Correlation between ultrasound calcification patterns, and clinicopathological factors and recurrence risk in...

The incidence and mortality rates of differentiated thyroid cancer (DTC), particularly papillary thyroid carcinoma (PTC), continue to show a gradual increase worldwide. Despite advances in diagnostic imaging and molecular characterization, the role of specific ultrasound features, such as calcification patterns, in the diagnostic and prognostic stratification of PTC remains relatively underexplored and poorly characterized in the literature. This study aims to investigate the association between different ultrasound calcification patterns and key clinicopathological factors. Furthermore, we seek to evaluate the predictive value of these calcification patterns not only in improving preoperative risk stratification but also in estimating the risk of disease recurrence, with the goal of enhancing individualized management strategies for PTC patients.

The clinicopathological data of 1,182 PTC patients diagnosed at the Tianjin Medical University Cancer Institute and Hospital (from January 2020 to December 2021) were collected. According to the preoperative ultrasound calcification morphology within thyroid nodules, they were divided into non-calcified nodules​ and calcification nodules​, and a correlation analysis was conducted with the clinicopathological factors, hematological indicators, and recurrence risk.

Calcifications were detected in 75.0% of the patient cohort, of which microcalcifications were the predominant subtype, and were observed in 63.3% of cases. Notably, the risk of tumor recurrence was significantly higher in the patients with the microcalcification type (χ²=69.009, P<0.001) than those with the non-calcified/mixed types. The logistic regression analysis further showed that the patients with microcalcifications had a 2.0-fold increased risk of the tumor diameter exceeding 1 cm, while those with mixed calcifications had a 3.1-fold increased risk of the tumor diameter exceeding 1 cm. Further, the patients with microcalcifications had a 1.6-fold increased risk of central lymph node metastasis and a 4.1-fold increased risk of lateral lymph node metastasis.

Our analysis revealed that ultrasound-detected calcification patterns are significantly associated with tumor aggressiveness and patient prognosis in PTC. Microcalcifications emerge as a strong and independent predictor of lymph node metastasis and disease recurrence risk. Mixed calcification patterns correlate more with the extent of primary tumor growth, possibly relating to larger tumor size. These findings highlight the clinical value of preoperative calcification pattern analysis, supporting its use as a non-invasive imaging biomarker for risk stratification and surgical decisions. We advocate integrating calcification pattern evaluation into standard PTC ultrasound reporting to improve treatment personalization and prediction of long-term outcomes.