Petersen Manuela, Schenke Simone A, Veit Franziska, Görges Rainer, Seifert Philipp, Zimny Michael, Croner Roland S, Kreissl Michael C, Stahl Alexander R
Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany.
Department and Institute of Nuclear Medicine, Hospital Bayreuth, 95445 Bayreuth, Germany.
J Clin Med. 2024 Jan 17;13(2):514. doi: 10.3390/jcm13020514.
To examine the applicability of the "taller than wide" (ttw) criterium for risk assessment of thyroid nodules (TNs) in primary/secondary care units and the role of thyroid scintigraphy therein.
German bicenter study performed in a setting of primary/secondary care. Patient recruitment and analysis in center A was conducted in a prospective manner. In center B, patient data were retrieved from a database that was originally generated by prospective data collection. TNs were assessed by ultrasound and thyroid scans, mostly fine needle biopsy and occasionally surgery and others. In center A, only patients who presented for the first time were included. The inclusion criterion was any TN ≥ 10 mm that had at least the following two sonographic risk features: solidity and a ttw shape. In center B, consecutive patients who had at least ttw and hypofunctioning nodules ≥ 10 mm were retrieved from the above-mentioned database. The risk of malignancy was determined according to a mixed reference standard and compared with literature data.
In center A, 223 patients with 259 TNs were included into the study. For further analysis, 200 nodules with a reference standard were available. The overall malignancy rate was 2.5% (upper limit of the 95% CI: 5.1%). After the exclusion of scintigraphically hyperfunctioning nodules, the malignancy rate increased slightly to 2.8% (upper limit of the 95% CI: 5.7%). Malignant nodules exhibited sonographic risk features additional to solidity and ttw shape more often than benign ones. In addition to the exclusion of hyperfunctioning nodules, when considering only nodules without additional US risk features, i.e., exclusively solid and ttw-nodules, the malignancy rate decreased to 0.9% (upper limit 95% CI: 3.7%). In center B, from 58 patients, 58 ttw and hypofunctioning TNs on thyroid scans with a reference standard were available. Malignant nodules from center B were always solid and hypoechoic. The overall malignancy rate of hypofunctioning and ttw nodules was 21%, with the lower limit of the 95% CI (one-sided) being 12%.
In primary/secondary care units, the lowest TIRADS categories for indicating FNB, e.g., applying one out of five sonographic risk features, may not be appropriate owing to the much lower a priori malignancy risk in TNs compared to tertiary/quaternary care units. Even the combination of two sonographic risk features, "solidity" and "ttw", may only be appropriate in a limited fashion. In contrast, the preselection of TNs according to hypofunctioning findings on thyroid scans clearly warranted FNB, even when applying only one sonographic risk criterion ("ttw"). For this reason, thyroid scans in TNs may not only be indicated to rule out hyperfunctioning nodules from FNB but also to rule in hypofunctioning ones.
探讨“高大于宽”（ttw）标准在基层/二级医疗机构甲状腺结节（TNs）风险评估中的适用性及其甲状腺闪烁扫描在此过程中的作用。
在基层/二级医疗机构环境中开展的德国双中心研究。中心A以前瞻性方式进行患者招募和分析。中心B从最初通过前瞻性数据收集生成的数据库中检索患者数据。通过超声和甲状腺扫描评估TNs，主要是细针穿刺活检，偶尔也包括手术及其他检查。在中心A，仅纳入首次就诊的患者。纳入标准为任何直径≥10 mm且至少具有以下两种超声风险特征的TN：实性和ttw形状。在中心B，从上述数据库中检索至少具有ttw且功能减退的直径≥10 mm的连续患者。根据混合参考标准确定恶性风险，并与文献数据进行比较。
在中心A，223例患者的259个TNs纳入研究。为进一步分析，有200个具有参考标准的结节。总体恶性率为2.5%（95%CI上限：5.1%）。排除闪烁扫描显示功能亢进的结节后，恶性率略有上升至2.8%（95%CI上限：5.7%）。恶性结节比良性结节更常表现出除实性和ttw形状之外的超声风险特征。除排除功能亢进结节外，仅考虑无其他超声风险特征的结节，即仅实性和ttw结节时，恶性率降至0.9%（95%CI上限：3.7%）。在中心B，从58例患者中获得了58个具有参考标准的甲状腺扫描显示ttw且功能减退的TNs。中心B的恶性结节总是实性且低回声的。功能减退和ttw结节的总体恶性率为21%，95%CI（单侧）下限为12%。
在基层/二级医疗机构中，由于与三级/四级医疗机构相比，TNs的先验恶性风险要低得多，因此用于指示FNB的最低甲状腺影像报告和数据系统（TIRADS）类别，例如应用五种超声风险特征之一，可能并不合适。即使是“实性”和“ttw”这两种超声风险特征的组合，可能也仅在有限程度上适用。相比之下，根据甲状腺扫描显示功能减退的结果对TNs进行预选显然有必要进行FNB，即使仅应用一种超声风险标准（“ttw”）。因此，对TNs进行甲状腺扫描不仅可能有助于排除FNB中的功能亢进结节，还能确定功能减退结节。
