From the Department of Radiology (M.C.F., C.B.B.), Department of Medicine, Division of Endocrinology, Diabetes and Hypertension (E.K.A.), and Department of Pathology (J.A.B.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02067; and University of Vermont Medical School, Burlington, Vt (M.P.P.).
Radiology. 2021 May;299(2):374-380. doi: 10.1148/radiol.2021201596. Epub 2021 Mar 2.
Background US of the thyroid bed in patients with thyroid cancer often depicts small lesions, but it is unclear whether US characteristics of lesions can help predict cancer recurrence. Purpose To determine whether size or US features of lesions in the thyroid bed after thyroidectomy in conjunction with clinical features can help predict thyroid cancer recurrence. Materials and Methods With use of a US reporting database, all patients imaged between July 2006 and June 2016 with an indication of post-thyroidectomy follow-up were retrospectively identified. Recorded data included patient demographic characteristics; date of thyroidectomy; thyroid cancer type; presence, size, and US characteristics of thyroid bed lesions; and results of fine-needle aspiration (FNA). Images were reviewed for lesions that underwent FNA. The Fisher exact test was used for analysis. Results A total of 1885 patients (mean age ± standard deviation, 48 years ± 15; 1493 female patients) underwent 5732 US examinations. Most patients (1541 of 1885 [82%]) had papillary cancer. Overall, 3163 thyroid bed lesions were reported in 5732 US examinations (40.4%). More than half of these lesions (1860 of 3163 [58.8%]) had a maximum measurement of 6 mm or greater. FNA was performed in 144 of the 3163 lesions (4.6%), of which 61 (42.4%) were malignant, 33 (22.9%) were benign, and 50 (34.7%) were nondiagnostic. Five nondiagnostic lesions eventually proved malignant. Only the presence of punctate echogenicities in the lesion (28 of 61 malignant lesions [45.9%]; three of 33 benign lesions [9%]; 12 of 50 nondiagnostic lesions [24%]; < .001) or the history of positive lymph nodes at thyroidectomy (44 of 61 malignant lesions [72.1%]; 10 of 33 benign lesions [30%]; 19 of 50 nondiagnostic lesions [38%]; < .001) were associated with malignancy. Of 3019 thyroid bed lesions that did not undergo FNA, three were malignant and 2248 showed no growth at follow-up US ranging from 6 months to 10 years and are presumed benign. Of the 1303 lesions smaller than 6 mm, only two (0.2%) were malignant. Conclusion Small lesions are commonly found in the thyroid bed after thyroidectomy, and most are likely to be benign. Lesions smaller than 6 mm with no punctate echogenicities had a minimal risk for malignancy. © RSNA, 2021 See also the editorial by Grant and Malhi in this issue.
背景 甲状腺癌患者甲状腺床的 US 常显示小病变，但尚不清楚病变的 US 特征是否有助于预测癌症复发。目的 旨在确定甲状腺床术后 US 显示的病变大小或特征与临床特征相结合，是否有助于预测甲状腺癌复发。材料与方法 利用 US 报告数据库，回顾性分析 2006 年 7 月至 2016 年 6 月间因甲状腺癌术后随访而接受 US 检查的所有患者。记录的数据包括患者的人口统计学特征、甲状腺切除术日期、甲状腺癌类型、甲状腺床病变的存在、大小和 US 特征以及细针抽吸 (FNA) 的结果。对接受 FNA 的病变进行图像回顾。采用 Fisher 确切检验进行分析。结果 共纳入 1885 例患者(平均年龄±标准差，48 岁±15 岁；1493 例女性)，共进行了 5732 次 US 检查。大多数患者(1885 例中的 1541 例[82%])患有乳头状癌。总体而言，5732 次 US 检查中共报告 3163 个甲状腺床病变(40.4%)。这些病变中超过一半(3163 个中的 1860 个[58.8%])的最大测量值为 6 mm 或更大。对 3163 个病变中的 144 个进行了 FNA(4.6%)，其中 61 个(42.4%)为恶性，33 个(22.9%)为良性，50 个(34.7%)为非诊断性。5 个非诊断性病变最终证实为恶性。仅病变内存在点状回声(61 个恶性病变中的 28 个[45.9%]；33 个良性病变中的 3 个[9%]；50 个非诊断性病变中的 12 个[24%]；<.001)或甲状腺切除术时存在阳性淋巴结史(61 个恶性病变中的 44 个[72.1%]；33 个良性病变中的 10 个[30%]；50 个非诊断性病变中的 19 个[38%]；<.001)与恶性病变相关。在未行 FNA 的 3019 个甲状腺床病变中，有 3 个为恶性，2248 个在 6 个月至 10 年的随访 US 中未见生长，推测为良性。在 1303 个小于 6 mm 的病变中，只有 2 个(0.2%)为恶性。结论 甲状腺切除术后甲状腺床常发现小病变，且大多数病变可能为良性。直径小于 6 mm 且无点状回声的病变恶性风险极小。©RSNA，2021 另见本期 Grant 和 Malhi 的社论。
