Farrá Josefina C, Picado Omar, Liu Sophia, Ouyang Wenqi, Teo Richard, Franco Alexa M, Lew John I
Division of Endocrine Surgery The DeWitt Daughtry Family, Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida; Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, Florida.
Division of Endocrine Surgery The DeWitt Daughtry Family, Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida.
J Surg Res. 2017 Nov;219:341-346. doi: 10.1016/j.jss.2017.06.050. Epub 2017 Jul 22.
With widespread use of diagnostic imaging modalities, incidental thyroid nodules are frequently identified in patients for unrelated reasons. If underlying thyroid cancer risk in such patients is significant, further evaluation becomes imperative. This study evaluates the malignancy rate of incidentally discovered compared to clinically apparent thyroid nodules in surgical patients.
A retrospective review of prospectively collected data of 809 patients who underwent thyroidectomy at a tertiary referral center was performed. The association between incidental discovery of thyroid nodules, malignancy rates, and clinicopathologic characteristics was assessed.
Of 809 patients, 12% (n = 98) had incidental thyroid nodules, where malignancy was found in 65 (66%) of these patients. The overall rate of malignancy identified incidentally by routine imaging was 14% (65/466). Most common imaging modalities leading to detection were ultrasound (32%), computed tomography (29%), and magnetic resonance imaging (23%). Of patients with incidental thyroid nodules harboring malignancy, follicular variant papillary thyroid cancer (PTC) (48%), classical variant PTC (18%), tall cell variant PTC (12%), and diffuse sclerosing variant PTC (12%) were most commonly found. Patients with malignant incidental thyroid nodules had more lymphovascular invasion and positive lymph nodes compared to nonincidental malignant thyroid nodules (53% versus 41% and 47% versus 33%, P < 0.05, respectively).
Incidentally discovered thyroid nodules by imaging represent an important group of surgical patients with clinically significant rates of underlying malignancy. Patients with incidentally discovered thyroid nodules by imaging should undergo appropriate evaluation and counseling for further surgical treatment.
随着诊断性成像技术的广泛应用，患者常因无关原因被发现存在甲状腺结节。如果此类患者潜在的甲状腺癌风险较高，进一步评估就变得至关重要。本研究评估了手术患者中偶然发现的甲状腺结节与临床明显的甲状腺结节相比的恶性率。
对一家三级转诊中心前瞻性收集的809例行甲状腺切除术患者的数据进行回顾性分析。评估甲状腺结节的偶然发现、恶性率与临床病理特征之间的关联。
809例患者中，12%（n = 98）有偶然发现的甲状腺结节，其中65例（66%）患者发现有恶性病变。通过常规成像偶然发现的恶性病变总体发生率为14%（65/466）。导致发现结节的最常见成像方式为超声（32%）、计算机断层扫描（29%）和磁共振成像（23%）。在有恶性病变的偶然发现甲状腺结节患者中，最常见的是滤泡状变异型乳头状甲状腺癌（PTC）（48%）、经典变异型PTC（18%）、高细胞变异型PTC（12%）和弥漫性硬化变异型PTC（12%）。与非偶然发现的恶性甲状腺结节相比，偶然发现的恶性甲状腺结节患者有更多的脉管侵犯和阳性淋巴结（分别为53%对41%和47%对33%，P < 0.05）。
通过成像偶然发现的甲状腺结节代表了一组具有临床显著潜在恶性率的重要手术患者。通过成像偶然发现甲状腺结节的患者应接受适当评估并咨询进一步的手术治疗。
