Tahvildari Ali M, Pan Lorraine, Kong Christina S, Desser Terry
Department of Radiology, Stanford University School of Medicine, Stanford, California USA. VA Palo Alto Health Care System, Palo Alto, California USA.
Department of Pathology, Stanford University School of Medicine, Stanford, California USA.
J Ultrasound Med. 2016 Aug;35(8):1645-52. doi: 10.7863/ultra.15.09048. Epub 2016 Jun 14.
It is commonly held that punctate nonshadowing echogenic foci on sonography, often termed microcalcifications, represent psammoma bodies. We aimed to determine the validity of this supposition by correlating the presence of punctate echogenic foci on sonography with their presence at histopathologic examination.
We examined 51 nodules (surgically proven papillary thyroid carcinoma) by sonography and histopathologic examination. On the latter, nodules were examined for evidence of psammomatous calcifications, dystrophic calcifications, and colloid. Two subspecialty-trained radiologists with 2 and 25 years of experience in sonography, respectively, reviewed the sonograms for the presence and distribution of punctate echogenic foci.
All nodules contained colloid at histologic examination. Twenty of the papillary carcinomas lacked any calcification at pathologic examination. In the remaining 31 nodules with calcifications, 13 had psammomatous calcifications only; 6 had both coarse and psammomatous calcifications; and 12 had only coarse calcifications. The presence of punctate echogenic foci on sonography was 74% sensitive, was 46% to 53% specific, and had a positive predictive value of only 45% to 48% for the presence of psammomatous calcifications. The computed 2-tailed P value indicated that the punctate echogenic foci-to-psammoma body correlation was not statistically significant.
The sonographic signature commonly referred to as "microcalcifications" may represent a variety of entities, including psammomatous calcifications, dystrophic calcifications, and eosinophilic colloid; for this reason, "punctate echogenic foci" would be a more accurate term.
人们普遍认为，超声检查中出现的点状无回声增强灶（常称为微钙化）代表砂粒体。我们旨在通过将超声检查中出现的点状回声增强灶与组织病理学检查结果相关联，来确定这一假设的正确性。
我们对51个结节（手术证实为甲状腺乳头状癌）进行了超声检查和组织病理学检查。在组织病理学检查中，检查结节是否有砂粒体钙化、营养不良性钙化和胶体的证据。两位分别有2年和25年超声检查经验的经过亚专业培训的放射科医生，对超声图像进行了回顾，以确定点状回声增强灶的存在和分布情况。
所有结节在组织学检查中均含有胶体。20个乳头状癌在病理检查中未发现任何钙化。在其余31个有钙化的结节中，13个仅有砂粒体钙化；6个既有粗大钙化又有砂粒体钙化；12个仅有粗大钙化。超声检查中出现点状回声增强灶对砂粒体钙化存在的敏感性为74%，特异性为46%至53%，阳性预测值仅为45%至48%。计算得出的双侧P值表明，点状回声增强灶与砂粒体的相关性无统计学意义。
通常被称为“微钙化”的超声特征可能代表多种实体，包括砂粒体钙化、营养不良性钙化和嗜酸性胶体；因此，“点状回声增强灶”是一个更准确的术语。
