Department of Pathology, The University of Chicago, Chicago, Illinois.
Endocrine Surgery Research Program Department of Surgery, The University of Chicago, Chicago, Illinois.
Thyroid. 2018 Dec;28(12):1595-1608. doi: 10.1089/thy.2018.0221. Epub 2018 Oct 30.
Management of large thyroid nodules is controversial, as data are conflicting regarding overall rates of malignancy (ROM) in all nodules and frequency of false-negative fine-needle aspiration results (FNR) in cytologically benign nodules. This meta-analysis aimed to evaluate and compare ROM and FNR in small versus large nodules published in the literature. Articles indexed in PubMed, written in English, published electronically or in print on or prior to December 8 2017 were searched for "false negative thyroid size or cm" and "malignancy rates benign thyroid nodules." Three hundred fifty-two unique citations were identified. Multiple reviewers selected a final set of 35 articles that contained nodules stratified by size (3, 4, or 5 cm), with benign or all cytologic diagnoses, and with postsurgical histologic diagnoses. Multiple observers extracted data, including numbers of total, cytologically benign, and histologically malignant nodules. Size cutoffs of 3, 4, and/or 5 cm were analyzed in 14, 24, and 1 article, respectively. ROM in all nodules ≥3 cm (13.1%) and ≥4 cm (20.9%) was lower than those <3 cm (19.6%) and <4 cm (19.9%; odds ratio [OR] = 0.72 [confidence interval (CI) 0.64-0.81] and OR = 0.85 [CI 0.77-0.95]). FNR in nodules ≥3 cm (7.2%) was not different from smaller nodules (5.7%; OR = 1.47 [CI 0.80-2.69]). FNR in nodules ≥4 cm (6.7%) was slightly higher than those <4 cm (4.5%; OR = 1.38 [CI 1.06-1.80]). The most frequently reported false-negative diagnosis was papillary thyroid carcinoma. Rates of malignancy and false-negative FNA results vary but, in most studies, are not higher in larger nodules. Patients with large, cytologically benign thyroid nodules need not undergo immediate surgical resection, as false-negative FNA rates are low and are expected to decrease in light of nomenclature revision of a subset of follicular variants of papillary thyroid carcinoma.
大甲状腺结节的管理存在争议，因为所有结节的恶性肿瘤总体发生率（ROM）以及细胞学良性结节中细针抽吸结果假阴性（FNR）的频率数据相互矛盾。本荟萃分析旨在评估和比较文献中大、小结节的 ROM 和 FNR。在 PubMed 中检索到索引的英文文章，发表于 2017 年 12 月 8 日或之前的电子或印刷文章，检索词为“false negative thyroid size or cm”和“malignancy rates benign thyroid nodules”。确定了 352 个独特的引文。多名审阅者选择了一组最终的 35 篇文章，这些文章包含按大小（3、4 或 5cm）分层的结节，有良性或所有细胞学诊断，以及术后组织学诊断。多名观察者提取了数据，包括总结节、细胞学良性结节和组织学恶性结节的数量。分别对 3cm、4cm 和/或 5cm 的大小截止值进行了分析。所有≥3cm（13.1%）和≥4cm（20.9%）结节的 ROM 均低于<3cm（19.6%）和<4cm（19.9%；比值比[OR]分别为 0.72[置信区间（CI）0.64-0.81]和 OR=0.85[CI 0.77-0.95]）。≥3cm（7.2%）结节的 FNR 与较小结节（5.7%）无差异（OR=1.47[CI 0.80-2.69]）。≥4cm（6.7%）结节的 FNR 略高于<4cm（4.5%）结节（OR=1.38[CI 1.06-1.80]）。最常报道的假阴性诊断为甲状腺乳头状癌。恶性肿瘤发生率和假阴性细针抽吸结果各不相同，但在大多数研究中，大结节并不更高。对于细胞学良性的大甲状腺结节患者，无需立即进行手术切除，因为假阴性 FNA 率较低，而且由于部分滤泡状甲状腺癌的命名法修订，预计这一比率将会降低。
