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© 2008 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 27:1425-1430 • 0278-4297

Sonographic Differentiation of Thyroid Nodules With Eggshell Calcifications

Byung Moon Kim, MD, Min Jung Kim, MD, Eun-Kyung Kim, MD, Jin Young Kwak, MD, Soon Won Hong, MD, Eun Ju Son, MD and Ki Hwang Kim, MD

Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea (B.M.K.); and Department of Radiology, Research Institute of Radiological Science (M.J.K., E.-K.K., J.Y.K., E.J.S., K.H.K.), and Department of Pathology (S.W.H.), Yonsei University Health System, Seoul, Korea.

Address correspondence to Min Jung Kim, MD, Department of Radiology, Yonsei University Health System, 134 Shinchon-dong, Seodaemun-ku, Seoul 120-752, Korea. E-mail: mines{at}yuhs.ac

Objective. The purpose of this study was to assess the role of known suspicious sonographic findings and to find other additional sonographic findings to differentiate benign and malignant thyroid nodules with "eggshell" calcifications. Methods. Our Institutional Review Board approved this retrospective study, and informed consent was not required. We reviewed sonographic findings of thyroid nodules in 795 patients who underwent thyroid surgery in our institution between August 2006 and February 2007. Ninety-three thyroid nodules with eggshell calcifications in 92 patients were included in this study. Each lesion was evaluated for known suspicious sonographic criteria, including marked hypoechogenicity, irregular or microlobulated margins, and a taller-than-wide shape, as well as 2 additional sonographic findings: a hypoechoic halo and disruption of eggshell calcifications (halo and disrupted calcification rim). The sensitivity and specificity based on the sonographic criteria were calculated and compared among the 2 types of criteria. Results. Among the 93 thyroid nodules, 59 were malignant and 34 were benign. The halo and disrupted calcification rim showed higher sensitivity (62.7% and 76.3%, respectively) than any of the known suspicious sonographic criteria (40.7%, 35.6%, and 55.9%). The combination of both the halo and the disrupted calcification rim showed significantly higher sensitivity (93.2%) than the combination of the known suspicious sonographic criteria (78%; P < .05), although both had the same specificity (64.7%). Conclusions. In thyroid nodules with eggshell calcifications but no other calcifications, the findings of a peripheral halo and disruption of the eggshell calcifications may be more useful sonographic predictors of malignancy than hypoechogenicity, microlobulated margins, and a taller-than-wide shape.

Key Words: calcifications • sonography • thyroid

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Copyright © 2008 by the American Institute of Ultrasound in Medicine.