Clinical significance of micro- and macrocalcifications in thyroid nodules (based on multiparametric ultrasound and morphological verification)

Background. Calcifications are a key ultrasound feature in the risk stratification of thyroid nodules, but their interpretation remains debated due to ambiguous prognostic significance depending on the morphological type.

Objective. To assess the prognostic significance of micro- and macrocalcifications in the differential diagnosis of thyroid nodules of various histological types (colloid goiter, adenoma, carcinoma) based on a comparison of multiparametric ultrasound (US) data and pathomorphological examination.

Materials and methods. A retrospective cohort study included 243 patients with thyroid nodules (102 – colloid goiter, 62 – adenoma, 79 – carcinoma). All patients underwent preoperative multiparametric US (B-mode, color Doppler mapping) with classification of calcifications into micro- (<1 mm) and macrocalcifications (≥1 mm). Correlation analysis (Kendall’s τ), ROC analysis, and logistic regression were performed.

Results. Calcifications were detected in 56.8 % of patients. Microcalcifications were significantly more frequent in thyroid carcinomas (45.7 % vs 1.6 % in goiter; p<0.001) and significantly correlated with high-risk TI-RADS categories (τ=0.327; p=0.020). Macrocalcifications predominated in colloid goiter (48.2 % vs. 24.3 % in carcinoma; p<0.001) and showed no significant correlation with TI-RADS category in malignant nodules (p=0.970). In adenomas, the «calcifications» sign did not reach statistical significance (p=0.465). ROC analysis confirmed high diagnostic value of the sign for differentiating colloid goiter and carcinoma (AUC=0.956) and moderate value for adenomas and carcinoma (AUC=0.860).

Conclusions. Microcalcifications are a highly specific predictor of malignancy and require mandatory fine-needle aspiration biopsy. Macrocalcifications are predominantly associated with benign processes and have no independent prognostic value. In adenomas, calcifications should be interpreted only in conjunction with other ultrasound features.

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