, et al. Thyroid nodule size and prediction of cancer. J Clin Endocrinol Metab 2013; 98: 564-570.
Anil G, Hegde A, Chong FV. Thyroid nodules: risk stratification for malignancy with ultrasound and guided biopsy. Cancer Imaging 2011; 11: 209-223.
Lee JY, Na DG, Yoon SJ, et al. Ultrasound malignancy risk stratification of thyroid nodules based on the degree of hypoechogenicity and echotexture. Eur Radiol 2020; 30: 1653-1663.
Tugendsam C, Petz V, Buchinger W, et al. Ultrasound criteria for risk stratification of thyroid nodules in the previously iodine deficient area of Austria – a single centre, retrospective analysis. Thyroid Res 2018; 11: 3.
Malhi HS, Velez E, Kazmierski B, et al. Peripheral thyroid nodule calcifications on sonography: evaluation of malignant potential. AJR Am J Roentgenol 2019; 213: 672-675.
Yin L, Zhang W, Bai W, He W. Relationship between morpholo­gic characteristics of ultrasonic calcification in thyroid nodules and thyroid carcinoma. Ultrasound Med Biol 2020; 46: 20-25.
Journals System - logo
Scroll to top