From the Chung Shan Medical University Hospital, Department of Internal Medicine, Division of Endocrinology and Metabolism, Institute of Medicine, Taichung, Taiwan; The Chung Shan Medical University, School of Medicine, Institute of Medicine, Taichung, Taiwan; Chung Shan Medical University, Institute of Medicine, Taichung, Taiwan.
From the Chung Shan Medical University Hospital, Department of Internal Medicine, Division of Endocrinology and Metabolism, Institute of Medicine, Taichung, Taiwan; Chung Shan Medical University, Institute of Medicine, Taichung, Taiwan.
Endocr Pract. 2020 Nov;26(11):1286-1290. doi: 10.4158/EP-2020-0136.
There are conflicting data on the risk of thyroid cancer in thyroid nodules 3 cm or larger, and few such studies on this issue have been conducted in Asia. This study aimed to examine the risk of thyroid cancer in patients with thyroid nodules 3 cm or larger.
This was a 7-year retrospective study conducted in a tertiary referral hospital in Taiwan. All patients with a thyroid nodule measuring ≥3 cm who underwent thyroid operation with or without fine-needle aspiration biopsy (FNAB) were included. The prevalence rate of thyroid cancer, as well as the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and false-negative rate of FNAB for thyroid nodule ≥3 cm were also examined.
A total of 132 patients were included in this study. Thyroid cancer was detected in 19 of 132 (14.4%) thyroid nodules measuring ≥3 cm. The performance of FNAB for detecting cancer in nodules 3 cm or larger without considering other ultrasonography parameters was relatively poor with a sensitivity of 50%, but the specificity (100%), PPV (100 %), and NPV (93.4 %) were excellent.
The risk of thyroid cancer for thyroid nodules ≥3 cm in this study was low. The PPV and NPV of FNAB were high for the detection of cancer in large nodules. The decision to perform thyroidectomy should not be solely based on nodule size and should include other factors, such as ultrasound characteristics and surgical risk.
关于直径≥3cm 的甲状腺结节发生甲状腺癌的风险存在相互矛盾的数据，亚洲针对该问题的此类研究较少。本研究旨在探讨直径≥3cm 的甲状腺结节患者发生甲状腺癌的风险。
这是一项在台湾一家三级转诊医院进行的 7 年回顾性研究。所有接受≥3cm 甲状腺结节手术（伴或不伴细针抽吸活检）的患者均纳入本研究。本研究还检查了甲状腺癌的患病率，以及 FNAB 对直径≥3cm 的甲状腺结节的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和假阴性率。
本研究共纳入 132 例患者。在 132 个直径≥3cm 的甲状腺结节中，发现了 19 个甲状腺癌（14.4%）。不考虑其他超声参数，FNAB 检测直径≥3cm 结节中癌症的表现相对较差，其敏感性为 50%，但特异性（100%）、PPV（100%）和 NPV（93.4%）均很高。
本研究中直径≥3cm 的甲状腺结节发生甲状腺癌的风险较低。FNAB 对大结节中癌症的检测具有较高的 PPV 和 NPV。决定是否进行甲状腺切除术不应仅基于结节大小，还应包括其他因素，如超声特征和手术风险。
