Karagüzel G, Tanyel F C, Büyükpamukçu N, Hiçsönmez A
Department of Pediatric Surgery, Hacettepe University, School of Medicine, Ankara, Turkey.
Eur J Pediatr Surg. 1996 Apr;6(2):70-4. doi: 10.1055/s-2008-1066474.
Although thyroid surgery is mainly based on the malignancy risk, determination of cases with thyroid malignancy among the patients with enlarged thyroid is a controversial issue in children. To find out whether thyroid enlargements have any predictive clinical or laboratory characteristic for thyroid malignancy, a retrospective clinical study was scheduled. A total of 137 patients who had undergone surgery for thyroid enlargement in a 15-year period were evaluated. The series was composed of 90 (65.7%) cases with uninodular goiter, 40 (29.2%) cases with multinodular goiter and seven (5.1%) cases with diffuse goiter. Histopathologic examination showed nine (6.6%) patients with differentiated thyroid carcinoma. All the remaining patients had benign thyroid enlargements. Analysis of results showed no ideal or near-ideal predictive one for thyroid malignancies among clinical or laboratory characteristics consisting of age, sex, presumptive symptoms, previous irradiation, type of nodularity, nodule localization and size, lymphadenopathy, thyroid function tests, ultrasonography and thyroid scan. No characteristic studied had a simultaneous high level of positive and negative predictive value. Only two physical characteristics including nodule size less than 2.5 cm in diameter and lymphadenopathy had simultaneous high levels of sensitivity and specificity above 50%. Therefore new guidelines with higher predictivity should be sought for surgical evaluation of the childhood thyroid enlargements. Fine-needle aspiration biopsy that is extensively used in adults may also be an alternative approach despite some restrictive aspects in children.
尽管甲状腺手术主要基于恶性风险，但在甲状腺肿大的儿童患者中确定甲状腺恶性肿瘤病例是一个有争议的问题。为了查明甲状腺肿大是否对甲状腺恶性肿瘤具有任何预测性临床或实验室特征，安排了一项回顾性临床研究。对15年间因甲状腺肿大接受手术的137例患者进行了评估。该系列包括90例（65.7%）单结节性甲状腺肿患者、40例（29.2%）多结节性甲状腺肿患者和7例（5.1%）弥漫性甲状腺肿患者。组织病理学检查显示9例（6.6%）患者患有分化型甲状腺癌。其余所有患者均为良性甲状腺肿大。结果分析表明，在年龄、性别、推测症状、既往照射、结节类型、结节定位和大小、淋巴结病、甲状腺功能检查、超声检查和甲状腺扫描等临床或实验室特征中，没有理想的或接近理想的甲状腺恶性肿瘤预测指标。所研究的特征均未同时具有高水平的阳性和阴性预测价值。只有两个体格检查特征，包括直径小于2.5 cm的结节大小和淋巴结病，同时具有高于50%的高水平敏感性和特异性。因此，应寻求具有更高预测性的新指南用于儿童甲状腺肿大的手术评估。尽管在儿童中有一些限制因素，但在成人中广泛使用的细针穿刺活检也可能是一种替代方法。
