{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T06:24:02Z","timestamp":1777875842456,"version":"3.51.4"},"reference-count":31,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2021,10,1]],"date-time":"2021-10-01T00:00:00Z","timestamp":1633046400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Thyroid\u00ae"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The American Thyroid Association Sonographic Pattern System (ATASPS) depicts five levels of suspicion for malignancy based on the sonographic appearance of a thyroid nodule. However, 3\u201337% of nodules are non-classifiable when the combination of grayscale findings is not depicted by the ATASPS. The only calcifications included in the ATASPS are in solid hypoechoic high suspicion (HS) nodules and include both microcalcifications and peripheral interrupted calcifications with soft tissue extrusion. Non-hypoechoic nodules with these and other calcification patterns, which we defined as non-high suspicion calcifications (NHSC), are not classifiable by ATASPS. We assessed the effect of assigning an ATASPS risk level to nodules with NHSC based on analysis of their other grayscale features.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A retrospective review of 728 consecutively biopsied nodules was performed. Nodules were classified by ATASPS as HS, intermediate suspicion (IS), low suspicion (LS), or very low suspicion (VLS); other nodules with patterns not described by ATASPS were non-classifiable (NC). If NC was due to NHSC, the nodule was assigned an ATASPS by analysis of grayscale features alone. Cytology and pathology results were correlated with assigned ATASPS level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A NC pattern was observed in 144 of the 728 nodules (20%). Of these, 101\/144 (70%) had NHSC and the assigned ATASPS was IS (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200918), LS (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200962) and VLS (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200921). The distribution of cytology diagnoses within this group was similar to classifiable nodules (IS\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.13, LS\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.55, VLS\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.44). The majority of NHSC (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200992, 91%) were macrocalcifications (large central or linear dystrophic calcifications); however, 9 LS pattern nodules had punctate echogenic foci, possibly representing microcalcifcations, with an estimated cancer prevalence of 19% (vs. 10% for total LS group,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.24). The remaining NC nodules (43\/144, 30%) included solid nodules with heterogeneous echogenicity (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200930) or presence of a complete circumferential rim calcification, limiting further sonographic assessment (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200913). Malignancy was identified in 11 out of 43 (26%) of these [9\/30 (30%) heterogeneous solid and 2\/13 (15%) with complete rim calcifications].\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Macrocalcifications accounted for the majority of NHSC and these did not alter the expected ATASPS malignancy risk based on grayscale features.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/thy.2021.0140","type":"journal-article","created":{"date-parts":[[2021,7,27]],"date-time":"2021-07-27T13:05:08Z","timestamp":1627391108000},"page":"1542-1548","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":9,"title":["Macrocalcifications Do Not Alter Malignancy Risk Within the American Thyroid Association Sonographic Pattern System When Present in Non-High Suspicion Thyroid Nodules"],"prefix":"10.1177","volume":"31","author":[{"given":"Kristen","family":"Kobaly","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline S.","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jill E.","family":"Langer","sequence":"additional","affiliation":[{"name":"Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan J.","family":"Mandel","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,10,18]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2013.07.006"},{"key":"e_1_3_4_3_2","unstructured":"Howlader N Noone AM Krapcho M Miller D Brest A Yu M Ruhl J Tatalovich Z Mariotto A Lewis DR Chen HS Feuer EJ Cronin KA (eds) 1975\u20132020 SEER Cancer Statistics Review. National Cancer Institute Bethesda MD. Available at https:\/\/seer.cancer.gov\/statfacts\/html\/thyro.html (accessed March14 2021)."},{"key":"e_1_3_4_4_2","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1111\/cen.12987","article-title":"Subcategorization of atypia of undetermined significance\/follicular lesion of undetermined significance (AUS\/FLUS): a study applying Thyroid Imaging Reporting and Data System (TIRADS)","volume":"85","author":"Yoon JH","year":"2016","unstructured":"Yoon JH, , Kwon HJ, , Kim EK, , Moon HJ, , Kwak JY. 2016. Subcategorization of atypia of undetermined significance\/follicular lesion of undetermined significance (AUS\/FLUS): a study applying Thyroid Imaging Reporting and Data System (TIRADS). Clin Endocrinol (Oxf), 85:275\u2013282.","journal-title":"Clin Endocrinol (Oxf)"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2018171074"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2018.0085"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.17.18822"},{"key":"e_1_3_4_8_2","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.7863\/ultra.15.09048","article-title":"Sonographic-pathologic correlation for punctate echogenic reflectors in papillary thyroid carcinoma: what are they?","volume":"35","author":"Tahvildari AM","year":"2016","unstructured":"Tahvildari AM, , Pan L, , Kong CS, , Desser T. 2016. Sonographic-pathologic correlation for punctate echogenic reflectors in papillary thyroid carcinoma: what are they?. 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Prospective validation of ATA and ETA sonographic pattern risk of thyroid nodules selected for FNAC. J Clin Endocrinol Metab, 103:2362\u20132368.","journal-title":"J Clin Endocrinol Metab"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2016.0555"},{"key":"e_1_3_4_16_2","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1007\/s12020-019-01843-x","article-title":"Comparison among TIRADS (ACR TI-RADS and KWAK-TI-RADS) and 2015 ATA Guidelines in the diagnostic efficiency of thyroid nodules","volume":"64","author":"Gao L","year":"2019","unstructured":"Gao L, , Xi X, , Jiang Y, , Yang X, , Wang Y, , Zhu S, , Lai X, , Zhang X, , Zhao R, , Zhang B. 2019. Comparison among TIRADS (ACR TI-RADS and KWAK-TI-RADS) and 2015 ATA Guidelines in the diagnostic efficiency of thyroid nodules. Endocrine, 64:90\u201396.","journal-title":"Endocrine"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2015150056"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2017.01.046"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.3348\/kjr.2016.17.3.370"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1159\/000478927"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-010-0827-3"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2473070944"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2015.0460"},{"key":"e_1_3_4_24_2","doi-asserted-by":"crossref","first-page":"605","DOI":"10.3348\/kjr.2019.0523","article-title":"Thyroid nodules with isolated macrocalcifications: malignancy risk of isolated macrocalcifications and postoperative risk stratification of malignant tumors manifesting as isolated macrocalcifications","volume":"21","author":"Gwon HY","year":"2020","unstructured":"Gwon HY, , Na DG, , Noh BJ, , Paik W, , Yoon SJ, , Choi SJ, , Shin DR. 2020. Thyroid nodules with isolated macrocalcifications: malignancy risk of isolated macrocalcifications and postoperative risk stratification of malignant tumors manifesting as isolated macrocalcifications. Korean J Radiol, 21:605\u2013613.","journal-title":"Korean J Radiol"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2019182128"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-13-0995"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2014.0353"},{"key":"e_1_3_4_28_2","doi-asserted-by":"crossref","first-page":"672","DOI":"10.2214\/AJR.18.20799","article-title":"Peripheral thyroid nodule calcifications on sonography: evaluation of malignant potential","volume":"213","author":"Malhi HS","year":"2019","unstructured":"Malhi HS, , Velez E, , Kazmierski B, , Gulati M, , Deurdulian C, , Cen SY, , Grant EG. 2019. Peripheral thyroid nodule calcifications on sonography: evaluation of malignant potential. 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