Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma "Sapienza," Roma, Italy.
Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
JAMA. 2018 Mar 6;319(9):914-924. doi: 10.1001/jama.2018.0898.
Thyroid nodules are common, being detected in up to 65% of the general population. This is likely due to the increased use of diagnostic imaging for purposes unrelated to the thyroid. Most thyroid nodules are benign, clinically insignificant, and safely managed with a surveillance program. The main goal of initial and long-term follow-up is identification of the small subgroup of nodules that harbor a clinically significant cancer (≈10%), cause compressive symptoms (≈5%), or progress to functional disease (≈5%).
Thyroid function testing and ultrasonographic characteristics guide the initial management of thyroid nodules. Certain ultrasound features, such as a cystic or spongiform appearance, suggest a benign process that does not require additional testing. Suspicious sonographic patterns including solid composition, hypoechogenicity, irregular margins, and microcalcifications should prompt cytological evaluation. Additional diagnostic procedures, such as molecular testing, are indicated only in selected cases, such as indeterminate cytology (≈20%-30% of all biopsies). The initial risk estimate, derived from ultrasound and, if performed, cytology report, should determine the need for treatment and the type, frequency, and length of subsequent follow-up. Management includes simple observation, local treatments, and surgery and should be based on the estimated risk of malignancy and the presence and severity of compressive symptoms.
Most thyroid nodules are benign. A diagnostic approach that uses ultrasound and, when indicated, fine-needle aspiration biopsy and molecular testing, facilitates a personalized, risk-based protocol that promotes high-quality care and minimizes cost and unnecessary testing.
甲状腺结节很常见，在普通人群中，有高达 65%的人被发现患有甲状腺结节。这可能是由于为了与甲状腺无关的目的而越来越多地使用诊断成像。大多数甲状腺结节是良性的，临床上无明显意义，并且可以通过监测计划安全地进行管理。初始和长期随访的主要目标是识别出一小部分具有临床意义的癌症（约 10%）、引起压迫症状（约 5%）或进展为功能性疾病（约 5%）的结节。
甲状腺功能检测和超声特征指导甲状腺结节的初始管理。某些超声特征，如囊性或海绵状外观，提示良性过程，不需要额外的检查。可疑的超声模式包括实性成分、低回声、不规则边缘和微钙化，应提示进行细胞学评估。仅在特定情况下，如不确定的细胞学（所有活检的约 20%-30%），才需要进行其他诊断程序，如分子检测。初始风险估计值来源于超声和，如果进行的话，细胞学报告，应确定是否需要治疗以及随后随访的类型、频率和持续时间。管理包括简单观察、局部治疗和手术，应基于恶性肿瘤的估计风险以及压迫症状的存在和严重程度。
大多数甲状腺结节是良性的。一种使用超声和在有指征时使用细针抽吸活检和分子检测的诊断方法，可以促进个性化、基于风险的方案，从而提供高质量的护理，同时最大限度地降低成本和不必要的检查。
