Lee Jisun, Lee Seung Young, Cha Sang-Hoon, Cho Bum Sang, Kang Min Ho, Lee Ok-Jun
1 Department of Radiology, Chungbuk National University , Cheongju, Korea.
Thyroid. 2013 Sep;23(9):1106-12. doi: 10.1089/thy.2012.0406. Epub 2013 Aug 27.
The presence of microcalcification is highly suggestive of malignancy; however, the association of macrocalcification with cancer remains unclear and controversial. The purpose of this study was to evaluate the diagnostic yield and accuracy of ultrasound (US)-guided fine-needle aspiration (FNA) of thyroid nodules with macrocalcifications and to investigate the association between macrocalcification subtype and malignancy risk.
We retrospectively reviewed sonographic findings and pathologic results of thyroid nodules with macrocalcification in patients who underwent US-guided FNA in our hospital from January 2009 through December 2010. Inclusion criteria were as follows: (i) malignant or benign nodules confirmed on histologic examination of surgical specimens after US-guided FNA and (ii) nodules not histologically confirmed that were subjected to FNA at least twice and follow-up US examinations for 2 years. Thyroid nodules with macrocalcification were classified into four groups: smooth total (eggshell) calcification, smooth partial calcification, irregular calcification, and nodular calcification. The diagnostic yield of FNA for thyroid nodules with macrocalcification was determined by cytology. Sensitivity, specificity, and diagnostic accuracy of preoperative FNA cytology were calculated and compared with those of histologic examination of surgical specimens.
There were 188 nodules with macrocalcification in 167 patients; of these, 95 were benign, 80 were malignant, and 13 were nondiagnostic. The diagnostic yield of FNA for thyroid nodules with macrocalcification was 93.08%. Sensitivity, specificity, positive predictive value, and negative predictive value were 98.51%, 90.91%, 95.65%, and 96.77%, respectively. The false-positive value and false-negative value were 9.09% and 1.49%, respectively. The diagnostic accuracy was 96%. There was no statistically significant difference in the association between macrocalcification subtype and malignancy risk (p > 0.05).
Macrocalcification associated with thyroid nodules is not a reliable criterion for malignancy. FNA of thyroid nodules with macrocalcification had a high diagnostic yield and a reliable accuracy. Consistency between cytology and histology was almost perfect. Therefore, FNA is a good screening method for malignancy of thyroid nodules with macrocalcification.
微钙化的存在高度提示恶性肿瘤；然而，大钙化与癌症之间的关联仍不明确且存在争议。本研究的目的是评估超声（US）引导下对伴有大钙化的甲状腺结节进行细针穿刺抽吸（FNA）的诊断率和准确性，并研究大钙化亚型与恶性风险之间的关联。
我们回顾性分析了2009年1月至2010年12月在我院接受US引导下FNA的患者中伴有大钙化的甲状腺结节的超声检查结果和病理结果。纳入标准如下：（i）US引导下FNA后手术标本组织学检查确诊为恶性或良性的结节，以及（ii）未进行组织学确诊但至少接受两次FNA及2年随访超声检查的结节。伴有大钙化的甲状腺结节分为四组：光滑完全（蛋壳样）钙化、光滑部分钙化、不规则钙化和结节状钙化。通过细胞学确定FNA对伴有大钙化的甲状腺结节的诊断率。计算术前FNA细胞学的敏感性、特异性和诊断准确性，并与手术标本的组织学检查结果进行比较。
167例患者中有188个伴有大钙化的结节；其中，95个为良性，80个为恶性，13个为无法诊断。FNA对伴有大钙化的甲状腺结节的诊断率为93.08%。敏感性、特异性、阳性预测值和阴性预测值分别为98.51%、90.91%、95.65%和96.77%。假阳性值和假阴性值分别为9.09%和1.49%。诊断准确性为96%。大钙化亚型与恶性风险之间的关联无统计学显著差异（p>0.05）。
与甲状腺结节相关的大钙化不是恶性肿瘤的可靠标准。对伴有大钙化的甲状腺结节进行FNA具有较高的诊断率和可靠的准确性。细胞学与组织学之间的一致性几乎完美。因此，FNA是伴有大钙化的甲状腺结节恶性肿瘤的一种良好筛查方法。
