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Seo and Kim: Comparative Study of US Features, US-guided Fine Needle Aspiration Cytology, and Pathology Results for Eggshell Calcified Thyroid Nodules
Head and Neck Radiology
Original Article

Journal of the Korean Society of Radiology 2011; 64(6): 531-535.

Published online: 30 June 2011

DOI: https://doi.org/10.3348/jksr.2011.64.6.531

Comparative Study of US Features, US-guided Fine Needle Aspiration Cytology, and Pathology Results for Eggshell Calcified Thyroid Nodules

Yoon Nae Seo, M.D.1, Dong Wook Kim, M.D.1

1Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Korea.

Address reprint requests to: Dong Wook Kim, M.D., Department of Radiology, Busan Paik Hospital, Inje University College of Medicine 633-165 Gaegeum-dong, Busanjin-gu, Busan 614-735, Korea. Tel. 82-51-890-6549, Fax. 82-51-896-1065, dwultra@lycos.co.kr

Received 24 February 2011       Accepted 5 April 2011

Copyright © 2011 The Korean Society of Radiology

Abstract

Purpose

The aim of this study was to investigate ultrasound (US) findings of eggshell calcified thyroid nodules associated with thyroid malignancy and the diagnostic usefulness for US-guided fine-needle aspiration cytology (US-FNAC) of eggshell calcified thyroid nodules.

Materials and Methods

We analyzed 36 eggshell calcified thyroid nodules in 35 patients who underwent thyroid US and US-FNAC from January to December of 2009. We compared the US findings and US-FNAC results with the pathologic results confirmed by surgery.

Results

Twenty eggshell calcified nodules were surgically removed in 19 patients, from which 8 papillary thyroid carcinomas and 12 hyperplasia nodules were confirmed. The sensitivity, specificity, positive, and negative predictive values, as well as accuracy for US diagnosis and US-FNAC of eggshell calcified nodules were 100% and 20%, 25% and 100%, 43.8% and 100%, 100% and 63.6%, and 55% and 66.7%, respectively.

Conclusion

The results of this study indicate that thick peripheral hypoechoic rim and thickening of eggshell calcified nodules are significantly related to malignancy, but focal disruption of eggshell calcification is not.

Keywords: Thyroid, Thyroid Nodule, Biopsy, Fine-Needle, Ultrasonography

Figures and Tables

Fig. 1

Schematic drawings of eggshell calcified nodules (Inner thick rim and outer thin rim are an eggshell calcification and a hypoechoic rim, respectively).

A. A simple eggshell calcification. B. A disrupted eggshell calcification. C. A thickening of eggshell calcification. D. An eggshell calcified nodule with peripheral thick hypoechoic rim.
jksr-64-531-g001
Fig. 2

A. A simple eggshell calcification in a 50-year-old woman. Transverse sonogram shows a simple eggshell calcified nodule in right thyroid lobe, and it was pathologically confirmed as nodular hyperplasia because of coexisting thyroid malignancy although it had been cytologically diagnosed as benign after US-FNAC.

B. A disrupted eggshell calcification in a 40-year-old woman. Transverse sonogram shows an eggshell calcified nodule with focal defect (arrow) in right thyroid lobe, and it was surgically resected because of suspicious follicular neoplasm in US-FNAC (nodular hyperplasia by pathology).
C. A peripheral thick hypoechoic rim and disrupted eggshell in a 45-year-old woman. Transverse sonogram shows an eggshell calcified nodule with peripheral thick hypoechoic rim (arrows) and disrupted eggshell in left thyroid lobe, and it was pathologically confirmed as papillary thyroid carcinoma because of suspicious cytology.
jksr-64-531-g002
Table 1

Incidence and Pathology Results on the US Features of Eggshell Calcified Thyroid Nodules

Note.─ A-disrupted eggshell calcification, B-peripheral thick hypoechoic rim, C-thickening of eggshell
jksr-64-531-i001

Note.─ A-disrupted eggshell calcification, B-peripheral thick hypoechoic rim, C-thickening of eggshell

Table 2

Cytopathology Results on the Initial US-FNAC of Eggshell Calcified Thyroid Nodules

jksr-64-531-i002
Table 3

Diagnostic Index of US Diagnosis and US-FNAC for Eggshell Calcified Thyroid Nodules

jksr-64-531-i003

Note.─ *-when eggshell calcified nodules showing one of three malignant US features are considered malignancy.

Table 4

Diagnostic Index According to Individual US Features and Their Combination in Eggshell Calcified Thyroid Nodules

jksr-64-531-i004

Note.─ A-disrupted eggshell calcification, B-peripheral thick hypoechoic rim, C-thickening of eggshell calcification, PPV-positive predictive value, NPV-negative predictive value.

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