对实性非典型混合回声甲状腺结节进行风险分层的挑战。

TouchREVIEWS in endocrinology Pub Date : 2024-04-01 Epub Date: 2023-11-09 DOI:10.17925/EE.2023.20.1.2
Evana Valenzuela-Scheker, David N Bimston, Hubert Golingan, Allan Golding, R Mack Harrell
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引用次数: 0

摘要

背景:目的:确定具有2015年美国甲状腺协会超声风险分层系统(NC ATA)无法分类的声像图模式的实性非典型混合回声甲状腺结节(SAMENs)的患病率和恶性风险(ROM)。研究方法我们搜索了前瞻性收集的内分泌手术甲状腺结节(TN)数据库,尤其关注那些属于 NC ATA 的实性结节。根据 2015 年美国甲状腺协会超声风险分层系统(ATA USRSS),一种算法将每个结节划分为五个 ATA 风险组之一。算法无法分配到风险组的 TN 被视为 NC ATA,随后进行分析。此外,我们还使用基于 2017 年美国放射学会甲状腺成像报告和数据系统(ACR-TIRADS)的算法对该组进行了分类。我们特别关注导致 2015 ATA USRSS 未分类的特征以及该组患者的细针穿刺活检 (FNAB) 细胞学和手术病理学结果。结果:我们评估了 5040 个结节的数据,其中 1772 个进行了手术病理检查。有150个实性结节未按2015 ATA USRSS分类,所有这些结节都表现出非典型特征,同时伴有等、异、高和混合回声(实性非典型混合回声结节-SAMENs)。其中 60 个结节被切除并送去做手术病理检查,90 个结节则没有做手术切除。在未进行手术的 90 个结节中,82 个进行了 FNAB 和细胞学评估。在我们的150例SAMEN中,40例经手术组织学检查为恶性,6例经细胞学检查可能为恶性(不伴有乳头状类核特征的非侵袭性滤泡性甲状腺肿瘤的SAMEN ROM总数占31%)。在我们的SAMEN组中,最常见的声像图模式是等回声实性成分伴微钙化(占所有切除恶性结节的28/40-70%)。在我们切除的恶性 SAMEN 中,50% 表现为滤泡型肿瘤结构,48% 表现为乳头状结构。结论我们的研究表明,SAMENs至少有一个可疑的声像图特征:包括(1)微钙化;(2)边缘不规则或其他可疑特征;opulation,且ROM(31%)高于2015 ATA USRSS的中危组(10-20%)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Challenges in Risk Stratification of Solid Atypical Mixed Echogenicity Thyroid Nodules.

Background: To determine the prevalence and risk of malignancy (ROM) in solid atypical mixed echogenicity thyroid nodules (SAMENs) with sonographic patterns not classifiable by the 2015 American Thyroid Association Ultrasound Risk Stratification System (NC ATA). Methods: We searched our prospectively collected endocrine surgery thyroid nodule (TN) database, with particular attention to those solid nodules that were NC ATA. An algorithm assigned each into one of the five ATA risk groups per the 2015 American Thyroid Association Ultrasound Risk Stratification System (ATA USRSS). TNs that the algorithm could not assign to a risk group were deemed NC ATA and were subsequently analyzed. Additionally, we categorized this group using an algorithm based on the 2017 American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS). We were specifically interested in the characteristics that resulted in non-classification by the 2015 ATA USRSS and the fine needle aspiration biopsy (FNAB) cytology and surgical pathology results from the group. Results: We evaluated data from 5,040 nodules, of which 1,772 had surgical pathology. There were 150 solid nodules not classified by 2015 ATA USRSS, all of which demonstrated atypical features along with iso-, hetero-, hyper-and mixed echogenicity (solid atypical mixed echogenicity nodules-SAMENs). Sixty of these nodules were excised and sent for surgical pathology, while 90 were followed without surgical excision. Out of the 90 that did not undergo surgery, 82 underwent FNAB with cytologic evaluation. Of our 150 SAMENs, 40 were malignant by surgical histology and six were likely malignant by cytology (total SAMEN ROM without noninvasive follicular thyroid neoplasm with papillary-l ike nuclear features 31%). The most common sonographic pattern present in our SAMEN group consisted of an isoechoic solid component with microcalcifications (28/40-70% of all excised malignant nodules). In our excised malignant SAMENs, 50% demonstrated follicular-patterned neoplastic architecture while 48% displayed papillary architecture. Conclusion: Our study demonstrates that SAMENs with at least one suspicious sonographic feature: including (1) microcalcifications; (2) irregular or other suspicious margins,;opulation, and a higher ROM (31%) than the intermediate-risk group of the 2015 ATA USRSS (10-20%).

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