[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-357358-105":59,"doc-detail-357358-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","ultrasonographic-punctate-echogenic-foci-in-metastatic-lymph-nodes-and-their-presence-in-primary-thyroid-cancer","Ultrasonographic punctate echogenic foci in metastatic lymph nodes and their presence in primary thyroid cancer","","Ultrasonographic punctate echogenic foci (PEF), representing microcalcifications, require careful origin assessment when seen in cervical lymph nodes. This retrospective observational study evaluated malignancy rates of lymph nodes (LNs) with PEF and examined their association with primary thyroid cancer. Among 315 LNs from 2019 US-guided fine-needle aspiration at a tertiary hospital, PEF in primary thyroid cancer significantly increased LN malignancy risk, while LNs without PEF showed no such association.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/ultrasonographic-punctate-echogenic-foci-in-metastatic-lymph-nodes-and-their-presence-in-primary-thyroid-cancer/357358/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/ultrasonographic-punctate-echogenic-foci-in-metastatic-lymph-nodes-and-their-presence-in-primary-thyroid-cancer/357358.png","ImageObject",300,407,{"name":92,"@type":93},"Ben ","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-23",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What is the purpose of identifying PEF in cervical lymph nodes?","Question",{"text":113,"@type":114},"The study focuses on determining the origin of ultrasonographic punctate echogenic foci (PEF) seen as microcalcifications in cervical lymph nodes and how this relates to malignancy and primary thyroid cancer.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How did the presence of PEF affect malignancy rates in lymph nodes?",{"text":118,"@type":114},"LNs with PEF were significantly associated with malignancy when PEF was present in primary thyroid cancer (P \u003C .0001, odds ratio 50.63). For LNs without PEF, no significant association was observed (P = .7574).",{"name":120,"@type":111,"acceptedAnswer":121},"Can benign conditions produce PEF in lymph nodes?",{"text":122,"@type":114},"Yes. Benign lymphadenitis produced PEF in lymph nodes, and PEF in benign LNs could be misrecognized as an echogenic hilum or a single hyperechoic spot.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},357358,1790431523,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":34,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},2336478951081,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","®  \n Observational Study   \nUltrasonographic punctate echogenic foci in metastatic lymph nodes and their presence in primary thyroid cancer  \nSurin Park, MDa ,b , Jung Hee Shin, MD, PhDa ,* , Won-Jin Moon, MD, PhDb , Soo Yeon Hahn, MD, PhDa , Myoung Kyoung Kim, MDa , Haejung Kim, MD, PhDa , Jeongmin Lee, MD, PhDa , Tae Hyuk Kim, MD, PhDc  \n\n| Abstract\u003Cbr>It is important to identify the origin of ultrasonographic punctate echogenic foci (PEF), which represent microcalcifications, in cervical lymph nodes (LNs) . This study aimed to explore the malignancy rate of LNs with PEF and investigate its association with their presence in primary thyroid cancer. This retrospective study included 315 LNs of patients who underwent US-guided fineneedle aspiration at a tertiary hospital in 2019. The LN with PEF group showed a significant association between PEF in primary thyroid cancer and malignancy in LNs (P \u003C .0001, odds ratio = 50.63, 95% confidence interval 10.6–241.75) . In the group of LNs without PEF, no such significant association was observed (P = .7574, odd ratio = 0.89, 95% confidence interval 0 .44–1.82) . PEFin benign LNs were misrecognized as an echogenic hilum or a single hyperechoic spot. Benign lymphadenitis produced PEF in LNs. Cervical metastatic LNs with ultrasonographic PEF harbor PEF in primary thyroid cancer. In primary thyroid tumors without PEF, LNs with PEF are benign or associated with a nonthyroidal origin.\u003Cbr>Abbreviations: CNB = core needle biopsy FNA = fine-needle aspiration IRB = Institutional Review Board K-TIRADS = Korean |\n| --- |\n| , , ,\u003Cbr>Thyroid Imaging Reporting and Data System, LNs = lymph nodes, PBs = psammoma bodies, PEF = punctate echogenic foci, TB = pulmonary tuberculosis, Tg = thyroglobulin, US = ultrasound. |\n| Keywords: lymph node, metastasis, microcalcification, thyroid cancer, ultrasonography |\n\n1. Introduction  \nUltrasound (US) examination of the cervical lymph nodes (LNs) is important in the evaluation of thyroid cancer because, even if the primary thyroid cancer is small and confined to the thyroid gland, 20% to 50% of patients will experience metastases to the cervical LNs. [1,2] It is well known that calcification in cervical LNs is most strongly associated with thyroid cancer, but it is also associated with many other disease entities, such as tuberculous lymphadenitis (the most common form of extrapulmonary tuberculous infection),[3] lymphadenopathies (sarcoidosis, amyloidosis), and metastases from other primary head and neck cancers (especially p16-positive squamous cell carcinoma) . [4,5] This complexity presents a challenge in discerning whether the specific calcifications seen during US as PEF within LNs are related to primary thyroid cancer. US-detected cervical LNs with calcification are suspicious findings, with a malignancy rate of 86% to 100% in node-by-node correlation. [6]  \nThe term “calcifications” in US analysis has recently been superseded with the term “echogenic foci,” and “microcalcifications” has been replaced with the term “punctate echogenic foci (PEF)” based on the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and International Expert Consensus. [6,7] This is because the US findings previously called microcalcifications do not exclusively represent psammoma bodies (PBs), but include various entities associated with PBs, sticky colloids, and coarse calcifications, which cannot be differentiated by US. [8,9]  \nPEF measuring ≤1 mm located in the solid portion of a thyroid nodule (especially a hypoechoic nodule) have a high malignancy rate (73.9%–77.8%) . [10, 11] Even though there are varying opinions on their exact pathologic identity[8,9] the degree of suspicion for US-detected PEF in LNs is not well established.  \nThe pathogenesis of PBs, the entity of calcification, is controversial but has been described as cellular necrosis due to thrombosis of the papillary vascular stalk, calcification of tumor thrombi, or intralymphatic necrosis in the thyro","cbCaiq7tZQsGXyih","https://ap.wps.com/l/cbCaiq7tZQsGXyih","pdf",1224769,"English","# Introduction\n## Rationale for evaluating cervical lymph node calcifications\n## Terminology shift to punctate echogenic foci (PEF)\n## Suspicion and diagnostic uncertainty for PEF in lymph nodes\n## Background on psammoma bodies and calcification pathogenesis","[{\"question\":\"What is the purpose of identifying PEF in cervical lymph nodes?\",\"answer\":\"The study focuses on determining the origin of ultrasonographic punctate echogenic foci (PEF) seen as microcalcifications in cervical lymph nodes and how this relates to malignancy and primary thyroid cancer.\"},{\"question\":\"How did the presence of PEF affect malignancy rates in lymph nodes?\",\"answer\":\"LNs with PEF were significantly associated with malignancy when PEF was present in primary thyroid cancer (P \\u003c .0001, odds ratio 50.63). For LNs without PEF, no significant association was observed (P = .7574).\"},{\"question\":\"Can benign conditions produce PEF in lymph nodes?\",\"answer\":\"Yes. Benign lymphadenitis produced PEF in lymph nodes, and PEF in benign LNs could be misrecognized as an echogenic hilum or a single hyperechoic spot.\"}]","Ultrasonographic punctate echogenic foci in metastatic lymph nodes and their presence in primary thyroid cancer | PDF",1790129728,18]