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Purpose <p>Papillary thyroid microcarcinoma (PTMC) with acoustic shadowing without a high-echo signal is occasionally encountered in clinical practice. However, the pathophysiology underlying such findings has not been investigated. We aimed to elucidate the clinical significance of acoustic shadowing without a high-echo signal in PTMC.</p> Methods <p>Nine PTMC nodules with acoustic shadowing but no high-echo signal and 76 PTMC nodules without acoustic shadowing or high-echo signal were included. Nodules were analyzed using ultrasound, aspiration cytology, and histological examination.</p> Results <p>Punctate echogenic foci were not observed in PTMC nodules with acoustic shadowing but no high-echo signals. The frequency (11.1%) of psammoma bodies in PTMC nodules with acoustic shadowing was lower than that in nodules without acoustic shadowing (31.6%); however, the difference was not significant. Extensive hyalinization was observed in 66.7% and 3.9% of PTMC nodules with and without acoustic shadowing, respectively (<i>p</i> &lt; 0.001). The distributions of acoustic shadowing and hyalinized stroma were correlated.</p> Conclusions <p>Acoustic shadowing without a high-echo signal is caused not by calcification but rather by extensive hyalinization. Our results may help refine the sonographic criteria for PTMC and provide a novel imaging marker for identifying indolent tumors, thereby supporting active surveillance strategies and potentially reducing overtreatment.</p>

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Clinical significance of acoustic shadowing without high-echo signal in papillary thyroid microcarcinoma

  • 期刊论文

  • 发表日期：

    2026年5月19日

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  • Yuna Omori,
  • Mitsuyoshi Hirokawa,
  • Miyoko Higuchi,
  • Maki Oshita,
  • Hiroyuki Yamaoka,
  • Makoto Fujishima,
  • Akira Miyauchi,
  • Takashi Akamizu

摘要

Purpose

Papillary thyroid microcarcinoma (PTMC) with acoustic shadowing without a high-echo signal is occasionally encountered in clinical practice. However, the pathophysiology underlying such findings has not been investigated. We aimed to elucidate the clinical significance of acoustic shadowing without a high-echo signal in PTMC.

Methods

Nine PTMC nodules with acoustic shadowing but no high-echo signal and 76 PTMC nodules without acoustic shadowing or high-echo signal were included. Nodules were analyzed using ultrasound, aspiration cytology, and histological examination.

Results

Punctate echogenic foci were not observed in PTMC nodules with acoustic shadowing but no high-echo signals. The frequency (11.1%) of psammoma bodies in PTMC nodules with acoustic shadowing was lower than that in nodules without acoustic shadowing (31.6%); however, the difference was not significant. Extensive hyalinization was observed in 66.7% and 3.9% of PTMC nodules with and without acoustic shadowing, respectively (p < 0.001). The distributions of acoustic shadowing and hyalinized stroma were correlated.

Conclusions

Acoustic shadowing without a high-echo signal is caused not by calcification but rather by extensive hyalinization. Our results may help refine the sonographic criteria for PTMC and provide a novel imaging marker for identifying indolent tumors, thereby supporting active surveillance strategies and potentially reducing overtreatment.