Rano Elodie, Lin Lucien, Molinie Vincent, Sulpicy Caroline, Dorival Marie-Josée, Drak Alsibai Kinan, Nacher Mathieu, Drame Moustafa, Sabbah Nadia
Department of Endocrinology and Metabolic Diseases, University Hospital Centre Louis Domergues, F-97220 La Trinité, France.
Department of Pathology, University Hospital Centre Pierre Zobda Quitman, F-97261 Fort-de-France, France.
Cancers (Basel). 2022 May 11;14(10):2365. doi: 10.3390/cancers14102365.
The incidence of thyroid cancer is increasing worldwide. The aim of this study is to describe the epidemiological, clinical and ultrasound characteristics of malignancy in thyroid nodules and to evaluate the predictive value of the Bethesda system for thyroid cytology in the diagnosis of malignancy in an Afro-Caribbean population. We conducted a retrospective study in Martinique involving 420 patients with a diagnosis of thyroid nodules between 2011 and 2014. Of the 192/420 (45.7%) patients operated on for thyroid nodules, 9% had thyroid cancer. All patients with thyroid cancer were obese women with a mean age of 50 years. The final histological examination revealed papillary microcarcinomas in 61% of cases and papillary carcinomas in 39% of cases. Thyroid cytology alone had a low sensitivity (22.2%) and positive predictive value (15.4%) for the diagnosis of malignancy, with a good specificity (91.1%) and negative predictive value (94.2%). None of the standard ultrasound criteria of malignancy were significantly predictive of cancer, but hypoechogenicity and central vascularity were frequently found in malignant nodules. These epidemiological, clinical and ultrasound results could increase awareness and guide practitioners in their diagnostic approach and management of thyroid nodules in an Afro-Caribbean population. Bethesda system-based cytology revealed lower sensitivity in analyzing the risk of malignancy in this population. The high prevalence of papillary microcarcinomas may explain the inconclusive ultrasound and cytological results.
全球范围内甲状腺癌的发病率正在上升。本研究的目的是描述甲状腺结节恶性肿瘤的流行病学、临床和超声特征，并评估贝塞斯达甲状腺细胞学系统在非洲加勒比人群甲状腺恶性肿瘤诊断中的预测价值。我们在马提尼克岛进行了一项回顾性研究，纳入了2011年至2014年间诊断为甲状腺结节的420例患者。在因甲状腺结节接受手术的192/420例（45.7%）患者中，9%患有甲状腺癌。所有甲状腺癌患者均为肥胖女性，平均年龄50岁。最终组织学检查显示，61%的病例为微小乳头状癌，39%的病例为乳头状癌。单独的甲状腺细胞学检查对恶性肿瘤诊断的敏感性较低（22.2%），阳性预测值较低（15.4%），但特异性良好（91.1%），阴性预测值良好（94.2%）。恶性肿瘤的标准超声标准均不能显著预测癌症，但低回声和中央血管在恶性结节中较为常见。这些流行病学、临床和超声结果可提高人们的认识，并指导从业者对非洲加勒比人群甲状腺结节进行诊断和管理。基于贝塞斯达系统的细胞学检查在分析该人群恶性肿瘤风险时显示出较低的敏感性。微小乳头状癌的高患病率可能解释了超声和细胞学检查结果的不确定性。
