Division of Endocrinology, Metabolism and Lipid Research, Department of Internal Medicine; School of Medicine, St. Louis, Missouri.
Mallinckrodt Institute of Radiology; Washington University in St. Louis, School of Medicine, St. Louis, Missouri.
Thyroid. 2020 Mar;30(3):401-407. doi: 10.1089/thy.2019.0478. Epub 2020 Jan 28.
Thyroid nodules are routinely evaluated with ultrasound. Our aim was to determine if thyroid nodule location was a useful feature to predict thyroid cancer. Retrospective review of patients with thyroid nodules from six referral centers from 2006 to 2010. A total of 3313 adult patients with thyroid nodules and confirmed benign or malignant thyroid diagnoses were included. Mean patient age was 54.2 (18-97) years, and the majority were women ( = 2635, 79.8%). A total of 3241 nodules were analyzed, 335 (10.3%) of which were malignant. Thyroid nodule location was an independent risk factor in predicting thyroid cancer ( = 0.005). Thyroid cancer odds were highest in the isthmus (odds ratio [OR] = 2.4, 95% confidence interval [CI] 1.6-3.6, < 0.0001). In a multivariate regression model adjusting for age, sex, family history of thyroid cancer, radiation exposure, nodule size, and American College of Radiology (ACR) TI-RADS (Thyroid Imaging Reporting and Data System) score, the isthmus nodules had the highest risk of malignancy (OR = 2.4 [CI 1.5-3.9], = 0.0007), followed by upper thyroid nodules (OR = 1.8 [CI 1.2-2.7], = 0.005) and then middle thyroid nodules (OR = 1.5 [CI 1.1-2.0], = 0.01) compared with lower thyroid nodules. Isthmus nodules were significantly smaller in size compared with middle ( < 0.0001) and lower ( = 0.0004), but not upper nodules ( = 0.25), with a mean size of 15.5 mm (±10.7). Thyroid nodule location is an independent risk factor in predicting the risk of thyroid cancer. Isthmic nodules carry the highest risk of cancer diagnosis and lower lobe nodules carry the lowest risk.
甲状腺结节通常通过超声进行评估。我们的目的是确定甲状腺结节的位置是否是预测甲状腺癌的有用特征。
这是一项回顾性研究，纳入了 2006 年至 2010 年来自六个转诊中心的甲状腺结节患者。共纳入 3313 例成人甲状腺结节患者，经证实良性或恶性甲状腺诊断。患者平均年龄为 54.2（18-97）岁，大多数为女性（=2635，79.8%）。共分析了 3241 个结节，其中 335 个（10.3%）为恶性。甲状腺结节位置是预测甲状腺癌的独立危险因素（=0.005）。甲状腺癌的几率在峡部最高（优势比[OR] = 2.4，95%置信区间[CI] 1.6-3.6， <0.0001）。在调整年龄、性别、甲状腺癌家族史、辐射暴露、结节大小和美国放射学院（ACR）TI-RADS（甲状腺成像报告和数据系统）评分的多变量回归模型中，峡部结节的恶性风险最高（OR = 2.4 [CI 1.5-3.9]， =0.0007），其次是上甲状腺结节（OR = 1.8 [CI 1.2-2.7]， =0.005），然后是中甲状腺结节（OR = 1.5 [CI 1.1-2.0]， =0.01）与下甲状腺结节相比。与中（ <0.0001）和下（ =0.0004）相比，峡部结节明显更小，而与上（ =0.25）相比则没有，平均大小为 15.5 mm（±10.7）。甲状腺结节位置是预测甲状腺癌风险的独立危险因素。峡部结节的癌症诊断风险最高，而下叶结节的癌症诊断风险最低。
