Yonsei Med J.  2014 Mar;55(2):339-344.

Thyroid Nodules with Macrocalcification: Sonographic Findings Predictive of Malignancy

  • 1Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea. chrismd@hanmail.net
  • 2Department of Radiology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
  • 3Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea.
  • 4Department of Surgery, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea.


To analyze which sonographic features of thyroid nodules with macrocalcifications were predictable of thyroid malignancy.
We reviewed sonographic findings of 854 macrocalcified thyroid nodules in patients who underwent fine needle aspiration biopsy between December 2009 and January 2011. There were 171 non-diagnostic aspirations, 34 nodules with category 3, 4, 5 based on Bethesda system, which were not confirmed by surgery, and these nodules were excluded from the analysis. Sonographic characteristics of the macrocalcifications including its thickness, interruption, and existence of soft tissue rim outside the macrocalcification were analyzed. Other sonographic characteristics of nodules such as shape, margin, composition, echo pattern, vascularity, and underlying parenchymal echogenicity were also evaluated. The correlation of sonographic features with cytopathologic results and the diagnostic performance of sonographic features for the prediction of malignancy were analyzed.
Among 649 nodules, 179 (27.6%) nodules were malignant and 470 (72.4%) nodules were benign. Among the features of the macrocalcification, interruption, irregular thickness, or the presence of soft tissue outside calcification rim were associated with malignancy (p<0.001). A high sensitivity and negative predictive values for the prediction of malignancy was found in sonographic characteristics of irregular thickness (92.2% and 91.0%, respectively) and the presence of soft tissue (88.5% and 88.8%, respectively).
Sonographic characteristics of macrocalcification such as interruption, irregular thickness and the presence of soft tissue rim were associated with malignancy in thyroid nodules with macrocalcifications.


Sonography; papillary thyroid cancer; macrocalcification

MeSH Terms

Aspirations (Psychology)
Biopsy, Fine-Needle
Thyroid Gland*
Thyroid Nodule*


  • Fig. 1 US findings of malignant thyroid nodule with macrocalcification. Transverse US image in a 42-year-old woman shows a nodule with interrupted macrocalcification (white arrows), irregular thickness and soft tissue rim outside the calcification (black arrow) and the nodule was diagnosed as papillary thyroid carcinoma by fine needle aspiration cytology.

  • Fig. 2 US findings of benign thyroid nodule with macrocalcification. Transverse US image of a 54-year-old woman shows a nodule with macrocalcification (arrows) which has regular margin and regular thickness without interruption. The soft tissue rim outside of the macrocalcification was not visible and the nodule was diagnosed as adenomatous hyperplasia by fine needle aspiration biopsy.


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