How often are thyroid nodule microcalcifications cancerous? can capsule be ruptured during biopsy?

Slightly higher risk: When microcalcifications are seen on a thyroid nodule that is 1cm or bigger, we get concerned more than usual that this may be a cancerous nodule. An ultrasound guided fna is warranted at that point. There is no risk of capsule rupture or seeding tumor cells outside of the thyroid with fna.

Common. No: Depending on the exact type of microcalcification, there is a significant rate of cancer. So nodules with microcalcs should be biopsied. There is minimal risk to doing thyroid fine needle aspiration/biopsy. No issues with rupture of the capsule, spread of cancer, etc.

Possible cancer: Microcalcificstions an signal the presence of papillary thyroid cancer. Fna is the best way to biopsy nodules. Concern for fracturing the capsule (which is not clinically relevant) should not preclude the need/obtaining the biopsy.