1 Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
AJR Am J Roentgenol. 2018 Feb;210(2):412-417. doi: 10.2214/AJR.17.18532. Epub 2017 Nov 1.
The purpose of this study was to evaluate the malignancy rate of nodules with nondiagnostic cytologic results based on the American Thyroid Association (ATA) ultrasound (US) patterns and to suggest management guidelines for these nodules.
From January 2013 to December 2014, 441 nodules (≥ 1 cm) were found in 437 patients with nondiagnostic results of ultrasound (US)-guided fine-needle aspiration biopsy (nondiagnostic nodules). A total of 191 nodules that were cytopathologically confirmed or were smaller (> 3 mm) at follow-up US were enrolled. The US findings of each nodule were reviewed. One radiologist classified the nodules into the following five categories according to the 2015 ATA guidelines: high, intermediate, low, and very low suspicion for malignancy and benign. The reference standard was histopathologic confirmation. Nodules that were smaller at follow-up US were considered benign. The malignancy rate of each category was calculated.
Among a total 191 nodules, 20 (10.5%) were malignant. Solid composition, marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, and taller-than-wide shape were more frequently seen in malignant nodules (all p < 0.001). The malignancy rate of nodules with very low suspicion of malignancy was 0% (0/58); low, 0% (0/45); intermediate, 10.3% (6/58); and high, 46.7% (14/30) (p < 0.001).
When US findings of thyroid nodules are assessed according to the 2015 ATA guidelines, nondiagnostic thyroid nodules with very-low- or low-suspicion US patterns can be followed up with US. Nondiagnostic nodules with intermediate or highly suspicious US patterns should be evaluated with repeat US-guided fine-needle aspiration biopsy.
本研究旨在评估基于美国甲状腺协会（ATA）超声（US）模式的非诊断性细胞学结果结节的恶性率，并为这些结节提出管理指南。
2013 年 1 月至 2014 年 12 月，对 437 例超声引导下细针抽吸活检结果为非诊断性（非诊断性结节）的患者的 441 个结节（≥1cm）进行了研究。共纳入 191 个经细胞病理学证实或随访超声（US）较大（>3mm）的结节。回顾每个结节的 US 结果。一名放射科医生根据 2015 年 ATA 指南将结节分为以下五类：高度、中度、低度、非常低度恶性和良性。参考标准为组织病理学证实。随访 US 较小的结节被认为是良性的。计算每个类别的恶性率。
在总共 191 个结节中，有 20 个（10.5%）为恶性。实性成分、明显低回声、微分叶或不规则边缘、微钙化和高宽比是恶性结节更常见的特征（均 p<0.001）。非常低度可疑恶性的结节恶性率为 0%（0/58）；低度为 0%（0/45）；中度为 10.3%（6/58）；高度为 46.7%（14/30）（p<0.001）。
当根据 2015 年 ATA 指南评估甲状腺结节的 US 结果时，具有非常低或低度可疑 US 模式的非诊断性甲状腺结节可以通过 US 进行随访。具有中度或高度可疑 US 模式的非诊断性结节应通过重复 US 引导下细针抽吸活检进行评估。
