Moon Hee Jung, Kim Eun-Kyung, Kwak Jin Young
Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Ann Surg Oncol. 2014 Jun;21(6):1898-903. doi: 10.1245/s10434-014-3556-2. Epub 2014 Feb 21.
The indications of repeat fine-needle aspiration (FNA) for thyroid nodules with benign results of the Bethesda system were investigated.
A total of 1,398 nodules were classified according to the Thyroid Imaging Reporting and Data System (TIRADS). TIRADS category 3 included nodules without solidity, hypoechogenicity or marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, and taller-than-wide shape on ultrasonography (US). Categories 4a, 4b, 4c, and 5 included nodules with one, two, three or four, or five suspicious US features, respectively. The malignancy risks, and odds ratio (OR) with 95 % confidence interval (CI) were calculated. Analyses were performed for all nodules, nodules >10 mm, and nodules ≤10 mm.
Of 1.398 nodules, 43 (3.1 %) were malignanct. The malignancy risks of benign nodules with categories 3, 4a, and 4b were 0.7, 1.2, and 0.7 %, respectively, whereas those for nodules with categories 4c and 5 were 9.8 and 22.2 %, respectively. The ORs of nodules with categories 4c and 5 were 19.4 (95 % CI 5.0-76.2) and 50.6 (95 % CI 10.4-245.0), respectively. In nodules >10 mm, the malignancy risks of categories 4c and 5 were 2.7 and 20 %, respectively, and the ORs were 10.7 (95 % CI 1.2-93.7) and 236.1 (95 % CI 12.6-4426.4), respectively. In nodules ≤ 10 mm, the malignancy risks of categories 4c and 5 were 12.6 and 22.6 %, respectively, and the ORs were 10.1 (95 % CI 1.3-78.0) and 18.9 (95 % CI 2.1-168.9), respectively.
Repeat US-guided FNA should be considered in benign thyroid nodules with three or more suspicious US features regardless of size.
对贝塞斯达系统结果为良性的甲状腺结节进行重复细针穿刺抽吸（FNA）的指征进行了研究。
根据甲状腺影像报告和数据系统（TIRADS）对总共1398个结节进行分类。TIRADS 3类包括超声检查（US）显示无实性、低回声或显著低回声、微叶状或不规则边缘、微钙化以及纵横比大于1的结节。4a、4b、4c和5类分别包括具有1个、2个、3个或4个或5个可疑超声特征的结节。计算恶性风险以及95%置信区间（CI）的比值比（OR）。对所有结节、直径>10mm的结节和直径≤10mm的结节进行分析。
在1398个结节中，43个（3.1%）为恶性。3类、4a类和4b类良性结节的恶性风险分别为0.7%、1.2%和0.7%，而4c类和5类结节的恶性风险分别为9.8%和22.2%。4c类和5类结节的OR分别为19.4（95%CI 5.0 - 76.2）和50.6（95%CI 10.4 - 245.0）。在直径>10mm的结节中，4c类和5类的恶性风险分别为2.7%和20%，OR分别为10.7（95%CI 1.2 - 93.7）和236.1（95%CI 12.6 - 4426.4）。在直径≤10mm的结节中，4c类和5类的恶性风险分别为12.6%和22.6%，OR分别为10.1（95%CI 1.3 - 78.0）和18.9（95%CI 2.1 - 168.9）。
无论大小，具有三个或更多可疑超声特征的良性甲状腺结节应考虑重复超声引导下FNA。
