Li Xin, Yang Wen-Yu, Zhang Fan, Shan Rui, Mei Fang, Song Shi-Bing, Sun Bang-Kai, Chen Jing, Hu Run-Ze, Yang Yang, Yang Yi-Hang, Liu Jing-Yao, Yuan Chun-Hui, Liu Zheng
Department of General Surgery, Peking University Third Hospital, Beijing, China.
China Center for Health Development Studies, Peking University, Beijing, China.
JMIR Cancer. 2025 Jul 11;11:e73069. doi: 10.2196/73069.
Surgeons often face challenges in distinguishing between benign and malignant follicular thyroid neoplasms (FTNs), particularly small tumors, until diagnostic surgery is performed.
This study aimed to identify the size-specific predictors for the malignancy risk of FTNs preoperatively.
A retrospective cohort study was conducted at Peking University Third Hospital in Beijing, China, from 2012 to 2023. Patients with a postoperative pathological diagnosis of follicular thyroid adenoma (FTA) or follicular thyroid carcinoma (FTC) were included. FTNs were classified into small- and large-sized categories based on the cutoff value of the tumor diameter derived from spline regression, which indicated the turning point of malignancy risk. We identified the 5 most important predictors from 22 variables including demography, sonography, and hormones, using machine learning methods. We also calculated the odds ratios (OR) with 95% CI for these predictors in both small- and large-sized FTNs.
Altogether, we included 1494 FTNs, comprising 1266 FTAs and 228 FTCs. FTNs with a maximum diameter less than 3.0 cm were grouped as small-sized tumors (n=715), while those with larger diameters were categorized as large-sized tumors (n=779). In the small-sized group, tumors with macrocalcification (OR 2.90, 95% CI 1.50-5.60), those with peripheral calcification (OR 4.50, 95% CI 1.50-13.00), and those in younger patients (OR 1.33, 95% CI 1.05-1.69) showed a higher malignancy risk. In the large-sized group, tumors presenting with a nodule-in-nodule appearance (OR 3.30, 95% CI 1.30-7.90) exhibited a higher malignancy risk. In both groups, lower thyroid-stimulating hormone levels (OR 1.49, 95% CI 1.20-1.85 for small-sized FTNs; OR 1.61, 95% CI 1.37-1.96 for large-sized FTNs) and a larger mean diameter (OR 1.40, 95% CI 1.10-1.70 for small-sized FTNs; OR 1.50 95% CI 1.20-1.70 for large-sized FTNs) were associated with the malignancy risk of FTNs.
This study identified size-specific predictors for malignancy risk in FTNs, highlighting the importance of stratified prediction based on tumor size.
在进行诊断性手术之前，外科医生在区分良性和恶性甲状腺滤泡性肿瘤（FTN），尤其是小肿瘤方面常常面临挑战。
本研究旨在术前确定FTN恶性风险的大小特异性预测因素。
2012年至2023年在中国北京的北京大学第三医院进行了一项回顾性队列研究。纳入术后病理诊断为甲状腺滤泡性腺瘤（FTA）或甲状腺滤泡癌（FTC）的患者。根据样条回归得出的肿瘤直径临界值将FTN分为小尺寸和大尺寸类别，该临界值表明恶性风险的转折点。我们使用机器学习方法从包括人口统计学、超声检查和激素在内的22个变量中确定了5个最重要的预测因素。我们还计算了这些预测因素在小尺寸和大尺寸FTN中的比值比（OR）及95%置信区间（CI）。
总共纳入了1494个FTN，包括1266个FTA和228个FTC。最大直径小于3.0 cm的FTN被归为小尺寸肿瘤（n = 715），而直径较大的则被归为大尺寸肿瘤（n = 779）。在小尺寸组中，有粗大钙化的肿瘤（OR 2.90，95% CI 1.50 - 5.60）、有周边钙化的肿瘤（OR 4.50，95% CI 1.50 - 13.00）以及年轻患者的肿瘤（OR 1.33，95% CI 1.05 - 1.69）显示出较高的恶性风险。在大尺寸组中，呈现结节内结节外观的肿瘤（OR 3.30，95% CI 1.30 - 7.90）表现出较高的恶性风险。在两组中，较低的促甲状腺激素水平（小尺寸FTN的OR 1.49，95% CI 1.20 - 1.85；大尺寸FTN的OR 1.61，95% CI 1.37 - 1.96）和较大的平均直径（小尺寸FTN的OR 1.40，95% CI 1.10 - 1.70；大尺寸FTN的OR 1.50，95% CI 1.20 - 1.70）与FTN的恶性风险相关。
本研究确定了FTN恶性风险的大小特异性预测因素，强调了基于肿瘤大小进行分层预测的重要性。
