Int J Thyroidol.  2023 Nov;16(2):195-199. 10.11106/ijt.2023.16.2.195.

Strategies for Safe and Effective Core Needle Biopsy of Thyroid Nodules with Macrocalcification

• Shin JH

• KMID: 2548748
• DOI: http://doi.org/10.11106/ijt.2023.16.2.195

Abstract

The case report aimed to evaluate feasibility of hydrodissection-assisted core needle biopsy (CNB) of thyroid nodules with macrocalcification, and utility of mammography to confirm calcification in CNB specimen. Two patients with entirely calcified nodules and one with rim macrocalcification underwent CNB. All three patients underwent successful CNB without complications, and mammography confirmation of CNB specimen. On mammography, traces of calcifications were conspicuous in all cases. First-line CNB is recommended for entirely calcified nodules or thick rim macrocalcifications with prominent posterior acoustic shadowing, and operators should take advantage of the rapid confirmation of calcification on mammography for accurate CNB specimen acquisition.

Keyword

Biopsy; Mammography; Thyroid; Ultrasonography

Figure

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  Fig. 1 Anterolateral hydrodissection-assisted core needle biopsy (CNB) of entirely calcified nodule. (A) A 68-year-old female patient presented with an entirely calcified nodule (*) with dimension of 6×7×11 mm on the left side of the thyroid gland with prominent posterior acoustic shadowing. (B) Anterolateral hydrodissection was performed to create a safe margin (dotted lines). CCA: common carotid artery. (C) Two CNB specimens were acquired and underwent subsequent mammography magnification examination, which demonstrated clustered punctate calcifications (arrow). The normalized SI values of calcifications (arrow) were 2.1 and non-calcified portions were 1.5. The pathology confirmed it as adenomatous hyperplasia with microfollicular and macrofollicular proliferation.

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  Fig. 2 Pre-tracheal hydrodissection-assisted core needle biopsy (CNB) of entirely calcified nodule. (A) A 57-year-old female patient presented with an entirely calcified nodule (*) with dimension of 7×12×13 mm on the left side of the thyroid gland near the trachea. (B) Pre-tracheal hydrodissection was performed to create safe margin (dotted lines) between the trachea and the target nodule (*). (C) Two CNB specimen were acquired and underwent subsequent mammography magnification examination, which demonstrated a thick calcified line (arrow). The normalized SI values of calcification (arrow) was 2.2 and non-calcified portion was 1.4.

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  Fig. 3 Core needle biopsy (CNB) of a large isoechoic nodule with thick rim macrocalcification. (A) A 83-year-old female patient presented with a large isoechoic nodule (21×24×25 mm) on the left side of the thyroid with thick rim macrocalcification with prominent posterior acoustic shadowing. (B) Since macrocalcification had enough clearance from the left common carotid artery and trachea, hydrodissection was not performed. Trans-isthmic approach of CNB needle was performed. (C) The mammography demonstrated normalized SI of calcification (arrow) as 2.0, while non-calcified portion as 1.3. The pathology confirmed it as probable benign nodule with hyalinized stroma with calcification and focal area of macrofollicular proliferation.

Reference

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