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Published on: April 17, 2013
The sonographer's and pathologist's perspective of echogenic microfoci in papillary thyroid carcinoma
Adile Begüm Bahçecioğlu1, Alptekin Gürsoy2, Serpil Dizbay Sak3
11Department of Endocrinology and Metabolism, Ankara University, School of Medicine, Ankara, Turkey.
Objective:
Punctate echogenic foci (PEF)/microcalcifications are thought to represent psammoma bodies (PB) in histopathology. However, there are few and contradictory data on this. Different types of sonographic echogenic microfoci (EMF) are seen in papillary thyroid carcinoma (PTC), and their histopathological equivalents are not clearly known. There is also conflicting data on the interobserver agreement between the sonographers on EMF.
Methods:
We prospectively collected US video records of PTC nodules with and without EMF in two large thyroid centers. All video recordings were independently interpreted by three blinded, experienced sonographers. EMF were classified as true microcalcifications (punctate echogenic foci (PEF) ≤1 mm long), linear microechogenities (>1 mm long, posterior acoustic enhancement of the back wall of a microcystic area), comet-tail artifacts/reverberations or linear microechogenities with comet-tail artifacts/reverberations, non-shadowing coarse echogenic foci (>1 mm nonlinear areas) and unclassifiable. Histopathological evaluation was performed by two blinded, qualified pathologists.
Results:
A total of 114 malignant nodules were included. The average Cohen's kappa (κ) of three sonographers for the EMF presence was 0.775, indicating substantial agreement. A substantial agreement for PEF with 0.658 κ, only fair agreement for other types of EMF with 0.052 to 0.296 κ were detected. EMF were significantly associated with PB and papillae. PEF had an evident relationship with PB in multivariate analysis. There was a strong positive correlation between the amount of PEF and PB (r = 0.634, P < 0.001).
Conclusions:
PEF in PTC mainly correspond to PB on histopathology. Although observation of EMF varies among sonographers, this inconsistency can be reduced by classifying EMF into subgroups and keeping the term 'PEF' only for true microcalcifications.
Insights
Punctate echogenic foci (PEF) in papillary thyroid carcinoma (PTC) ultrasound correlate with psammoma bodies (PB) on pathology. Standardizing PEF classification improves diagnostic consistency for these microcalcifications.
Area of Science:
- Radiology
- Pathology
- Oncology
Background:
- Punctate echogenic foci (PEF) on ultrasound are often presumed to be psammoma bodies (PB) in histopathology.
- However, data are limited and conflicting regarding the precise histopathological equivalents of various sonographic echogenic microfoci (EMF) in papillary thyroid carcinoma (PTC).
- Interobserver agreement among sonographers for EMF detection and classification also remains unclear.
Purpose of the Study:
- To investigate the histopathological correlation of different types of echogenic microfoci (EMF) observed in papillary thyroid carcinoma (PTC) nodules.
- To assess interobserver agreement among sonographers for the detection and classification of EMF in PTC.
- To determine the relationship between sonographically identified EMF and psammoma bodies (PB) on histopathology.
Main Methods:
- Prospective collection of ultrasound video records of PTC nodules from two major thyroid centers.
- Independent blinded interpretation of EMF by three experienced sonographers, with classification into predefined categories.
- Histopathological evaluation of nodules by two blinded pathologists to identify psammoma bodies (PB) and other relevant features.
Main Results:
- Substantial interobserver agreement (Cohen's kappa = 0.775) was found for the overall presence of EMF in PTC nodules.
- Punctate echogenic foci (PEF) showed substantial agreement (kappa = 0.658) and a strong positive correlation (r = 0.634) with psammoma bodies (PB) on histopathology.
- Other EMF types exhibited only fair agreement (kappa = 0.052–0.296), suggesting heterogeneity in their histopathological basis.
Conclusions:
- Punctate echogenic foci (PEF) observed on ultrasound in PTC are predominantly indicative of psammoma bodies (PB) in histopathology.
- While sonographic observation of EMF can vary, classifying EMF into subgroups, specifically designating 'PEF' for true microcalcifications, can enhance diagnostic consistency.
- Standardized classification of EMF may improve the reliability of ultrasound in evaluating PTC.
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