Solymosi Tamas, Hegedüs Laszlo, Bodor Miklos, Nagy Endre V
Endocrinology and Metabolism Clinic, Bugat Hospital, 20 Dozsa u, H-3200 Gyöngyös, Hungary.
Department of Endocrinology, Kløvervænget 6, 5.sal, Odense University Hospital, DK-5000 Odense, Denmark.
Int J Endocrinol. 2021 Sep 27;2021:9924041. doi: 10.1155/2021/9924041. eCollection 2021.
The classification of nodules by Thyroid Imaging Reporting and Data Systems (TIRADS) is important in guiding management. Whether sensitivity in identifying thyroid cancers varies with thyroid cancer phenotype remains unclarified.
The ultrasound (US) characteristics of nodules of 26,908 nodular goiter patients were recorded. Fine-needle aspiration cytology (FNA) was performed in all nodules >1 cm irrespective of US findings ( = 25,025) and in nodules between 5 mm and 10 mm with suspicious US characteristics ( = 1,883). Of the 3281 operated cases, 221, 30, and 23 were papillary (PTC), follicular (FTC), and medullary (MTC) cancers, respectively. The US-based indication of FNA, as defined by EU-TIRADS scores, combined with lesion size, was calculated. This study design is unique in avoiding the common selection bias when TIRADS' sensitivity is tested in a cohort selected for FNA and surgery based on the same US characteristics on which TIRADS is based.
The EU-TIRADS score influences decision of FNA in the 10-20 mm range. In such nodules ( = 118), the number of suspicious features (marked hypoechogenicity, microcalcifications, irregular shape, and irregular border) per lesion was lower in FTC (0.7 ± 0.6) than in PTC (1.7 ± 1.0) or MTC (1.8 ± 0.7; < 0.02), resulting in EU-TIRADS scores of 4.1 ± 0.6, 4.8 ± 0.3, and 4.9 ± 0.2, respectively ( < 0.01). The EU-TIRADS-based FNA indication rate was lower in FTC (55.5%) compared to PTC (85.0%) and MTC (88.9%) (=0.02).
EU-TIRADS-defined suspicious US features are less common in FTC than in PTC and MTC. Therefore, a substantial number of FTCs in the 10-20 mm range escape surgery.
甲状腺影像报告和数据系统（TIRADS）对结节进行分类在指导治疗管理方面很重要。甲状腺影像报告和数据系统在识别甲状腺癌时的敏感性是否会因甲状腺癌的病理类型而异仍不明确。
记录了26908例结节性甲状腺肿患者结节的超声特征。无论超声检查结果如何，对所有直径>1cm的结节（n=25025）以及具有可疑超声特征的5-10mm结节（n=1883）均进行了细针穿刺细胞学检查（FNA）。在3281例接受手术的病例中，分别有221例、30例和23例为乳头状癌（PTC）、滤泡状癌（FTC）和髓样癌（MTC）。计算了根据欧盟TIRADS评分定义的基于超声的FNA指征，并结合病变大小。本研究设计的独特之处在于，避免了在基于与TIRADS相同的超声特征而选择进行FNA和手术的队列中测试TIRADS敏感性时常见的选择偏倚。
欧盟TIRADS评分影响10-20mm范围内FNA的决策。在这类结节（n=118）中，FTC每个病变的可疑特征（显著低回声、微钙化、不规则形状和不规则边界）数量（0.7±0.6）低于PTC（1.7±1.0）或MTC（1.8±0.7；P<0.02），导致欧盟TIRADS评分分别为4.1±0.6、4.8±0.3和4.9±0.2（P<0.01）。与PTC（85.0%）和MTC（88.9%）相比，基于欧盟TIRADS的FNA指征率在FTC中较低（55.5%）（P=0.02）。
欧盟TIRADS定义的可疑超声特征在FTC中比在PTC和MTC中少见。因此，大量直径在10-20mm范围内的FTC逃脱了手术。
