Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 134 Shinchon-Dong, Seodaemun-gu, Seoul 120-752, Korea.
Radiology. 2010 Jan;254(1):292-300. doi: 10.1148/radiol.2541090460. Epub 2009 Dec 17.
To investigate the value of ultrasonographic (US) features in thyroid nodules with initially benign cytologic results.
The institutional review board approved this retrospective study and required neither patient approval nor informed consent for the review of images and records. From October 2003 to February 2006, 6118 focal thyroid nodules in 6025 consecutive patients underwent US-guided fine-needle aspiration biopsy (FNAB). This study included 1343 nodules 1 cm or larger in 1302 patients that were diagnosed as benign at initial cytologic evaluation and underwent pathologic or follow-up study. We compared the risk of malignancy according to US findings and calculated the likelihoods of different subgroups having benign nodules.
In total, 26 (1.9%) malignant and 1317 (98.1%) benign nodules were found according to reference standards. If initial cytologic results showed benign thyroid nodules, the likelihood of the nodule actually being benign was 98.1%. When a thyroid nodule had benign results at both initial and repeat FNAB, the likelihood increased to 100%. The likelihood of having a benign thyroid nodule with suspicious US features was lower (79.6%) than having a benign thyroid nodule with negative US features (99.4%, P<.001). In the nodule with benign features at initial US, the risk of malignancy for a thyroid nodule with an increase in size at follow-up US was slightly higher (1.4%) than that of a thyroid nodule with no interval change or decrease in size, but it was not significantly different (0.5%, P = .354).
Repeat FNAB should be performed for thyroid nodules that have suspicious US features, even if the initial cytologic results indicate that it is a benign lesion.
探讨超声（US）特征在最初细胞学良性的甲状腺结节中的价值。
该回顾性研究经机构审查委员会批准，由于仅对图像和记录进行复查，因此既无需患者批准，也无需知情同意。2003 年 10 月至 2006 年 2 月，对 6025 例连续患者的 6118 个局灶性甲状腺结节进行了 US 引导下的细针抽吸活检（FNAB）。本研究包括 1302 例患者的 1343 个 1cm 或更大的结节，这些患者在初始细胞学评估时被诊断为良性，并进行了病理或随访研究。我们根据 US 结果比较了恶性肿瘤的风险，并计算了不同亚组良性结节的可能性。
根据参考标准，总共发现 26 个（1.9%）恶性和 1317 个（98.1%）良性结节。如果初始细胞学结果显示良性甲状腺结节，则结节实际上为良性的可能性为 98.1%。如果甲状腺结节在初始和重复 FNAB 中均为良性结果，则可能性增加到 100%。具有可疑 US 特征的良性甲状腺结节的可能性较低（79.6%），而具有阴性 US 特征的良性甲状腺结节的可能性较高（99.4%，P<.001）。在初始 US 具有良性特征的结节中，随着随访 US 中结节大小增加，恶性肿瘤的风险略高（1.4%），而与结节大小无间隔变化或减小相比，差异无统计学意义（0.5%，P =.354）。
即使初始细胞学结果表明为良性病变，对于具有可疑 US 特征的甲状腺结节，也应进行重复 FNAB。
