The Impact of Hashimoto Thyroiditis on Thyroid Nodule Cytology and Risk of Thyroid Cancer
The Impact of Hashimoto Thyroiditis on Thyroid Nodule Cytology and Risk of Thyroid Cancer
复制标题
DOI：
10.1210/js.2018-00427
复制
发表时间：
2019-04-01
影响因子：
4.1
通讯作者：
Alexander, Erik K.
中科院分区：
文献类型：
--
作者：
de Morais, Nathalie Silva;Stuart, Jessica;Alexander, Erik K.
背景：桥本甲状腺炎（HT）对甲状腺癌风险的影响及其准确检测仍不清楚。慢性淋巴细胞浸润的存在提供了一种可能改变肿瘤转化的逻辑机制，同时也影响诊断评估的准确性。方法：我们对 1995 年至 2017 年间接受结节评估的 9851 名连续患者进行了前瞻性队列分析，这些患者有 21,397 个 >1 cm 的结节。HT 的定义包括 (i) 升高 甲状腺过氧化物酶抗体 (TPOAb) 水平和/或 (ii) 超声检查发现弥漫性异质性，和/或 (iii) 组织病理学发现弥漫性淋巴细胞性甲状腺炎。确定了 HT 对细胞学分布以及最终对恶性肿瘤风险的影响。结果：共有 2651 名患者 (27%) 被诊断为 HT，并对 3895 个 HT 结节和 10,168 个非 HT 结节进行了活检。 HT 组与非 HT 组的不确定性和恶性细胞学患病率较高（不确定性：分别为 26.3% vs 21.8%，P < 0.001；恶性：分别为 10.0% vs 6.4%，P < 0.001）。最终，在 HT 情况下，任何结节被证明为恶性的风险显着升高（相对风险，1.6；95% CI，1.44 至 1.79；P < 0.001），并且当单独分析单发或多发结节患者时，该风险保持不变（HT 与非 HT：单发 24.5% vs 16.3%；22.1% vs 15.4%）多结节; 0.01).结论：HT 会增加任何接受结节评估的患者患甲状腺恶性肿瘤的风险。评估时应使用弥散性超声检查异质性和/或 TPOAb 阳性进行风险评估。版权所有 (C) 2019 内分泌学会
Context: The impact of Hashimoto thyroiditis (HT) on the risk of thyroid cancer and its accurate detection remains unclear. The presence of a chronic lymphocytic infiltration imparts a logical mechanism potentially altering neoplastic transformation, while also influencing the accuracy of diagnostic evaluation.Methods: We performed a prospective, cohort analysis of 9851 consecutive patients with 21,397 nodules >1 cm who underwent nodule evaluation between 1995 and 2017. The definition of HT included (i) elevated thyroid peroxidase antibody (TPOAb) level and/or (ii) findings of diffuse heterogeneity on ultrasound, and/or (iii) the finding of diffuse lymphocytic thyroiditis on histopathology. The impact of HT on the distribution of cytology and, ultimately, on malignancy risk was determined.Results: A total of 2651 patients (27%) were diagnosed with HT, and 3895 HT nodules and 10,168 non-HT nodules were biopsied. The prevalence of indeterminate and malignant cytology was higher in the HT vs non-HT group (indeterminate: 26.3% vs 21.8%, respectively, P < 0.001; malignant: 10.0% vs 6.4%, respectively, P < 0.001). Ultimately, the risk of any nodule proving malignant was significantly elevated in the setting of HT (relative risk, 1.6; 95% CI, 1.44 to 1.79; P < 0.001), and was maintained when patients with solitary or multiple nodules were analyzed separately (HT vs non-HT: 24.5% vs 16.3% solitary; 22.1% vs 15.4% multinodular; P < 0.01).Conclusion: HT increases the risk of thyroid malignancy in any patient presenting for nodule evaluation. Diffuse sonographic heterogeneity and/or TPOAb positivity should be used for risk assessment at time of evaluation. Copyright (C) 2019 Endocrine Society