1 Department of Radiology and Thyroid Center, Chung-Ang University Hospital, Chung-Ang University College of Medicine , Seoul, Korea.
2 Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea.
Thyroid. 2017 Oct;27(10):1307-1315. doi: 10.1089/thy.2017.0034. Epub 2017 Sep 19.
In patients undergoing active surveillance of papillary thyroid microcarcinoma, definitive therapy-usually preceded by a definitive diagnostic procedure-is not recommended until evidence of disease progression is obtained, as stated in the American Thyroid Association guidelines. This is because the deferring of definitive diagnosis and therapy until disease progression has no impact on the disease-specific survival. This study evaluated the malignancy rate and probability of thyroid nodules, which was further stratified based on the size cutoff value of 1 cm, with suspicious findings on ultrasonography (US), by using various malignant stratification systems.
The data were retrospectively collected between January 2003 and June 2003 from nine university hospitals that had previously participated in the Korean Society of Thyroid Radiology multicenter study on the ultrasonographic differentiation between benign and malignant thyroid nodules. In total, 829 thyroid nodules from 711 patients (620 women, 91 men; M = 48.7 years; range 6-98 years; 351 malignant and 478 benign nodules) were included. The probability for malignancy of thyroid nodules was calculated, which was further stratified by size, by using four different types of malignant risk-stratification systems. The factors that could differentiate benign from malignant nodules were assessed using the chi-square test.
In the suspicious thyroid nodules <1 cm on US, the malignancy probability ranged from 77.4% to 82.8%; the lowest rate was found in the Korean Society of Thyroid Radiology multicenter study, whereas the highest rate was noted in the Web-based system. Thus, the probability of benign nodules among suspicious thyroid nodules <1 cm on US was 17.2-22.6%.
A biopsy should be considered before active surveillance to exclude benign nodules with suspicious US features, and could thus prevent unnecessary active surveillance and patient anxiety.
在接受甲状腺微小乳头状癌主动监测的患者中，美国甲状腺协会指南指出，在出现疾病进展的证据之前，不建议进行确定性治疗——通常在确定性诊断程序之前进行，因为延迟确定性诊断和治疗直到疾病进展不会影响疾病特异性生存。本研究评估了恶性肿瘤发生率和甲状腺结节概率，并进一步根据超声检查（US）可疑表现的 1cm 大小截断值进行分层，使用各种恶性分层系统。
本研究数据回顾性收集于 2003 年 1 月至 2003 年 6 月间，来自此前参与韩国甲状腺放射学会多中心超声鉴别甲状腺良恶性结节研究的 9 家大学医院。共纳入 711 例患者的 829 个甲状腺结节（620 名女性，91 名男性；M=48.7 岁；年龄范围 6-98 岁；351 个恶性结节和 478 个良性结节）。使用四种不同类型的恶性风险分层系统计算甲状腺结节恶性概率，并进一步根据大小进行分层。使用卡方检验评估可区分良恶性结节的因素。
在 US 显示可疑的<1cm 甲状腺结节中，恶性概率范围为 77.4%至 82.8%；最低的发生率来自韩国甲状腺放射学会多中心研究，而最高的发生率则来自基于网络的系统。因此，US 显示可疑的<1cm 甲状腺结节中良性结节的概率为 17.2%至 22.6%。
对于 US 显示可疑特征的结节，在进行主动监测之前应考虑进行活检，以排除良性结节，从而避免不必要的主动监测和患者焦虑。
