Letter to the Editor: Sensitivity of Palpation for Detection of Thyroid Nodules with Attention to Size.
Letter to the Editor: Sensitivity of Palpation for Detection of Thyroid Nodules with Attention to Size.
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致编辑的信：触诊检测甲状腺结节的敏感性，注意尺寸。
DOI：
10.1089/thy.2021.0692
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Francis,DavidO
中科院分区：
文献类型：
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作者：
Hsiao,Vivian;Arroyo,Natalia;Fernandes-Taylor,Sara;Chiu,AlexanderS;Davies,Louise;Francis,DavidO
甲状腺触诊是医学院常规教授的一项检查技能，并且仍然是初级保健，专科护理和牙科健康维护访视中体格检查的标准部分（1）。一般来说，甲状腺触诊旨在检测潜在的恶性结节。触诊在识别甲状腺结节方面的有效性以及结节大小如何影响检查的灵敏度尚不明确。据报道，在无症状人群中，甲状腺结节可触及4-7%，超声可检测到高达50-70%（2）。也有一个显着的假阳性率（触诊可能的结节与超声相关）为68%（1）。我们通过MEDLINE的PubMed界面检索了1985年至今的英文科学文献，以寻找患者独立接受甲状腺临床检查和超声评估的研究。识别并审查了1991年至1998年间发表的6篇文章（3-8）。两名独立的评审员（NA和VH）从这些研究中提取数据，通过协商一致解决分歧。总结了个体研究的甲状腺结节大小类别，以估计临床检查检测甲状腺结节的灵敏度（表1）。总体而言，21.3-58.1%的超声可检测甲状腺结节是可触及的，尽管数据很少，只有两项研究提供了按大小的颗粒结果（3，8）。审查数据显示，48.1-57.6%的大结节（> 2 cm）在临床检查中未检出。随着结节大小的减小，敏感性变差;颈部检查仅发现6.3-16.7%的结节< 1 cm。值得一提的是结节可检测性的潜在修正因素。首先，所有六项研究都是在1991年至1998年之间发表的，当时触诊是甲状腺发现的主要检测方式。其次，操作者的经验影响检查的准确性。这些研究中的检查者包括全科医生、内科医生、外科医生和具有不同水平甲状腺疾病专业知识的委员会认证的内分泌学家（表1）。第三，其他因素，包括颈围、肥胖、性别和结节在甲状腺内的位置，在这些研究中没有考虑，影响结节可触及的可能性。最后，我们受限于每个大小类别的相对较小的亚组，并且并非所有研究都检查了所有大小类别。甲状腺结节触诊在检测其他无症状结节时有很高的假阴性率，并且许多被认为是结节的发现与超声检查无关[1]。因此，甲状腺的体检作为结节的筛查试验仅具有有限的效用。这些发现应被视为甲状腺诊断算法，并随着时间的推移审查体格检查的目的和目标。
Palpation of the thyroid is an examination skill rou-tinely taught in medical school and remains a standard part of the physical examination in primary care, specialty care, and dental health maintenance visits (1). In general, thyroid palpation is intended to detect potentially malignant nodules. It is not well established how effective palpation is at identifying thyroid nodules, and how nodule size affects the sensitivity of the examination. Thyroid nodules are reportedly palpable in 4–7% in the asymptomatic population and can be detected in up to 50–70% by ultrasound (2). There is also a significant false positive rate (palpation of a possible nodule without a correlate on ultrasound) of 68%(1). We searched the scientific literature through the PubMed interface of MEDLINE for English-language scientific articles from 1985 to present for studies in which patients underwent both thyroid clinical examination and ultrasonographic assessment independently. Six articles published between 1991 and 1998 were identified and reviewed (3–8). Two independent reviewers (NA and VH) extracted data from these studies, with disagreements resolved by consensus. Thyroid nodule size categories from individual studies were summarized to estimate the sensitivity of clinical examination in detecting thyroid nodules (Table 1). In all, 21.3–58.1% of ultrasound detectable thyroid nodules were palpable, though data are sparse, with only two studies providing granular results by size (3, 8). Reviewed data showed that 48.1–57.6% of large (> 2 cm) nodules were not detected on clinical examination. Sensitivity worsened as nodule size decreased; only 6.3–16.7% of nodules< 1 cm were found on neck examination. Potential modifying factors for nodule detectability are worth mentioning. First, all six studies were published between 1991 and 1998, an era when palpation was the main detection modality for thyroid findings. Second, operator experience affects examination accuracy. Examiners in these studies included general practitioners, internists, surgeons, and board-certified endocrinologists with varying levels of expertise in thyroid disease (Table 1). Third, other factors including neck girth, obesity, sex, and position of the nodule within the thyroid were not considered in these studies and affect the likelihood of a nodule being palpable. Finally, we were limited by the relatively small subgroups for each size category, and not all size categories were examined in all studies.Thyroid nodule palpation has a high false negative rate in detecting otherwise asymptomatic nodules, and many findings thought to be nodules have no sonographic correlate (1). Thus, physical examination of the thyroid gland has only limited utility as a screening test for nodules. These findings should be considered as thyroid gland diagnostic algorithms and physical examination purposes and goals are reviewed over time.