ArticleEndocrine2025
Rethinking macrocalcifications in thyroid nodules: a critical evaluation of the ACR TI-RADS scoring system and its impact on case selection for biopsy.
Article in Endocrine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThyroid nodules affect up to 50% of adults, although only 7–15% are malignant. However, the role of macrocalcifications in malignancy remains unclear. This study reassesses the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) framework by evaluating how excluding macrocalcifications from the scoring system impacts unnecessary biopsies and missed malignancies.
methodsThis single-center retrospective study evaluated thyroid nodules using cytological evaluation by fine-needle aspiration biopsy (FNAB) between 2012 and 2019. The clinical and sonographic characteristics of the nodules with and without macrocalcifications were compared. Additionally, the ACR TI-RADS classification was modified by removing the points assigned for macrocalcifications to assess their impact on the biopsy recommendations.
resultsWe analyzed 287 thyroid nodules from 264 patients (median age 58.6 years, IQR 47.9–68.3; 84.8% female). Macrocalcifications were present in 41 nodules (14.3%) from 37 patients (14.0%). The malignancy rate did not differ significantly between nodules with versus without macrocalcifications (12.2% vs. 16.7%, P = 0.056). Stratified by ACR TI-RADS categories, nodules without macrocalcifications had significantly higher malignancy rates (P < 0.001). Multivariate analysis (adjusting for sex, age, nodule size, and TI-RADS categories) showed no association between macrocalcifications and malignant cytology (OR 0.949, 95% CI 0.836–1.078, P = 0.622). After removing macrocalcification points, the modified TI-RADS classification reduced FNAB indications by 5.6% (n = 16) without missing any malignancies.
conclusionsExcluding macrocalcifications from ACR TI-RADS scoring could reduce unnecessary biopsies without missing malignant nodules.
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