Lyuman Eda, McArthur Claire
School of Medicine, University of Glasgow, Glasgow, G12 8QQ, United Kingdom.
Department of Radiology, Glasgow Royal Infirmary, Glasgow, G4 0SF, United Kingdom.
Br J Radiol. 2025 May 1;98(1169):686-692. doi: 10.1093/bjr/tqaf002.
Incidental thyroid nodules (ITNs) are found in up to 25% of CT scans. Increased use of cross-sectional imaging has contributed to the increased incidence of thyroid cancer worldwide. ITNs pose a management dilemma since nodule malignancy rate is 5%-15% but most cancers are indolent and prognosis in differentiated thyroid cancer is excellent. Study aims are to determine prevalence of ITNs ≥1 cm on CT scans, evaluate reporting practices, assess for emergence of clinically evident thyroid cancer during 13-year follow-up and assess interim nodule growth and clinical outcomes in nodules that were further investigated.
Direct image review of 1499 consecutive CT scans that included the thyroid, performed during January 2009 in a large NHS health board was performed. Clinical data up to January 2022 was analysed in 150 patients with at least 1 ITN ≥1 cm.
ITN prevalence was 11% with mean patient age 70 years and mean nodule diameter 17.5 mm. 30% of ITNs were mentioned in the CT report. During the follow-up period 11% proceeded to thyroid ultrasound, 5% fine needle aspiration, and 2% diagnostic hemithyroidectomy with no thyroid malignancy found. One hundred twenty patients (80%) were deceased by the study endpoint, none from thyroid malignancy. No patients presented with clinically evident thyroid malignancy during follow-up.
None of 150 ITN cases developed clinically evident thyroid malignancy in a 13-year follow-up period with 80% of patients deceased by the study endpoint from non-thyroid causes.
This would suggest that ITNs detected on CT do not require further investigation unless malignant appearances or significant clinical concern for thyroid malignancy.
高达25%的CT扫描中会发现意外甲状腺结节（ITN）。横断面成像的使用增加导致全球甲状腺癌发病率上升。ITN带来了管理难题，因为结节恶性率为5%-15%，但大多数癌症生长缓慢，分化型甲状腺癌的预后良好。研究目的是确定CT扫描中≥1 cm的ITN的患病率，评估报告做法，评估13年随访期间临床明显甲状腺癌的出现情况，并评估进一步检查的结节的中期生长情况和临床结局。
对2009年1月在一个大型NHS健康委员会进行的1499例连续甲状腺CT扫描进行直接图像审查。对150例至少有1个≥1 cm的ITN的患者分析了截至2022年1月的临床数据。
ITN患病率为11%，患者平均年龄70岁，结节平均直径17.5 mm。30%的ITN在CT报告中被提及。在随访期间，11%的患者进行了甲状腺超声检查，5%的患者进行了细针穿刺，2%的患者进行了诊断性半甲状腺切除术，未发现甲状腺恶性肿瘤。到研究终点时，120例患者（80%）死亡，均非死于甲状腺恶性肿瘤。随访期间没有患者出现临床明显的甲状腺恶性肿瘤。
在13年的随访期内，150例ITN病例均未发展为临床明显的甲状腺恶性肿瘤，80%的患者在研究终点时因非甲状腺原因死亡。
这表明CT检查发现的ITN除非有恶性表现或对甲状腺恶性肿瘤有重大临床担忧，否则无需进一步检查。
