Rates of Detecting Thyroid Nodules Recommended for Biopsy with Ultrasound: Are All Indications Equal?
Rates of Detecting Thyroid Nodules Recommended for Biopsy with Ultrasound: Are All Indications Equal?
复制标题
DOI：
10.1089/thy.2023.0234
复制
发表时间：
2023-12-01
期刊：
影响因子：
6.6
通讯作者：
Chiu，Alexander S.
中科院分区：
文献类型：
--
作者：
Kennedy，Elena;Zhang，Yanchen;Chiu，Alexander S.
背景：甲状腺超声的使用逐年增加，增加了成本并导致临床不相关结节的过度检测。我们调查了哪些适应症最常促使转诊进行甲状腺超声检查，以及不同适应症的诊断效用。方法：我们对 2017 年至 2019 年在一家三级学术中心接受初次专门甲状腺超声检查的成年人（≥18 岁）进行了一项回顾性观察队列研究。转诊的指定原因分为疑似可触及结节（SPN）、压迫症状（CS）、代谢症状（MS）、高危因素筛查、其他影像学偶然发现的随访以及综合因素。根据适应症比较超声检查中可识别结节和建议活检结节的百分比。使用单独的逻辑回归模型来确定与发现任何结节和活检建议结节相关的因素。 结果：在纳入的 1739 名患者中，甲状腺超声最常见的指征是 SPN (40%)，其次是偶然成像 (28%)、CS (13%)、组合 (11%)、MS (6%) 和高危因素 (2%)。总体而言，62% 的超声检查发现了结节。偶然发现的超声检查结节识别率最高 (94%)，而 SPN、CS 和 MS 的结节识别率分别为 55%、39% 和 43% (p<0.05)。只有 27% 的超声检查发现了建议活检的结节。偶然发现的结节推荐活检结节的比例最高，为 55%。 SPN、CS 和 MS 推荐活检结节的比例分别为 21%、6% 和 10%。 Logistic 回归表明，与转诊至 SPN 的患者相比，那些偶发结节的患者在超声检查中发现结节的可能性高出 10 倍（优势比 [OR] = 10.6 [CI 7.0–16.0]），而那些转诊至 CS 的患者出现结节的可能性只有一半（OR = 0.5 [CI 0.4–0.7]）。类似的因素与活检建议结节的识别相关。结论：在所有新的专用甲状腺超声检查中，只有四分之一发现了活检建议的结节，近 40% 根本没有发现结节。值得注意的是，只有 55% 的 SPN 超声检查发现了结节。 CS 和 MS 超声检测结节的比率最低。就何时进行甲状腺超声检查提供明确的指导可以帮助减少不必要的医疗保健利用和潜在的过度治疗。
Background:The use of thyroid ultrasound increases yearly, adding to costs and overdetection of clinically irrelevant nodules. We investigated which indications most commonly prompt referral for thyroid ultrasound and the diagnostic utility by indication.Methods:We performed a retrospective observational cohort study of adults (≥18 years) undergoing an initial dedicated thyroid ultrasound between 2017 and 2019 at a tertiary academic center. Indicated reasons for referral were categorized into suspected palpable nodule (SPN), compressive symptoms (CS), metabolic symptoms (MS), screening due to high-risk factors, follow-up of incidental finding on other imaging, and combination of factors. Percentage of ultrasounds with an identifiable nodule and with a nodule recommended for biopsy was compared by indication. Separate logistic regression models were used to identify factors associated with finding any nodule and a biopsy-recommended nodule.Results:Among the 1739 patients included, the most common indication for thyroid ultrasound was SPN (40%), followed by incidental imaging (28%), CS (13%), combination (11%), MS (6%), and high-risk factors (2%). Overall, 62% of ultrasounds identified a nodule. Ultrasounds performed for incidental findings had the highest rate of nodule identification (94%), compared with 55%, 39%, and 43%, for SPN, CS, and MS, respectively (p< 0.05). Only 27% of ultrasounds identified a biopsy-recommended nodule. Nodules found incidentally had the highest rate of biopsy-recommended nodules at 55%. Rates of biopsy-recommended nodules for SPN, CS, and MS were 21%, 6%, and 10%, respectively. Logistic regression demonstrated that compared with patients referred for an SPN, those with incidental nodules were 10 times more likely to have a nodule found on ultrasound (odds ratio [OR] = 10.6 [CI 7.0–16.0]), while those referred for CS were half as likely to have a nodule (OR = 0.5 [CI 0.4–0.7]). Similar factors were associated with identification of biopsy-recommended nodules.Conclusions:Of all new dedicated thyroid ultrasounds, only a quarter find biopsy-recommended nodules, and nearly 40% do not identify a nodule at all. Notably, only 55% of ultrasounds done for SPN found a nodule. Ultrasound for CS and MS had the lowest rates of detecting nodules. Providing clear guidance on when to order thyroid ultrasounds can help reduce unnecessary health care utilization and potential overtreatment.