直径4厘米及以上甲状腺结节的恶变风险
Risk of Malignancy in Thyroid Nodules 4 cm or Larger.
作者信息
Megwalu Uchechukwu C
机构信息
Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA.
Department of Otolaryngology, Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
出版信息
Endocrinol Metab (Seoul). 2017 Mar;32(1):77-82. doi: 10.3803/EnM.2017.32.1.77. Epub 2017 Feb 6.
BACKGROUND
Several authors have questioned the accuracy of fine-needle aspiration cytology (FNAC) in large nodules. Some surgeons recommend thyroidectomy for nodules ≥4 cm even in the setting of benign FNAC, due to increased risk of malignancy and increased false negative rates in large thyroid nodules. The goal of our study was to evaluate if thyroid nodule size is associated with risk of malignancy, and to evaluate the false negative rate of FNAC for thyroid nodules ≥4 cm in our patient population.
METHODS
This is a retrospective study of 85 patients with 101 thyroid nodules, who underwent thyroidectomy for thyroid nodules measuring ≥4 cm.
RESULTS
The overall risk of malignancy in nodules ≥4 cm was 9.9%. Nodule size was not associated with risk of malignancy (odds ratio, 1.02) after adjusting for nodule consistency, age, and sex (P=0.6). The false negative rate for FNAC was 0%.
CONCLUSION
Nodule size was not associated with risk of malignancy in nodules ≥4 cm in our patient population. FNAC had a false negative rate of 0. Patients with thyroid nodules ≥4 cm and benign cytology should not automatically undergo thyroidectomy.
背景
几位作者对粗针穿刺细胞学检查（FNAC）在大结节中的准确性提出了质疑。一些外科医生建议，即使在FNAC结果为良性的情况下，对于直径≥4 cm的结节也应进行甲状腺切除术，因为大甲状腺结节的恶性风险增加且假阴性率升高。我们研究的目的是评估甲状腺结节大小是否与恶性风险相关，并评估在我们的患者群体中直径≥4 cm的甲状腺结节的FNAC假阴性率。
方法
这是一项对85例患者的101个甲状腺结节进行的回顾性研究，这些患者因甲状腺结节直径≥4 cm而接受了甲状腺切除术。
结果
直径≥4 cm的结节的总体恶性风险为9.9%。在对结节质地、年龄和性别进行校正后，结节大小与恶性风险无关（优势比，1.02）（P = 0.6）。FNAC的假阴性率为0%。
结论
在我们的患者群体中，直径≥4 cm的结节的大小与恶性风险无关。FNAC的假阴性率为0。甲状腺结节直径≥4 cm且细胞学检查为良性的患者不应自动接受甲状腺切除术。
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