Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Center for Clinical Investigation, Brigham and Women's Hospital, Boston, Massachusetts.
J Clin Endocrinol Metab. 2019 Nov 1;104(11):5665-5672. doi: 10.1210/jc.2019-00664.
Assessing thyroid nodules for malignancy is complex. The impact of patient and nodule factors on cancer evaluation is uncertain.
To determine precise estimates of cancer risk associated with clinical and sonographic variables obtained during thyroid nodule assessment.
Analysis of consecutive adult patients evaluated with ultrasound-guided fine-needle aspiration for a thyroid nodule ≥1 cm between 1995 and 2017. Demographics, nodule sonographic appearance, and pathologic findings were collected.
Estimated risk for thyroid nodule malignancy for patient and sonographic variables using mixed-effect logistic regression.
In 9967 patients [84% women, median age 53 years (range 18 to 95)], thyroid cancer was confirmed in 1974 of 20,001 thyroid nodules (9.9%). Significant ORs for malignancy were demonstrated for patient age <52 years [OR: 1.82, 95% CI (1.63 to 2.05), P < 0.0001], male sex [OR: 1.68 (1.45 to 1.93), P < 0.0001], nodule size [OR: 1.30 (1.14 to 1.49) for 20 to 19 mm, OR: 1.59 (1.34 to 1.88) for 30 to 39 mm, and OR: 1.71 (1.43 to 2.04) for ≥40 mm compared with 10 to 19 mm, P < 0.0001 for all], cystic content [OR: 0.43 (0.37 to 0.50) for 25% to 75% cystic and OR: 0.21 (0.15 to 0.28) for >75% compared with predominantly solid, P < 0.0001 for both], and the presence of additional nodules ≥1 cm [OR: 0.69 (0.60 to 0.79) for two nodules, OR: 0.41 (0.34 to 0.49) for three nodules, and OR: 0.19 (0.16 to 0.22) for greater than or equal to four nodules compared with one nodule, P < 0.0001 for all]. A free online calculator was constructed to provide malignancy-risk estimates based on these variables.
Patient and nodule characteristics enable more precise thyroid nodule risk assessment. These variables are obtained during routine initial thyroid nodule evaluation and provide new insights into individualized thyroid nodule care.
评估甲状腺结节的恶性程度较为复杂。患者和结节因素对癌症评估的影响尚不确定。
确定与甲状腺结节评估过程中获得的临床和超声变量相关的癌症风险的准确估计。
对 1995 年至 2017 年间进行超声引导下细针抽吸活检的直径≥1cm 的甲状腺结节的连续成年患者进行分析。收集了患者的人口统计学资料、结节的超声表现和病理结果。
使用混合效应逻辑回归分析患者和超声变量与甲状腺结节恶性程度的关系。
在 9967 例患者[84%为女性，中位年龄 53 岁（范围 18 至 95 岁）]中，2001 个甲状腺结节中有 1974 个（9.9%）被证实为甲状腺癌。患者年龄<52 岁[比值比（OR）：1.82，95%置信区间（CI）（1.63 至 2.05），P<0.0001]、男性[OR：1.68（1.45 至 1.93），P<0.0001]、结节大小[OR：1.30（1.14 至 1.49）对于 20 至 19mm，OR：1.59（1.34 至 1.88）对于 30 至 39mm，OR：1.71（1.43 至 2.04）对于≥40mm，与 10 至 19mm 相比，P<0.0001）、囊性内容物[OR：0.43（0.37 至 0.50）对于 25%至 75%囊性，OR：0.21（0.15 至 0.28）对于>75%与主要为实性相比，P<0.0001]和存在≥1cm 的额外结节[OR：0.69（0.60 至 0.79）对于两个结节，OR：0.41（0.34 至 0.49）对于三个结节，OR：0.19（0.16 至 0.22）对于大于或等于四个结节与一个结节相比，P<0.0001]。构建了一个免费的在线计算器，以根据这些变量提供癌症风险估计。
患者和结节特征能够更准确地评估甲状腺结节的风险。这些变量在甲状腺结节的常规初始评估过程中获得，并为个体化甲状腺结节护理提供了新的见解。
