基于甲状腺超声影像特征的甲状腺癌发病风险：一项基于人群的研究结果。
Risk of thyroid cancer based on thyroid ultrasound imaging characteristics: results of a population-based study.
机构信息
Department of Radiology and Biomedical Imaging, University of California, San Francisco2Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco3Department of Epidemiology and Biostatistics, University of California, San Francisco.
出版信息
JAMA Intern Med. 2013 Oct 28;173(19):1788-96. doi: 10.1001/jamainternmed.2013.9245.
IMPORTANCE
There is wide variation in the management of thyroid nodules identified on ultrasound imaging.
OBJECTIVE
To quantify the risk of thyroid cancer associated with thyroid nodules based on ultrasound imaging characteristics.
METHODS
Retrospective case-control study of patients who underwent thyroid ultrasound imaging from January 1, 2000, through March 30, 2005. Thyroid cancers were identified through linkage with the California Cancer Registry.
RESULTS
A total of 8806 patients underwent 11,618 thyroid ultrasound examinations during the study period, including 105 subsequently diagnosed as having thyroid cancer. Thyroid nodules were common in patients diagnosed as having cancer (96.9%) and patients not diagnosed as having thyroid cancer (56.4%). Three ultrasound nodule characteristics--microcalcifications (odds ratio [OR], 8.1; 95% CI, 3.8-17.3), size greater than 2 cm (OR, 3.6; 95% CI, 1.7-7.6), and an entirely solid composition (OR, 4.0; 95% CI, 1.7-9.2)--were the only findings associated with the risk of thyroid cancer. If 1 characteristic is used as an indication for biopsy, most cases of thyroid cancer would be detected (sensitivity, 0.88; 95% CI, 0.80-0.94), with a high false-positive rate (0.44; 95% CI, 0.43-0.45) and a low positive likelihood ratio (2.0; 95% CI, 1.8-2.2), and 56 biopsies will be performed per cancer diagnosed. If 2 characteristics were required for biopsy, the sensitivity and false-positive rates would be lower (sensitivity, 0.52; 95% CI, 0.42-0.62; false-positive rate, 0.07; 95% CI, 0.07-0.08), the positive likelihood ratio would be higher (7.1; 95% CI, 6.2-8.2), and only 16 biopsies will be performed per cancer diagnosed. Compared with performing biopsy of all thyroid nodules larger than 5 mm, adoption of this more stringent rule requiring 2 abnormal nodule characteristics to prompt biopsy would reduce unnecessary biopsies by 90% while maintaining a low risk of cancer (5 per 1000 patients for whom biopsy is deferred).
CONCLUSIONS AND RELEVANCE
Thyroid ultrasound imaging could be used to identify patients who have a low risk of cancer for whom biopsy could be deferred. On the basis of these results, these findings should be validated in a large prospective cohort.
重要性
在超声影像检查中发现的甲状腺结节的管理存在广泛差异。
目的
根据超声影像特征，量化与甲状腺结节相关的甲状腺癌风险。
方法
这是一项回顾性病例对照研究，纳入了 2000 年 1 月 1 日至 2005 年 3 月 30 日期间接受甲状腺超声检查的患者。通过与加利福尼亚癌症登记处的关联，确定了甲状腺癌病例。
结果
在研究期间，共有 8806 名患者接受了 11618 次甲状腺超声检查，其中 105 例随后被诊断为患有甲状腺癌。在被诊断为患有癌症的患者（96.9%）和未被诊断为患有甲状腺癌的患者（56.4%）中，甲状腺结节都很常见。三种超声结节特征——微钙化（比值比[OR]，8.1；95%置信区间[CI]，3.8-17.3）、直径大于 2 厘米（OR，3.6；95% CI，1.7-7.6）和完全实性成分（OR，4.0；95% CI，1.7-9.2）——是唯一与甲状腺癌风险相关的发现。如果使用 1 种特征作为活检指征，则可检测到大多数甲状腺癌病例（敏感性，0.88；95% CI，0.80-0.94），但假阳性率较高（0.44；95% CI，0.43-0.45），阳性似然比较低（2.0；95% CI，1.8-2.2），每诊断出 1 例癌症，需要进行 56 次活检。如果需要 2 种特征才能进行活检，则敏感性和假阳性率会更低（敏感性，0.52；95% CI，0.42-0.62；假阳性率，0.07；95% CI，0.07-0.08），阳性似然比会更高（7.1；95% CI，6.2-8.2），每诊断出 1 例癌症，仅需进行 16 次活检。与对所有大于 5 毫米的甲状腺结节进行活检相比，采用这种更严格的规则，即需要 2 种异常结节特征才能提示活检，可将不必要的活检减少 90%，同时保持较低的癌症风险（每 1000 名被推迟活检的患者中有 5 例）。
结论和相关性
甲状腺超声检查可用于识别癌症风险低的患者，可推迟对这些患者进行活检。基于这些结果，应在大型前瞻性队列中验证这些发现。
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