反复无法诊断的甲状腺结节:两家甲状腺诊所的经验。

IF 2.5 Q3 ENDOCRINOLOGY & METABOLISM
Filippo Egalini, Mattia Rossi, Chiara Mele, Yanina Lizet Castillo, Francesca Maletta, Barbara Puligheddu, Ezio Ghigo, Ruth Rossetto Giaccherino, Loredana Pagano, Mauro Papotti
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引用次数: 0

摘要

背景:通过细针穿刺细胞学检查(FNAc)对反复无诊断性甲状腺结节(RNDNs)进行临床管理是一个争论不休的问题,因为目前的建议和临床实践并非基于高质量的证据。我们的目的是描述 RNDNs 的特征,并评估我们中心的临床管理情况:这项回顾性观察研究纳入了 2016 年至 2020 年期间在两家意大利学术医院接受超声(US)引导 FNAc 的 319 例连续患者,这些患者之前都有细胞学非诊断性结果(TIR1)。研究人员检索了临床管理和病理数据,并由两名病理学家和内分泌学家对细胞学标本和超声检查进行了双盲审查:结果:低糜烂性结节发生 RNDNs 的风险明显更高(Odds Ratio [OR]=1.727,95% 置信区间 [CI]:1.090-2.735,P=0.02),而 10 年前发现的结节发生 RNDNs 的风险更低(OR=0.349,95% 置信区间 [CI]:0.153-0.796,P=0.01)。临床医生选择直接对多结节、中危结节(根据 AACE/AME 指南和 EUTIRADS 4 级)进行手术治疗,而对较大的结节(PConclusions:在现实生活中,RNDNs 的恶性率非常低,而且大多是长期已知的甲状腺肿,具有退行性变化,如低回声模式所示。因此,可以谨慎地假设采用临床-美国监测方法,同时对较大和美国风险较高(包括 EUTIRADS 4-5 级和 AACE/AME 中高危级别)的结节给予更多关注。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Repeatedly non-diagnostic thyroid nodules: the experience of two thyroid clinics.

Background: The clinical management of repeatedly non-diagnostic thyroid nodules (RNDNs) via fine needle aspiration cytology (FNAc) is a matter of debate because current recommendations and clinical practice are not based on high-quality evidence. Our purpose was to characterize RNDNs and evaluate their clinical management in our centers.

Methods: This retrospective observational study included 319 consecutive patients who underwent ultrasound (US-)guided FNAc in two Italian academic hospitals between 2016 and 2020 and had previous cytology non-diagnostic result (TIR1). Clinical management and anamnestic data were retrieved, and the cytological specimens and US exams were double-blindly reviewed by two pathologists and endocrinologists.

Results: The risk of RNDNs was significantly greater in hypoechogenic nodules (Odds Ratio [OR]=1.727, 95% confidence Interval [CI]: 1.090-2.735, P=0.02) and lower in nodules that had been recognized less than 10 years before (OR=0.349, 95% CI: 0.153-0.796, P=0.01). Clinicians chose to directly perform surgery on multinodular, intermediate-risk nodules (as per AACE/AME guidelines and EUTIRADS class 4), while larger (P<0.0001) and uninodular (P=0.03) lesions were further investigated with a third FNAc. Only 16 RNDNs were sent to surgery. Twelve nodules turned out to be benign goiters with a high rate of fibrosis, while only 3 were definitively malignant. However, retrospectively, all the malignant ones exhibited higher-risk ultrasound features and had an undetermined result (TIR3B) at the third cytological evaluation.

Conclusions: In a real-life context, RNDNs exhibited a very low rate of malignancy and were mostly long-known goiters with regressive changes, as suggested by a hypoechoic pattern. Consequently, a clinical-US surveillance approach could be cautiously hypothesized, while greater attention could be given to larger and higher-US-risk (both as EUTIRADS 4-5 and AACE/AME intermediate- and high-risk classes) nodules.

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