Natural history of benign solid and cystic thyroid nodules
Natural history of benign solid and cystic thyroid nodules
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DOI：
10.7326/0003-4819-138-4-200302180-00010
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发表时间：
2003-02-18
影响因子：
39.2
通讯作者：
Marqusee, E
中科院分区：
文献类型：
--
作者：
Alexander, EK;Hurwitz, S;Marqusee, E
背景：甲状腺结节是常见的，最常见的是良性的。然而，良性甲状腺结节的自然病史尚不清楚。目的：利用超声检查来确定细胞学良性甲状腺结节的自然病史。设计：回顾病例系列。背景：单一三级护理诊所。参与者：所有患者均在1995年至2000年期间在超声引导下细针吸取甲状腺结节获得良性细胞学结果，并在1个月至5年后返回进行要求的随访检查。测量：在两次就诊时测量结节大小，生长定义为计算体积增加15%或更多。这些结果与检查间隔时间、年龄、性别、基线血清促甲状腺激素浓度和每个结节的囊性含量相关。结果：结节体积随时间增加(P<；0.001)。5年后体积增加15%或更多的结节的估计比例为89%。囊性结节较实性结节不易生长(P=0.01)。330个结核中的74个在第二次检查时被证实。尽管体积平均增加了69%，但74个复发结节中只有1个是恶性的。因此，结节体积的增加本身并不是恶性肿瘤的可靠预测指标。
Background: Thyroid nodules are common and most often benign. The natural history of benign thyroid nodules, however, is unclear.Objective: To determine the natural history of cytologically benign thyroid nodules using ultrasonography.Design: Retrospective case series.Setting: Single tertiary care clinic.Participants: All patients referred to the Brigham and Women's Hospital Thyroid Nodule Clinic, Boston, Massachusetts, who had benign cytologic results on ultrasonography-guided fine-needle aspiration of a thyroid nodule between 1995 and 2000 and returned for a requested follow-up examination 1 month to 5 years later.Measurements: Nodule dimensions were measured at both visits, and growth was defined as an increase in calculated volume of 15% or greater. These results were correlated with the time between examinations, age, sex, baseline serum thyroid-stimulating hormone concentration, and cystic content of each nodule.Results: Nodule volume increased over time (P < 0.001). The estimated proportion of nodules with an increase in volume of 15% or greater after 5 years was 89%. Nodules with greater cystic content were less likely to grow than solid nodules (P = 0.01). Seventy-four of the 330 nodules were reaspirated on the second visit. Despite an average increase in volume of 69%, only 1 of 74 reaspirated nodules was malignant.Conclusion: Most solid, benign thyroid nodules grow. Therefore, an increase in nodule volume alone is not a reliable predictor of malignancy.