Diffuse Microcalcifications Only of the Thyroid Gland Seen on Ultrasound: Clinical Implication and Diagnostic Approach

See author's response to this letter here.


Letter to the Editor

Eun Ju Ha, MD, Jeong Hyun Lee, MD, and Jung Hwan Baek, MD

Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center Korea

To the Editors:

We read the article by Yoon et al with great interest in the Annals of Surgical Oncology.[1] We have, however, some concerns about the methodologies employed in the evaluation of "diffuse microcalcifications only" on ultrasound (US) examination. The authors defined the "diffuse microcalcifications only" as localized or diffuse scattered microcalcifications without an accompanying mass in the thyroid. On the other hand, the authors stated that they tried to target at the area that was most densely concentrated with microcalcifications during the US-fine needle aspiration biopsy (FNAB).[1,2] However, based on our experience, we feel that this area may be a primary focus of papillary thyroid cancer.

We experienced similar cases of thyroid cancer which were initially considered as diffuse microcalcifications only lesions in thyroid US. However, most of them were presented as a mass in the surgical specimen. From the radiology-pathology discussions of the issues, we concluded that aggregated or clustered microcalcifications in the background of diffuse microcalcifications on US examinations were a possible primary focus of papillary thyroid cancer. Indeed, most of the cases additionally showed focal parenchymal changes in terms of echogenicity around the aggregated or clustered microcalcifications. In this respect, we are curious that the surgical results of densely concentrated microcalcifications in their study were primary focus of papillary thyroid carcinoma or simple calcifications. In summary, the authors need to reconsider the definition of "diffuse microcalcifications only" by reevaluation of the pathologic results and US findings of their patients. If the densely concentrated calcifications are a primary focus of papillary thyroid carcinoma, targeting at this area may increase the performance of US-FNAB.

References

1. Yoon JH, Kim EK, Son EJ, et al. Diffuse microcalcifications only of the thyroid gland seen on ultrasound: clinical implication and diagnostic approach. Ann Surg Oncol 2011; 18(10):2899-906.

2. Kwak JY, Kim EK, Son EJ, et al. Papillary thyroid carcinoma manifested solely as microcalcifications on sonography. AJR Am J Roentgenol 2007; 189(1):227-31.


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