Results of a Preliminary Study Correlating Calcification Detected By Thyroid Ultrasound with Digital Radiography and Histopathology

Program: Abstracts - Orals, Poster Previews, and Posters
Session: SAT 270-310-Thyroid Neoplasia (posters)
Saturday, April 2, 2016: 1:15 PM-3:15 PM
Exhibit/Poster Hall (BCEC)

Poster Board SAT 275
Poorani Nallam Goundan*, Anita Deshpande, Sandra Cerda, Boris N Bloch and Stephanie L Lee
Boston Medical Center, Boston, MA
The decision to work up a thyroid nodule is heavily dependent on ultrasound characteristics of the nodule. High risk characteristics include microcalcification, hypoechogenic appearance, taller than wide configuration, irregular margins, macrocalcification (especially discontinuous rim calcification), extra thyroidal extension and the presence of abnormal lymphadenopathy. In clinical practice is it difficult to distinguish microcalcifications with other non-shadowing hyperechoic foci. Thus, in practice, microcalcifications have a variable positive predictive value (41.8 to 94.2%), and a low sensitivity (26.1 to 59.1%). There is very little data available characterizing microcalcifications and other hyper echogenic foci observed on ultrasound including comparison with other well-established imaging modalities such as digital radiography used for studying microcalcification in breast. We present the results of a preliminary study comparing ultrasound findings, digital x-ray and histopathology of 10 benign and 10 malignant thyroid nodules following thyroidectomy. Tissue blocks from prior thyroidectomies were selected and digital radiographs were obtained of the samples. Ultrasound images of the thyroid gland and the concerning nodule were reviewed and the results were compared with the radiographic images. Among the significant findings include the appearance of multiple different forms of calcification including punctate, rounded, linear and coarse calcifications and calcifications with specific shapes.  We have identified on digital radiography a novel form of calcification in the classical variant of papillary thyroid carcinoma.  This structure is a circular or oval rim of calcification with a central translucency that may correspond to hyaline globules surrounded by a ring of calcium on histopathology. There were also calcifications seen on digital radiographs that were not reported on the corresponding ultrasound. These preliminary findings need to be followed up with larger studies. The study does however highlight our lack in ability to reliably detect multiple different forms of microcalcification on ultrasound and a gap in our understanding of the histologic correlation of the various types of calcification.

Haugen BR, Alexander EK, Bible KC, Doherty GM, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2015 [ahead of print] doi:10.1089/thy.2015.0020Moon WJ, Jung SL, Lee JH, et al. Benign and malignant thyroid nodules: US differentiation – multicenter retrospective study. Radiology 2008;247:762-770

Nothing to Disclose: PNG, AD, SC, BNB, SLL

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