Thomas C G, Buckwalter J A, Staab E V, Kerr C Y
Ann Surg. 1976 May;183(5):463-9. doi: 10.1097/00000658-197605000-00002.
Controversy exists concerning the management of solitary thryoid nodules because of conflicting information converning the high clinical incidence of thyroid nodules, the varying incidence of cancer reported in those surgically excised and the infrequency of death from thyroid cancer. During the past several years, a plan for evaluating patients with dominant thyroid masses has evolved. The objective is to avoid unnecessary operations by identifying patients with a high risk of cancer. The criteria which are used are the age and sex of the patient, the duration of the mass, 125I or 99mTc scans, 75Selenomethionine scans, B-mode ultrasonography and the response of the mass to suppressive therapy. This is a report of the findings in 222 patients who have been studied employing this approach. Thirty per cent of the patients were operated upon. Forty per cent had neoplasms (well differentiated cancer--28.8%, adenoma--12.1%), 47.0%--nodular goiter, 6.1% cysts, and 6.1% chronic thyroiditis. The incidence of cancer in the 222 patients was 8.6% and adenoma 3.6%. Patients at greatest risk of having cancer are those with solid nonfunctioning nodules which fail to regress with suppressive therapy. This study indicates that the approach described above is effective in selecting for surgical excision those individuals at greatest risk of having thyroid cancer.
由于关于甲状腺结节临床高发病率、手术切除结节中报道的不同癌症发病率以及甲状腺癌死亡罕见性的信息相互矛盾，因此对于孤立性甲状腺结节的处理存在争议。在过去几年中，已形成了一项评估有明显甲状腺肿块患者的方案。目的是通过识别癌症高危患者来避免不必要的手术。所使用的标准包括患者的年龄和性别、肿块持续时间、125I或99mTc扫描、75硒蛋氨酸扫描、B型超声检查以及肿块对抑制治疗的反应。这是一份关于采用这种方法研究的222例患者结果的报告。30%的患者接受了手术。40%患有肿瘤（高分化癌——28.8%，腺瘤——12.1%），47.0%为结节性甲状腺肿，6.1%为囊肿，6.1%为慢性甲状腺炎。222例患者中癌症发病率为8.6%，腺瘤为3.6%。患癌风险最高的患者是那些实性无功能结节且抑制治疗后不消退的患者。这项研究表明，上述方法在选择那些患甲状腺癌风险最高的个体进行手术切除方面是有效的。
