Investigating the Effect of Thyroid Nodule Location on the Risk of Thyroid Cancer
Investigating the Effect of Thyroid Nodule Location on the Risk of Thyroid Cancer
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DOI：
10.1089/thy.2019.0478
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发表时间：
2020-01-28
期刊：
影响因子：
6.6
通讯作者：
Middleton, William D.
中科院分区：
文献类型：
--
作者：
Jasim, Sina;Baranski, Thomas J.;Middleton, William D.
背景：常规超声检查甲状腺结节。我们的目的是确定甲状腺结节的位置是否是预测甲状腺癌的有用特征。材料与方法：回顾性分析2006 - 2010年6个转诊中心的甲状腺结节患者。共纳入3313例甲状腺结节确诊为良性或恶性甲状腺的成年患者。结果：患者平均年龄为54.2（18-97）岁，以女性居多（n = 2635，占79.8%）。共分析3241例结节，其中335例（10.3%）为恶性结节。甲状腺结节位置是预测甲状腺癌的独立危险因素（p = 0.005）。峡部患甲状腺癌的几率最高（优势比[OR] = 2.4, 95%可信区间[CI] 1.6 ~ 3.6, p < 0.0001）。在调整年龄、性别、甲状腺癌家族史、辐射暴露、结节大小和美国放射学会（ACR） TI-RADS（甲状腺影像学报告和数据系统）评分的多因素回归模型中，峡部结节的恶性风险最高（OR = 2.4 [CI 1.5-3.9], p = 0.0007），其次是甲状腺上部结节（OR = 1.8 [CI 1.2-2.7], p = 0.005），其次是甲状腺中部结节（OR = 1.5 [CI 1.1-2.0], p = 0.01）。峡部结节的大小明显小于中部（p < 0.0001）和下部（p = 0.0004），但与上部结节无关（p = 0.25），平均大小为15.5 mm（+/- 10.7）。结论：甲状腺结节位置是预测甲状腺癌发生的独立危险因素。峡部结节的癌症诊断风险最高，而下肺叶结节的风险最低。
Background: Thyroid nodules are routinely evaluated with ultrasound. Our aim was to determine if thyroid nodule location was a useful feature to predict thyroid cancer. Materials and Methods: Retrospective review of patients with thyroid nodules from six referral centers from 2006 to 2010. A total of 3313 adult patients with thyroid nodules and confirmed benign or malignant thyroid diagnoses were included. Results: Mean patient age was 54.2 (18-97) years, and the majority were women (n = 2635, 79.8%). A total of 3241 nodules were analyzed, 335 (10.3%) of which were malignant. Thyroid nodule location was an independent risk factor in predicting thyroid cancer (p = 0.005). Thyroid cancer odds were highest in the isthmus (odds ratio [OR] = 2.4, 95% confidence interval [CI] 1.6-3.6, p < 0.0001). In a multivariate regression model adjusting for age, sex, family history of thyroid cancer, radiation exposure, nodule size, and American College of Radiology (ACR) TI-RADS (Thyroid Imaging Reporting and Data System) score, the isthmus nodules had the highest risk of malignancy (OR = 2.4 [CI 1.5-3.9], p = 0.0007), followed by upper thyroid nodules (OR = 1.8 [CI 1.2-2.7], p = 0.005) and then middle thyroid nodules (OR = 1.5 [CI 1.1-2.0], p = 0.01) compared with lower thyroid nodules. Isthmus nodules were significantly smaller in size compared with middle (p < 0.0001) and lower (p = 0.0004), but not upper nodules (p = 0.25), with a mean size of 15.5 mm (+/- 10.7). Conclusions: Thyroid nodule location is an independent risk factor in predicting the risk of thyroid cancer. Isthmic nodules carry the highest risk of cancer diagnosis and lower lobe nodules carry the lowest risk.