The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing, People's Republic of China.
Department of General Surgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, NO.1 Da Hua Road, Dong Dan, Beijing, 100730, People's Republic of China.
World J Surg Oncol. 2023 Feb 3;21(1):34. doi: 10.1186/s12957-023-02917-x.
The preoperative diagnosis of cytologically indeterminate thyroid nodules (ITNs) is very challenging. In this study, we aim to provide an integrated risk assessment for thyroid nodules with indeterminate cytology to guide surgical decision-making, which includes results of blood tests, molecular tests, and repeat fine-needle aspiration biopsy (FNAB).
The study retrospectively included 265 ITNs between June 2019 and April 2022. According to our integrated risk assessment process that starts with blood testing, followed by supplementary DNA mutation detection on the first FNAB, and finally repeat FNAB, we divided the ITNs into high-risk and low-risk groups. Performance was evaluated with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), area under the receiver operating characteristic curve (AUC), and the consistency between the risk evaluation and histological results.
Of the 265 ITNs, 87 were included in the risk assessment process. The risk assessment had a sensitivity of 84.1%, specificity of 83.3%, PPV of 95.1%, NPV of 57.7%, and AUC of 0.837. The nodules with consistent results between the risk groups and histological outcomes, which included malignant cases in the high-risk group and benign cases in the low-risk group, accounted for 83.9% of all risk-assessed nodules.
These data suggest that the integrated risk assessment might provide proper information for surgical decision-making in patients with ITNs.
细胞学不确定的甲状腺结节（ITNs）的术前诊断极具挑战性。本研究旨在为具有不确定细胞学结果的甲状腺结节提供综合风险评估，以指导手术决策，包括血液检查、分子检测和重复细针抽吸活检（FNAB）的结果。
本研究回顾性纳入了 2019 年 6 月至 2022 年 4 月期间的 265 例 ITNs。根据我们的综合风险评估流程，首先进行血液检查，然后对首次 FNAB 进行补充 DNA 突变检测，最后再次进行 FNAB，我们将 ITNs 分为高风险和低风险组。通过敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、受试者工作特征曲线（ROC）下面积（AUC）以及风险评估与组织学结果之间的一致性来评估性能。
在 265 例 ITNs 中，有 87 例纳入风险评估流程。风险评估的敏感性为 84.1%，特异性为 83.3%，PPV 为 95.1%，NPV 为 57.7%，AUC 为 0.837。在风险组和组织学结果一致的结节中，包括高风险组中的恶性病例和低风险组中的良性病例，占所有风险评估结节的 83.9%。
这些数据表明，综合风险评估可能为 ITNs 患者的手术决策提供适当的信息。
