Mayo Clinic Arizona, Department of Surgical Oncology and Endocrine Surgery, Phoenix, Arizona.
Mayo Clinic Arizona, Department of Surgical Oncology and Endocrine Surgery, Phoenix, Arizona.
J Surg Res. 2024 Nov;303:248-253. doi: 10.1016/j.jss.2024.09.019. Epub 2024 Oct 8.
The incidence of thyroid nodules has increased as diagnostic imaging has become more prevalent, but the management in transplant candidates, a high-risk population because of the need for chronic immunosuppression, has not been described. We sought to review our institution's approach to thyroid nodules incidentally found during pretransplant workup.
A multisite retrospective review was performed of pretransplant patients with incidental thyroid nodules diagnosed between 2011 and 2021. Demographics, nodule characteristics, treatment timeline, and oncologic outcomes were collected. Patients diagnosed before and after 2017 were compared to evaluate how adoption of Thyroid Imaging Reporting and Data System and expansion of a dedicated transplant center were correlated with changes in patient management.
A total of 10,340 patients underwent abdominal transplant, 236 had incidental thyroid nodules. After 2017, radiology recommendations for biopsy decreased from 39% to 29% (P = 0.174) and fewer biopsies were performed, 45%-33% (P = 0.055). Time between imaging and biopsy was significantly shorter after 2017, from 14 mo to 4 (P = 0.038). Overall time from imaging to transplant was also significantly reduced, from 31 mo to 11 (P < 0.001). Thirty-one (13.1%) patients underwent thyroid surgery before transplant and four (1.7%) patients after.
In the recent years, thyroid biopsy rates for thyroid incidentalomas found during pretransplant workup have decreased and more closely match imaging-based guideline recommendations. Patients who required biopsy obtained them sooner and underwent transplant surgery sooner. Guideline-driven thyroid incidentaloma workup for the pretransplant population allows for timely and appropriate cancer care while avoiding unnecessary delays in transplant.
随着诊断影像学的普及，甲状腺结节的发病率有所增加，但在需要长期免疫抑制的高危人群——移植候选人中，其管理尚未得到描述。我们旨在回顾我们机构在移植前检查中偶然发现甲状腺结节的处理方法。
对 2011 年至 2021 年间诊断为偶然甲状腺结节的移植前患者进行了多站点回顾性研究。收集了人口统计学、结节特征、治疗时间线和肿瘤学结果。比较了 2017 年前后诊断的患者，以评估甲状腺成像报告和数据系统的采用以及专门的移植中心的扩展与患者管理变化的关系。
共有 10340 名患者接受了腹部移植，其中 236 名患者偶然发现了甲状腺结节。2017 年后，放射科推荐进行活检的比例从 39%降至 29%（P=0.174），活检数量也从 45%降至 33%（P=0.055）。2017 年后，影像学检查与活检之间的时间间隔明显缩短，从 14 个月缩短至 4 个月（P=0.038）。从影像学检查到移植的总时间也显著缩短，从 31 个月缩短至 11 个月（P<0.001）。31 名（13.1%）患者在移植前接受了甲状腺手术，4 名（1.7%）患者在移植后接受了手术。
近年来，移植前检查中偶然发现的甲状腺偶发瘤的甲状腺活检率有所下降，与基于影像学的指南建议更加一致。需要活检的患者更早地获得了活检，并更早地接受了移植手术。针对移植前人群的基于指南的甲状腺偶发瘤检查可以及时提供适当的癌症护理，同时避免移植不必要的延迟。
