Chaikhoutdinov Irina, Mitzner Ron, Goldenberg David
Division of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center College of Medicine, Hershey, Pennsylvania, USA.
Division of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center College of Medicine, Hershey, Pennsylvania, USA
Otolaryngol Head Neck Surg. 2014 Jun;150(6):939-42. doi: 10.1177/0194599814524705. Epub 2014 Mar 11.
To examine patients with incidentally discovered thyroid nodules (IDTNs) with a focus on identification, evaluation, surgical intervention, and rates of malignancy.
Case series with chart review.
Tertiary care medical center.
A total of 1408 patients were identified by cross-referencing thyroid diagnosis codes with ultrasound (US) codes between July 2008 and June 2009. Information regarding demographics, follow-up, and outcomes was extracted from the medical record.
A total of 249 patients with IDTNs were identified. Most were discovered on computed tomography (CT) scans (59.8%); the most common indication for obtaining imaging was for evaluation of an unrelated malignancy (26.9%). Malignant IDTNs were identified on 23.8% of positron emission tomography/CT scans and 6.8% of CT scans. Initial evaluation of IDTNs was performed by US in 62.2% and by US with fine-needle aspiration (FNA) in 36.1% of patients. The most common pathology on FNA of IDTNs was benign follicular nodule (64.1%) followed by papillary thyroid cancer (PTC; 13.5%); however, 31.7% of all cytology indicated suspicion for malignancy. Fifty-five patients (22.1%) were treated surgically. On final surgical pathology, 33 malignancies were present, of which 28 were PTC. The overall malignancy rate for incidental thyroid nodules was 13.3%.
We identified a malignancy of at least 13.3% in IDTNs, reaffirming that IDTNs should undergo thorough workup.
检查偶然发现的甲状腺结节（IDTNs）患者，重点关注其识别、评估、手术干预及恶性率。
病例系列研究并进行病历回顾。
三级医疗中心。
通过交叉对照2008年7月至2009年6月间甲状腺诊断编码与超声（US）编码，共识别出1408例患者。从病历中提取有关人口统计学、随访及结果的信息。
共识别出249例IDTNs患者。大多数结节是在计算机断层扫描（CT）中发现的（59.8%）；进行成像检查最常见的指征是评估无关的恶性肿瘤（26.9%）。在23.8%的正电子发射断层扫描/CT和6.8%的CT扫描中发现了恶性IDTNs。62.2%的患者对IDTNs进行了超声初步评估，36.1%的患者进行了超声引导下细针穿刺活检（FNA）。IDTNs细针穿刺活检最常见的病理结果是良性滤泡性结节（64.1%），其次是甲状腺乳头状癌（PTC；13.5%）；然而，所有细胞学检查中有31.7%提示怀疑为恶性。55例患者（22.1%）接受了手术治疗。最终手术病理显示有33例恶性肿瘤，其中28例为PTC。偶然发现的甲状腺结节总体恶性率为13.3%。
我们发现IDTNs的恶性率至少为13.3%，再次证实IDTNs应接受全面检查。
