Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada.
Can Assoc Radiol J. 2019 Feb;70(1):62-67. doi: 10.1016/j.carj.2018.10.001.
To determine the incidence of malignancy, follow-up ultrasound (US), and repeat fine needle aspiration (FNA) in thyroid nodules that have been previously biopsied as benign.
This is a retrospective, descriptive study of benign thyroid nodules evaluated by US between 2010-2011. We determined the frequency of follow-up ultrasounds and FNAs, mean years of follow-up, interval between follow-up US, change in nodule size, reasons for repeat FNA (rFNA), frequency of thyroidectomy, and thyroid malignancy during 5 years of follow-up.
A total of 733 benign thyroid nodules were reviewed in 615 patients. Mean years of US follow-up was 3.47 ± 1.65 years; 275 (37.5%) had no follow-up US; 109 (14.9%) had 1 follow-up US; 93 (12.7%) had 2 follow-up US; and 256 (34.9%) had 3 or more follow-up US. Assessment of thyroid nodule size showed that 215 (28.8%) nodules decreased in size, 145 (19.4%) increased in size by less than 50%, and 91 (12.1%) increased in size by more than 50%. Of the 733 nodules, 17 nodules (2.3%) underwent thyroidectomy for which the pathology result of 9 (1.2%) showed malignancy, and 65 (8.9%) thyroid nodules underwent rFNA. When applying the 2015 recommendations for repeat FNA, 35% were done unnecessarily.
In our sample of initially benign thyroid nodules, only 9 patients (1.2%) had pathology-proven malignancy after a mean follow-up of 3.5 years. Over 30% of patients had more than 3 rUSs. Decreased interval and frequency of rUS should be considered in future guidelines for thyroid management.
确定先前经活检诊断为良性的甲状腺结节中恶性肿瘤的发生率、后续超声（US）检查和重复细针抽吸活检（FNA）的情况。
这是一项回顾性描述性研究，对 2010-2011 年间经 US 评估的良性甲状腺结节进行了研究。我们确定了随访 US 和 FNA 的频率、平均随访年限、随访 US 之间的时间间隔、结节大小的变化、重复 FNA（rFNA）的原因、甲状腺切除术的频率以及在 5 年随访期间的甲状腺恶性肿瘤发生率。
共对 615 例患者的 733 个良性甲状腺结节进行了回顾。US 随访的平均年限为 3.47±1.65 年；275 个（37.5%）无后续 US 检查；109 个（14.9%）有 1 次 US 随访；93 个（12.7%）有 2 次 US 随访；256 个（34.9%）有 3 次或更多次 US 随访。评估甲状腺结节大小显示，215 个（28.8%）结节体积缩小，145 个（19.4%）结节体积增加小于 50%，91 个（12.1%）结节体积增加超过 50%。在 733 个结节中，17 个（2.3%）因结节进行了甲状腺切除术，其中 9 个（1.2%）的病理结果显示为恶性，65 个（8.9%）甲状腺结节进行了 rFNA。应用 2015 年重复 FNA 建议时，有 35%的患者不必要地进行了 rFNA。
在我们的良性甲状腺结节样本中，平均随访 3.5 年后，只有 9 例（1.2%）患者的病理结果证实为恶性肿瘤。超过 30%的患者进行了 3 次以上的 rUS 检查。未来的甲状腺管理指南应考虑减少 rUS 的间隔和频率。
