Patterns of Sonographically Detectable Echogenic Foci in Pediatric Thyroid Carcinoma with Corresponding Histopathology: An Observational Study

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Fig 1.
Typical sonography samples of categories of ACR TI-RADS echogenic foci and types of distribution. A, Macrocalcifications with posterior acoustic shadowing (arrow) in a left-sided 4.7-cm thyroid nodule in an 18-year-old girl with histologically proved papillary thyroid carcinoma. The distribution is classified as sparse. B, Punctate echogenic foci with small, 0.7-mm comet-tail artifacts in the same patient as in A. The distribution is diffuse. Pathology revealed stromal calcifications and sticky colloid, both sparsely distributed, and the absence of psammomatous calcifications. C, Punctate echogenic foci with no posterior artifacts (arrows) in a left-sided 3.5-cm thyroid nodule in a 12-year-old girl with a histologically proved follicular variant of papillary thyroid carcinoma. The distribution is sparse. Histology revealed no corresponding calcifications or sticky colloid.
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Fig 2.
Examples of psammomatous (thick arrows) and stromal calcifications (thin arrows) from a thyroidectomy specimen of a 16-year-old girl showing papillary thyroid carcinoma in a background of lymphocytic thyroiditis (hematoxylin-eosin stain, 20×).

Table 1:

Observed agreement between radiologists for presence and distribution of thyroid nodule echogenic foci^{^a}

US Classification	Agreement for Presence or Absence (No.) (%)	Agreement for Distribution (No.) (%)
Punctate echogenic foci	15/15 (100%)	14/15 (93%)
Echogenic foci with large comet-tail artifacts	11/15 (73%)	11/15 (73%)
Macrocalcifications	8/15 (53%)	8/15 (53%)
Peripheral rim calcifications	15/15 (100%)	15/15 (100%)

Table 2:

Thyroid nodule pathology as a function of US patterns^{^a}

Pathology Finding (No.)	Punctate Echogenic Foci (No.)		Macrocalcifications (No.)
Pathology Finding (No.)	Present (n = 15)	Absent (n = 0)	Present (n = 4)	Absent (n = 11)
Stromal calcification present (9)	9 (60%)	0 (0%)	4 (100%)	5 (45%)
Stromal calcification absent (6)	6 (40%)	0 (0%)	0 (0%)	6 (55%)
Psammomatous calcification present (4)	4 (27%)	0 (0%)	1 (25%)	3 (27%)
Psammomatous calcification absent (11)	11 (73%)	0 (0%)	3 (75%)	8 (73%)
Sticky colloid present (8)	8 (53%)	0 (0%)	3 (75%)	5 (45%)
Sticky colloid absent (7)	7 (47%)	0 (0%)	1 (25%)	6 (55%)