J Korean Soc Radiol.  2011 Jun;64(6):531-535. 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

• Seo YN
• Kim DW

• KMID: 1443501
• DOI: http://doi.org/10.3348/jksr.2011.64.6.531

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.

MeSH Terms

Biopsy, Fine-Needle
Humans
Hyperplasia
Sensitivity and Specificity
Thyroid Gland
Thyroid Neoplasms
Thyroid Nodule

Figure

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  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.

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  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.

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