# Malignant risk of thyroid nodules with isolated macrocalcifications – A study based on surgery results

## TL;DR

This study finds that thyroid nodules with isolated macrocalcifications have a moderate risk of being cancerous, with specific ultrasound features indicating higher malignancy risk.

## Contribution

The study identifies focal disruption of the anterior margin of isolated macrocalcifications as a novel predictor of thyroid nodule malignancy.

## Key findings

- Thyroid nodules with isolated macrocalcifications had a 30.43% malignancy risk.
- Focal disruption of the anterior margin of macrocalcifications was significantly linked to malignancy.
- Nodule size did not affect malignancy or lymph node metastasis risk in these cases.

## Abstract

•Focal disruption of the anterior margin of IMC was significantly associated with malignancy.•Both small and large thyroid nodules with IMC had a lower intermediate risk of malignancy.•Interruption of IMC is more often seen in malignant nodules.

Focal disruption of the anterior margin of IMC was significantly associated with malignancy.

Both small and large thyroid nodules with IMC had a lower intermediate risk of malignancy.

Interruption of IMC is more often seen in malignant nodules.

To determine the malignancy risk of thyroid nodules with Isolated Macrocalcifications (IMC) based on surgical results and evaluate the postoperative risk of malignant nodules with IMC.

A total of 46 thyroid nodules with IMC were enrolled from 3680 consecutive patients who underwent thyroidectomy between August 2018 and September 2023. The malignancy risk of IMC nodules, postoperative risk of malignant nodules, and whether the ultrasonic features of IMC (smooth, lobulated, or focal disruption of the anterior margin) were associated with malignancy were investigated. The nodules were further divided into three groups (group A, maximum diameter < 10 mm; group B, maximum diameter of 10‒14 mm and group C, maximum diameter ≥ 15 mm). Differences in malignancy and Lymph Node Metastasis (LNM) risks were also evaluated among the three groups.

The malignancy risk of the IMC nodules was 30.43% (14/46). Four patients developed LNM. Eight nodules were staged as T1aN0M0 and low-risk, whereas six nodules were staged as T1bN1aM0 and intermediate-risk. Focal disruption of the anterior margin of IMC was significantly associated with malignancy. Malignant and LNM risk showed no differences among nodules with different sizes.

IMC nodules with different sizes had a lower intermediate risk of malignancy and exhibited the same aggressive behavior. The cutoff value of these nodules for further Fine Needle Aspiration (FNA) warranted further investigation. Interruption of IMC was more often seen in malignant nodules, and more attention should be paid to these nodules.