Kim Haejung, Shin Jung Hee, Kim Ka Eun, Kim Myoung Kyoung, Oh Jiyun, Hahn Soo Yeon
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Ultrasonography. 2023 Apr;42(2):307-313. doi: 10.14366/usg.22096. Epub 2023 Jan 5.
This study compared the malignancy risk of intermediate suspicion thyroid nodules according to the presence of suspicious ultrasonographic (US) findings.
From January 2014 to December 2014, 299 consecutive intermediate suspicion thyroid nodules in 281 patients (mean age, 50.6±12.5 years) with final diagnoses were included in this study. Two radiologists retrospectively reviewed the US findings and subcategorized the intermediate suspicion category into nodules without suspicious findings and nodules with suspicious findings, including punctate echogenic foci, nonparallel orientation, or irregular margins. The malignancy rates were compared between the two subcategory groups.
Of the 299 intermediate suspicion thyroid nodules, 230 (76.9%) were subcategorized as nodules without suspicious findings and 69 (23.1%) as nodules with suspicious findings. The total malignancy rate was 33.4% (100/299) and the malignancy rate of nodules with suspicious findings was significantly higher than that of nodules without suspicious findings (47.8% vs. 29.1%, P=0.004). In nodules with suspicious findings, the most common suspicious finding was punctate echogenic foci (48/82, 58.5%) followed by nonparallel orientation (22/82, 26.8%) and irregular margins (12/82, 14.6%). Thirteen nodules had two suspicious findings simultaneously. A linearly increasing trend in the malignancy rate was observed according to the number of suspicious US findings (P for trend=0.001).
Intermediate suspicion thyroid nodules with suspicious findings showed a higher malignancy rate than those without suspicious findings. Further management guidelines for nodules with suspicious findings should differ from guidelines for nodules without suspicious findings, even in the same US category.
本研究根据甲状腺结节超声检查（US）可疑表现的有无，比较中度可疑甲状腺结节的恶性风险。
2014年1月至2014年12月，本研究纳入了281例最终确诊患者的299个连续的中度可疑甲状腺结节（平均年龄50.6±12.5岁）。两名放射科医生回顾性分析了超声检查结果，并将中度可疑类别细分为无可疑表现的结节和有可疑表现的结节，后者包括点状强回声灶、非平行方位或边界不规则。比较了两个亚组的恶性率。
299个中度可疑甲状腺结节中，230个（76.9%）被归类为无可疑表现的结节，69个（23.1%）为有可疑表现的结节。总恶性率为33.4%（100/299），有可疑表现的结节的恶性率显著高于无可疑表现的结节（47.8%对29.1%，P = 0.004）。在有可疑表现的结节中，最常见的可疑表现是点状强回声灶（48/82，58.5%），其次是非平行方位（22/82，26.8%）和边界不规则（12/82，14.6%）。13个结节同时有两种可疑表现。根据超声可疑表现的数量，观察到恶性率呈线性增加趋势（趋势P = 0.001）。
有可疑表现的中度可疑甲状腺结节的恶性率高于无可疑表现的结节。对于有可疑表现的结节，即使在相同的超声分类中，进一步的管理指南也应与无可疑表现的结节不同。
