Kaliszewski Krzysztof, Diakowska Dorota, Ziętek Marcin, Knychalski Bartłomiej, Aporowicz Michał, Sutkowski Krzysztof, Wojtczak Beata
First Department and Clinic of General, Gastroenterological and Endocrine Surgery.
Department of Nervous System Diseases, Faculty of Health Science, Wroclaw Medical University.
Medicine (Baltimore). 2018 Dec;97(49):e13339. doi: 10.1097/MD.0000000000013339.
A thyroid nodule discovered during imaging study performed due to unrelated thyroid disease is known as a thyroid incidentaloma, while positron emission tomography (PET) associated incidental neoplasm of thyroid is known as a "PAIN" phenomenon.To evaluate which patients with "PAIN" phenomenon should undergo surgery in regards to cytology results.Retrospective review of 4716 patients consecutively admitted and surgically treated in tertiary surgical center. 49 (1.04%) patients with "PAIN" phenomenon were identified. All of them had ultrasound-guided fine needle aspiration biopsy (UG-FNAB) performed and cytological results were evaluated according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Patients were divided into 2 subgroups according to histopathological diagnosis: group 1 (n = 25) with benign tumor and group 2 (n = 24) with thyroid cancer.Cytology results were the significant predictors of cancer occurrence in patients with "PAIN" phenomenon (P < .0001). Logistic regression analysis confirmed that category III or higher of TBSRTC in patients with "PAIN" phenomenon significantly increased the risk of cancer (OR = 168.7, P < .0001).Patients with "PAIN" phenomenon and cytology assigned to category III or higher of the Bethesda system should undergo surgery due to significant risk of thyroid malignancy.
因无关甲状腺疾病进行影像学检查时发现的甲状腺结节称为甲状腺偶发瘤，而正电子发射断层扫描（PET）相关的甲状腺偶发肿瘤称为“PAIN”现象。为了根据细胞学结果评估哪些“PAIN”现象患者应接受手术。对一家三级外科中心连续收治并接受手术治疗的4716例患者进行回顾性分析。确定了49例（1.04%）有“PAIN”现象的患者。所有患者均接受了超声引导下细针穿刺活检（UG-FNAB），并根据甲状腺细胞病理学报告的贝塞斯达系统（TBSRTC）评估细胞学结果。根据组织病理学诊断将患者分为2个亚组：第1组（n = 25）为良性肿瘤，第2组（n = 24）为甲状腺癌。细胞学结果是“PAIN”现象患者癌症发生的重要预测因素（P <.0001）。逻辑回归分析证实，“PAIN”现象患者中TBSRTC为III类或更高类别显著增加了癌症风险（OR = 168.7，P <.0001）。由于甲状腺恶性肿瘤风险显著，“PAIN”现象且细胞学分类为贝塞斯达系统III类或更高类别的患者应接受手术。
