Thyroid incidentalomas: Management approaches to nonpalpable nodules discovered incidentally on thyroid imaging
Thyroid incidentalomas: Management approaches to nonpalpable nodules discovered incidentally on thyroid imaging
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DOI：
10.7326/0003-4819-126-3-199702010-00009
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发表时间：
1997-02-01
影响因子：
39.2
通讯作者：
Gharib, H
中科院分区：
文献类型：
--
作者：
Tan, GH;Gharib, H
背景资料：高灵敏度成像技术的引入使甲状腺中许多不可触及的结节或“偶发瘤”的发现成为可能。这些病变的发现引起了人们对其恶性程度的关注，但处理这些病变的最佳策略尚未明确建立。目的：回顾关于偶发瘤的证据，包括恶性肿瘤的患病率和风险，并为评估和治疗提供建议。数据来源：文献检索过去15年在主要英文医学期刊上发表的相关文章，回顾在此期间之前发表的选定文章，研究选择：包括3项尸检结果研究，11项超声检查结果研究，以及其他关于未触及甲状腺结节的报告。数据提取：关于尸检和超声系列中结节患病率的数据，触诊与超声检查的比较，照射腺体中发现的结节的恶性风险，甲状腺结节的自然史，资料综合：尸检资料显示甲状腺偶发瘤的发病率为30%~ 60%。比较临床触诊与甲状腺成像的研究显示，患病率为13%至50%。对随机选择的患者进行的前瞻性研究报告了19%至67%的患病率。在未照射的腺体中发现的无症状结节的恶性风险为0.45%至13%（平均值+/- SD，3.9% +/- 4.1%）。结论：高分辨率超声是敏感的，能够检测到许多小的，不可触及的甲状腺结节。这些病变大多数是良性的。对于大多数甲状腺成像偶然发现的不可触及结节的患者，简单的随访颈部触诊就足够了。
Background: The introduction of highly sensitive imaging techniques has made it possible to detect many nonpalpable nodules, or ''incidentalomas,'' in the thyroid. Discovery of these lesions raises concerns about their malignancy, but the optimal strategy for managing these lesions has not been clearly established.Purpose: To review evidence about incidentalomas, including prevalence and risk for malignancy, and to provide recommendations for their evaluation and treatment.Data Sources: Literature searches for relevant articles published in the past 15 years in major English-language medical journals, review of selected articles published before this period, and reviews of bibliographies in textbooks.Study Selection: Three studies on autopsy findings, 11 studies on ultrasonographic findings, and other reports on nonpalpable thyroid nodules were included.Data Extraction: Data on the prevalence of nodules on autopsy and in ultrasonographic series, palpation compared with ultrasonography, the risk for malignancy in nodules found in irradiated glands, the natural history of thyroid nodules, and the prevalence of occult cancer were collated and reviewed.Data Synthesis: Prevalence of thyroid incidentalomas estimated from autopsy studies ranges from 30% to 60%. Studies comparing clinical palpation with thyroid imaging show a prevalence of 13% to 50%. Prospective studies of randomly selected patients have reported a prevalence of 19% to 67%. The risk for malignancy in asymptomatic nodules found in nonirradiated glands is 0.45% to 13% (mean +/- SD, 3.9% +/- 4.1%).Conclusions: High-resolution ultrasonography is sensitive and capable of detecting many small, nonpalpable thyroid nodules. Most of these lesions are benign. For most patients with nonpalpable nodules that are incidentally detected by thyroid imaging, simple follow-up neck palpation is sufficient.