Ioakim Stamatina, Constantinides Vasilis, Toumba Meropi, Lyssiotis Theodoros, Kyriacou Angelos
School of Medicine, University of Milan, Milan, Italy.
Centre of Endocrine Surgery, Evangelistria Medical Centre, Nicosia, Cyprus.
Endocrinol Diabetes Metab Case Rep. 2021 Sep 1;2021. doi: 10.1530/EDM-21-0072.
Our objective is to demonstrate the importance of considering microcalcifications even without evidence of nodules as a potential sign of malignancy. Current guidelines, such as those of the British Thyroid Association, acknowledge the clinical significance of microcalcifications only when found within nodules. In this case, they are considered a suspicious feature, classifying the nodules as U5 (i.e. high risk) where fine-needle aspiration biopsy (FNAB) is warranted, following the high likelihood of cancer in these nodules. In addition, there is a dearth of evidence of ultrasound scan (USS) detection of microcalcifications in the thyroid gland outside of nodules, along with their associated clinical implications. Yet, this clinical manifestation is not so infrequent considering that we do encounter patients in the clinic showing these findings upon ultrasound examination. Three patients who presented to our clinic with thyroid-related symptoms were shown to have areas of microcalcifications without a nodule upon sonographic evaluation of their thyroid gland. These incidentally detected hyperechoic foci were later confirmed to correspond to areas of papillary thyroid carcinoma (PTC) on histopathological examination of resected tissue following thyroidectomy. Four more cases were identified with sonographic evidence of microcalcifications without nodules and given their clinical and other sonographic characteristics were managed with active surveillance instead.
Echogenic foci known as microcalcifications may be visible without apparent association to nodular structures. Microcalcifications without nodules may not be an infrequent finding. Microcalcifications are frequently indicative of malignancy within the thyroid gland even without a clearly delineated nodule. Empirically, the usual guidelines for the management of thyroid nodules can be applied to the management of microcalcifications not confined to a nodule, but such a finding per se should be classified as a 'high-risk' sign.
我们的目的是证明即使在没有结节证据的情况下，将微钙化视为恶性肿瘤潜在迹象的重要性。当前的指南，如英国甲状腺协会的指南，仅在结节内发现微钙化时才承认其临床意义。在这种情况下，它们被视为可疑特征，将结节分类为U5（即高风险），鉴于这些结节癌症可能性高，需要进行细针穿刺活检（FNAB）。此外，缺乏关于甲状腺结节外超声扫描（USS）检测微钙化及其相关临床意义的证据。然而，考虑到我们在临床上确实遇到超声检查显示这些发现的患者，这种临床表现并不罕见。三名因甲状腺相关症状前来就诊的患者，在对其甲状腺进行超声评估时显示有微钙化区域但无结节。这些偶然发现的高回声灶在甲状腺切除术后切除组织的组织病理学检查中后来被证实对应于甲状腺乳头状癌（PTC）区域。另外还发现了四例有微钙化但无结节的超声证据，鉴于其临床和其他超声特征，对其进行了积极监测。
被称为微钙化的回声灶可能在与结节结构无明显关联的情况下可见。无结节的微钙化可能并非罕见发现。即使没有清晰界定的结节，微钙化在甲状腺内也常提示恶性肿瘤。根据经验，甲状腺结节管理的通常指南可应用于不限于结节的微钙化管理，但这种发现本身应归类为“高风险”体征。
