期刊俱乐部：影像学检查发现的偶然甲状腺结节：是否可以通过使用放射学学会的建议和三级系统来减少诊断性检查？

Journal Club: incidental thyroid nodules detected at imaging: can diagnostic workup be reduced by use of the Society of Radiologists in Ultrasound recommendations and the three-tiered system?

机构信息

1 Department of Radiology, Duke University Medical Center, DUMC Box 3808, Durham, NC, 27710.

出版信息

AJR Am J Roentgenol. 2014 Jan;202(1):18-24. doi: 10.2214/AJR.13.10972.

DOI:10.2214/AJR.13.10972

PMID:24370125

Abstract

OBJECTIVE

The purpose of this study was to determine the number of thyroid nodule workups that could be eliminated and the number of malignant tumors that would be missed if the Society of Radiologists in Ultrasound (SRU) recommendations and the three-tiered system were applied to incidental thyroid nodules (ITN) detected at imaging.

MATERIALS AND METHODS

This retrospective study included ITN in 390 consecutively registered patients who underwent ultrasound-guided fine-needle aspiration of one or more thyroid nodules from July 2010 to June 2011. Images were reviewed, and nodules were categorized according to two workup criteria: ITN seen on ultrasound images were categorized according to SRU recommendations, and those seen on CT, MR, or PET/CT images were classified according to the three-tiered risk-categorization system.

RESULTS

In this study 114 of 390 (29%) patients had nodules first detected incidentally during imaging studies, and 107 patients met the inclusion criteria. These patients had 47 ITN seen at ultrasound and 60 ITN seen at either CT, MRI, or PET/CT. If the SRU recommendations had been applied, 14 of 47 (30%) patients with ITN on ultrasound images would not have received fine-needle aspiration and one of four cases of cancer would have been missed. The missed malignant tumor was a 14-mm localized papillary carcinoma. If the three-tiered system had been applied, 21 of 60 (35%) patients with ITN on CT, MR, or PET/CT images would not have received fine-needle aspiration, but none of the three malignancies would have been missed. Overall, 35 of 107 (33%) of patients with ITN did not meet the SRU recommendations or the three-tiered criteria.

CONCLUSION

Use of the SRU recommendations and three-tiered system can reduce the workup of ITN by one third compared with current practice without specific guidelines. One case of localized papillary carcinoma was missed when the SRU recommendations were used.

摘要

目的

本研究旨在确定如果将美国放射学会超声分会（SRU）的建议和三层系统应用于影像学检查偶然发现的甲状腺结节（ITN），可以消除多少甲状腺结节检查以及会遗漏多少恶性肿瘤。

材料和方法

这是一项回顾性研究，纳入了 2010 年 7 月至 2011 年 6 月期间连续登记的 390 例接受超声引导下细针抽吸甲状腺结节的患者，这些患者均偶然发现有 ITN。对图像进行了回顾性分析，并根据两种检查标准对结节进行了分类：根据 SRU 建议对超声图像上可见的 ITN 进行分类，根据 CT、MR 或 PET/CT 图像对可见的 ITN 进行分类。

结果

在这项研究中，390 例患者中有 114 例（29%）在影像学研究中偶然发现了结节，107 例患者符合纳入标准。这些患者中 47 例 ITN 在超声图像上可见，60 例 ITN 在 CT、MRI 或 PET/CT 上可见。如果应用 SRU 建议，47 例超声图像上的 ITN 患者中有 14 例将不会接受细针抽吸，4 例癌症中有 1 例将被遗漏。漏诊的恶性肿瘤为 14mm 局限性乳头状癌。如果应用三层系统，60 例 CT、MR 或 PET/CT 图像上的 ITN 患者中有 21 例将不会接受细针抽吸，但三种恶性肿瘤均不会被遗漏。总的来说，107 例 ITN 患者中有 35 例（33%）不符合 SRU 建议或三层标准。