Impact of thyroid calcification on pathological diagnosis and its value of time-gradient decalcification

LIU Shiwen; GUO Jingwei; SHEN Xihua; YANG Cuiping; WANG Yixun; QI Weijie; ZHENG Yuqin; PANG Nannan

doi:10.3969/j.issn.1007-8096.2025.12.015

Abstract：Objective Objective To systematically explore the association between thyroid calcification and papillary thyroid carcinoma(PTC),its impact on the expression of immunohistochemical markers,and to evaluate the value and optimization schemes of surface decalcification techniques in addressing diagnostic challenges of intraoperative frozen section.Methods A retrospective analysis of 451 thyroid surgery cases was conducted.The correlation between calcification and PTC was analyzed using the χ² test.The expression differences of Galectin-3,CD56,and Ki-67 were examined.A surface decalcification experiment was performed on fresh calcified tissues to assess the impact of decalcification time on frozen section quality and cellular morphology.Results Association analysis between calcification and malignancy showed that the proportion of PTC in the calcification group was significantly higher than in the non-calcification group.Immunohistochemically,the absence of CD56 showed 100%specificity for PTC with calcification;Galectin-3 had high sensitivity but low specificity;Ki-67>5%was more commonly detected in PTC without calcification.Decalcification experiment revealed that prolonged decalcification time improved section quality,but morphological features of most tumor cells were lost.Decalcification did not affect paraffin sectioning or immunohistochemical results.Conclusion Thyroid calcification is an important indicator of PTC.The'time-gradient decalcification and twice frozen sections'can effectively balance section quality and cell morphology preservation,providing a systematic solution to improve the accuracy of intraoperative frozen diagnosis of calcified thyroid lesions.