Thyroid nodule shape and prediction of malignancy
Thyroid nodule shape and prediction of malignancy
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DOI：
10.1089/thy.2004.14.953
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发表时间：
2004-11-01
期刊：
影响因子：
6.6
通讯作者：
Atri, A
中科院分区：
文献类型：
--
作者：
Alexander, EK;Marqusee, E;Atri, A
背景：甲状腺结节很常见，绝大多数是良性的。术前恶性肿瘤的确定仍然不准确，尽管细针穿刺（FNA）。许多风险因素已被提出用于预测恶性肿瘤，但很少被发现有用。氧气输送是肿瘤细胞生长的重要组成部分。据推测，恶性肿瘤可能会配置其形状，以最大限度地获得当地的营养输送。从数学上讲，表面积与体积之比通过球形形状最大化。我们试图确定球形是否是恶性肿瘤的预测因子。研究方法：1995年至2000年，747例连续患者接受了993个甲状腺实性结节（囊性< 25%）的超声评估和FNA，并进行了回顾性分析。根据FNA和/或手术病理将结节分类为良性或恶性。通过计算最长与最短尺寸的比值来估计球形，并与恶性程度相关。结果：球形与恶性风险独立相关（p < 0.001）。甲状腺癌的检出率为11%，但范围从球形结节的18%到最小球形结节的5%不等。发现有可疑或中间细胞学的结节显示恶性风险的相似变化。长轴与短轴之比大于2.5是良性病变的100%预测值，尽管在我们的队列中仅存在4%。进行了前瞻性验证，并确认了一致的结果（p < 0.01）。结论：球形与甲状腺实性结节恶性率的增加有关。形状的确定可能有助于甲状腺癌的临床风险评估。
Background: Thyroid nodules are common; the vast majority benign. Preoperative determination of malignancy remains imprecise, despite fine-needle aspiration (FNA). Numerous risk factors have been proposed for predicting malignancy, though few have been found useful. Oxygen delivery is a crucial component for tumor cell growth. It has been hypothesized that malignant tumors may configure their shape to maximize access to local nutrient delivery. Mathematically, surface area to volume is maximized by a spherical shape. We sought to determine if spherical shape is a predictor of malignancy. Methods: Seven hundred forty-seven consecutive patients underwent ultrasound evaluation and FNA of 993 solid thyroid nodules (< 25% cystic) between 1995 and 2000 and were retrospectively analyzed. Nodules were classified as benign or malignant based on FNA and/or surgical pathology. Spherical shape was estimated by calculating a ratio of the longest to shortest dimensions, and rate of malignancy correlated. Results: Spherical shape was independently correlated with risk of malignancy (p < 0.001). Thyroid cancer was detected in 11% of all nodules, but ranged from 18% in spherical nodules to 5% in those least spherical. Nodules found to have suspicious or intermediate cytology showed similar variation in malignant risk. A long to short axis ratio greater than 2.5 was 100% predictive of a benign process, although present in only 4% of our cohort. A prospective validation was performed and confirmed consistent results (p < 0.01). Conclusion: Spherical shape is associated with an increased rate of malignancy in solid thyroid nodules. Determination of shape may assist in clinical risk assessment of thyroid cancer.