Risk of thyroid cancer based on thyroid ultrasound imaging characteristics: results of a population-based study.
Risk of thyroid cancer based on thyroid ultrasound imaging characteristics: results of a population-based study.
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DOI：
10.1001/jamainternmed.2013.9245
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发表时间：
2013-10-28
影响因子：
39
通讯作者：
Kornak, John
中科院分区：
文献类型：
--
作者：
Smith-Bindman, Rebecca;Lebda, Paulette;Feldstein, Vickie A.;Sellami, Dorra;Goldstein, Ruth B.;Brasic, Natasha;Jin, Chengshi;Kornak, John
在超声成像上发现的甲状腺结节的治疗方法有很大的差异。根据甲状腺结节的超声特征量化甲状腺癌的风险。对2000年1月1日至2005年3月30日期间接受甲状腺超声检查的患者进行的回顾性病例对照研究。甲状腺癌是通过与加州癌症登记处的联系确定的。在研究期间，8806例患者接受了11618次甲状腺超声检查，其中105例随后诊断为甲状腺癌。甲状腺结节常见于诊断为癌症的患者（97%）和未诊断为甲状腺癌的患者（56%）。三个超声结节特征-微钙化（比值比[OR] 8.1 [95% CI 3.8，17.3]），大小大于2 cm（OR 3.6 [95% CI 1.7，7.6]）和完全固体成分（OR 4.0 [95% CI 1.7，9.2]）-是与甲状腺癌风险相关的唯一结果。如果一个单一的特征被用作活检的指征，大多数甲状腺癌患者将被检出（灵敏度.88 [95% CI .80，.94]），假阳性率高（0.44 [95% CI 0.43，0.45]）和低似然比阳性（2.0 [95% CI 1.8，2.2]），每例诊断的癌症将进行56次活检。如果需要两个特征进行活检，则敏感性和假阳性率会更低（敏感性0.52 [95% CI 0.42，0.62];假阳性率0.07 [95% CI 0.07，0.08]），阳性似然比会更高（7.1 [95% CI 6.2，8.2]），每例确诊癌症仅进行16次活检。与对所有大于5 mm的甲状腺结节进行活检相比，采用这种要求两个异常结节特征以提示活检的更严格规则将减少90%的不必要活检，同时保持低癌症风险，每1000名患者中有5名患者推迟活检。甲状腺超声可用于识别癌症风险较低的患者，这些患者的活检可以推迟。基于这些结果，这些发现应该在一个大的前瞻性队列中得到验证。
There is wide variation in the management of thyroid nodules identified on ultrasound imaging. To quantify the risk of thyroid cancer associated with thyroid nodules based on their ultrasound characteristics. Retrospective case-control study of patients who underwent thyroid ultrasound between January 1st, 2000 and March 30th, 2005. Thyroid cancers were identified through linkage with the California Cancer Registry. 8 806 patients underwent 11 618 thyroid ultrasound examinations during the study period including 105 subsequently diagnosed with thyroid cancer. Thyroid nodules were common in patients diagnosed with cancer (97%) and patients not diagnosed with thyroid cancer (56%). Three ultrasound nodule characteristics–micro-calcifications (odds ratio [OR] 8.1 [95% CI 3.8, 17.3]), size greater than 2 cm (OR 3.6 [95% CI 1.7, 7.6]) and an entirely solid composition (OR 4.0 [95% CI 1.7, 9.2] - were the only findings associated with the risk of thyroid cancer. If a single characteristic is used as an indication for biopsy, most patients with thyroid cancer would be detected (sensitivity .88 [95% CI .80, .94]) with a high false positive rate (.44 [95% CI .43, .45]) and a low likelihood ratio positive (2.0 [95% CI 1.8, 2.2]), and 56 biopsies will be performed per cancer diagnosed. If two characteristics were required for biopsy, the sensitivity and false positive rates would be lower (sensitivity 0.52 [95% CI 0.42, 0.62]; false positive rate 0.07 [95% CI 0.07, 0.08]), the likelihood ratio positive would be higher (7.1 [95% CI 6.2, 8.2]), and only 16 biopsies will be performed per cancer diagnosed. In comparison to performing biopsy of all thyroid nodules greater than 5 mm, adoption of this more stringent rule requiring two abnormal nodule characteristics to prompt biopsy would reduce unnecessary biopsies by 90%, while maintaining a low risk of cancer, 5 per 1000 patients, for whom biopsy is deferred. Thyroid ultrasound could be used to identify patients who have a low risk of cancer for whom biopsy could be deferred. Based on these results, these findings should be validated in a large prospective cohort.
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影响因子：
6.6
作者：
Alexander, EK;Marqusee, E;Atri, A
通讯作者：
Atri, A
影响因子：
1.3
作者：
Cibas, Edmund S.;Alexander, Erik K.;Mandel, Susan J.
通讯作者：
Mandel, Susan J.
影响因子：
2.3
作者：
Das, Barnali;Clegg, Limin X.;Pickle, Linda W.
通讯作者：
Pickle, Linda W.
影响因子：
5.8
作者：
Alexander, EK;Heering, JP;Marqusee, E
通讯作者：
Marqusee, E
DOI：
10.1016/j.endonu.2010.03.006
发表时间：
2010-06-01
期刊：
Endocrinologia y nutricion : organo de la Sociedad Espanola de Endocrinologia y Nutricion
影响因子：
--
作者：
Gonzalez-Gonzalez, Abel;Mate Valdezate, Alberto;Tenias Burillo, Jose M
通讯作者：
Tenias Burillo, Jose M