From the Departments of Radiology (I.E.T., J.E.L.-D.).
Clinical Research Office (B.M.), Loyola University Chicago Health Sciences Division, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois.
AJNR Am J Neuroradiol. 2018 Jan;39(1):156-161. doi: 10.3174/ajnr.A5419. Epub 2017 Oct 26.
Small echogenic foci within pediatric thyroid nodules are commonly seen by ultrasound and are one of the features used to determine the level of suspicion for malignancy. These are sometimes termed "microcalcifications," but their relation with malignancy is controversial due to the lack of standard terminology. Our aim was to evaluate sonographic patterns of echogenic foci in malignant pediatric thyroid nodules and describe the distribution of corresponding psammoma bodies and other histopathologic findings in thyroidectomy specimens.
Ultrasounds of 15 pathologically proved malignant thyroid nodules in children were retrospectively reviewed by 2 radiologists who separately classified echogenic foci into the 4 morphologic patterns described in the American College of Radiology Thyroid Imaging, Reporting and Data System and noted their presence and distribution. Interobserver agreement was assessed, and consensus was reached for nodules for which there was disagreement. Surgical pathology findings from thyroidectomy specimens were retrospectively reviewed for the presence and distribution of psammomatous and dystrophic/stromal calcifications and eosinophilic/sticky colloid. Ultrasound and histopathologic ratings were compared, and frequencies and percentages corresponding to observed agreement levels were calculated.
Interobserver agreement between radiologists' sonographic assessments for the presence and distribution of echogenic foci ranged from 53% to 100% for all categories. Punctate echogenic foci were present in all nodules, and macrocalcifications, in 27%. Histopathology of the 15 nodules revealed that only 4 (27%) had psammomatous calcifications, while 9 (60%) had stromal calcifications and 8 (53%) had sticky colloid.
Sonographically detectable echogenic foci in malignant pediatric thyroid nodules can be reliably classified on the basis of American College of Radiology Thyroid Imaging, Reporting and Data System, with punctate echogenic foci composing the most common subtype. These echogenic foci do not represent psammomatous calcifications most of the time; instead, more than half of the malignant thyroid nodules with echogenic foci contained stromal calcifications or sticky colloid.
儿科甲状腺结节的超声检查常可见到小的点状回声灶，这是用于判断恶性肿瘤可能性的特征之一。这些有时被称为“微钙化”，但由于缺乏标准术语，其与恶性肿瘤的关系存在争议。我们的目的是评估恶性儿童甲状腺结节中超声点状回声灶的模式，并描述在甲状腺切除术标本中相应的砂粒体和其他组织病理学发现的分布。
回顾性分析了 15 例经病理证实的恶性儿童甲状腺结节的超声图像，由 2 名放射科医生分别按照美国放射学院甲状腺影像报告和数据系统（ACR TI-RADS）中描述的 4 种形态学模式对回声灶进行分类，并记录其存在和分布情况。评估了观察者间的一致性，并对存在分歧的结节达成了共识。回顾性分析了甲状腺切除术标本的外科病理结果，以确定砂粒体和营养不良/基质钙化以及嗜酸性/粘性胶状物的存在和分布。比较了超声和组织病理学评分，并计算了与观察一致性水平相对应的频率和百分比。
两名放射科医生对所有类别回声灶的存在和分布的超声评估的观察者间一致性为 53%至 100%。所有结节均存在点状回声灶，27%存在大钙化灶。15 个结节的组织病理学检查显示，只有 4 个（27%）有砂粒体钙化，9 个（60%）有基质钙化，8 个（53%）有粘性胶状物。
基于美国放射学院甲状腺影像报告和数据系统（ACR TI-RADS），恶性儿童甲状腺结节中可检测到的超声回声灶可以可靠地进行分类，其中点状回声灶构成最常见的亚型。这些回声灶大多数情况下并不代表砂粒体钙化，相反，超过一半的有回声灶的恶性甲状腺结节含有基质钙化或粘性胶状物。
