Canu Gian Luigi, Cappellacci Federico, Abdallah Ahmed, Elzahaby Islam, Figueroa-Bohorquez David, Lori Eleonora, Miller Julie A, Pavia Sergio Zúñiga, Pinillos Pilar, Pongtippan Atcharaporn, Saleh Saleh Saleh, Sorrenti Salvatore, Sriphrapradang Chutintorn, Calò Pietro Giorgio, Medas Fabio
Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy.
Surgical Oncology, Mansoura University, Mansoura 35516, Egypt.
Cancers (Basel). 2023 Aug 7;15(15):3996. doi: 10.3390/cancers15153996.
Indeterminate thyroid nodules (ITNs) are characterized by an expected malignancy ranging from 5% to 30%, with most patients undergoing a diagnostic, rather than therapeutic, operation. The aim of our study was to compare the approach to ITNs across different regions of the world. In this retrospective, multicentric, international study, according to the WHO classification, we identified the South East Asian Region (SEAR), the Americas Region (AMR), the Eastern Mediterranean Region (EMR), the Europe Region (EUR), and the Western Pacific Region (WPR). One high-volume thyroid centre was included for each region. Demographic, preoperative, and pathologic data were compared among the different regions. Overall, 5737 patients from five high-volume thyroid centres were included in this study. We found that the proportion of ITNs over the global activity for thyroid disease was higher in the EUR (37.6%) than in the other regions (21.1-23.6%). In the EMR, the patients were significantly younger (with a mean of 43.1 years) than in the other regions (range, 48.8-57.4 years). The proportion of lobectomy was significantly higher in the WPR, where 83.2% (114/137) of patients received this treatment, than in the other regions, where lobectomies were performed in 44.1-58.1% of patients. The pathological diagnosis of malignancy was significantly higher in the SEAR centre, being over 60%, than in centres of the other regions, where it ranged from 26.3% to 41.3%. The occurrence of lymph node metastases was higher in the WPR (27.8%), AMR (26.9%), and EMR (20%) centres than in the EUR and SEAR centres, where it was lower than 10%. In summary, we found in our study different approaches and outcomes in the diagnosis and treatment of ITNs among countries. Overall, almost 60% of patients with ITNs who underwent surgery actually presented a benign disease, potentially undergoing an unnecessary operation.
甲状腺结节性质待定（ITNs）的特征是恶性概率预计在5%至30%之间，大多数患者接受的是诊断性而非治疗性手术。我们研究的目的是比较世界不同地区对ITNs的处理方式。在这项回顾性、多中心、国际性研究中，根据世界卫生组织的分类，我们确定了东南亚地区（SEAR）、美洲地区（AMR）、东地中海地区（EMR）、欧洲地区（EUR）和西太平洋地区（WPR）。每个地区纳入一个甲状腺手术量大的中心。对不同地区的人口统计学、术前和病理数据进行了比较。总体而言，本研究纳入了来自五个甲状腺手术量大的中心的5737例患者。我们发现，欧洲地区（EUR，37.6%）ITNs在全球甲状腺疾病活动中的占比高于其他地区（21.1 - 23.6%）。在东地中海地区（EMR），患者明显比其他地区的患者年轻（平均年龄43.1岁）（范围为48.8 - 57.4岁）。西太平洋地区（WPR）肺叶切除术的比例显著更高，该地区83.2%（114/137）的患者接受了这种治疗，高于其他地区，其他地区接受肺叶切除术的患者比例为44.1%至58.1%。东南亚地区（SEAR）中心恶性肿瘤的病理诊断率显著更高，超过60%，高于其他地区的中心，其他地区的诊断率在26.3%至41.3%之间。西太平洋地区（WPR，27.8%）、美洲地区（AMR，26.9%）和东地中海地区（EMR，20%）中心淋巴结转移的发生率高于欧洲地区（EUR）和东南亚地区（SEAR）中心，后两个地区低于10%。总之，我们在研究中发现不同国家对ITNs的诊断和治疗方式及结果存在差异。总体而言，几乎60%接受手术的ITNs患者实际上患的是良性疾病，可能接受了不必要的手术。
