一种结合分子检测和临床变量的Nomogram方法的发展,以改善细胞学上不确定的甲状腺结节的恶性肿瘤风险评估。

IF 6.7 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Thyroid Pub Date : 2025-05-01 Epub Date: 2025-03-05 DOI:10.1089/thy.2024.0481
Jiahui Wu, Paul Stewardson, Markus Eszlinger, Moosa Khalil, Sana Ghaznavi, Erik Nohr, Adrian Box, Ralf Paschke
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引用次数: 0

摘要

背景:单独引入细胞学不确定甲状腺结节(ITNs)的分子检测(MT)并没有影响甲状腺切除术率。因此,我们评估了除MT结果外的各种临床变量的增量诊断价值,以预测ITNs中恶性肿瘤(ROM)的风险。方法:这项前瞻性观察性研究包括1024例连续的itn患者,这些患者在2020年7月30日至2023年10月30日期间接受了反射性甲状腺激素治疗。建立多变量logistic回归模型来评估组织学结果与临床变量的关系,包括通过触觉发现的结节、超声危险类别、最大结节大小、Bethesda类别、Bethesda非典型型和甲状腺spec类别。在1024例接受手术且所有变量数据完整的患者中,共有332例被纳入模型。随后,在该模型的基础上开发了一个nomogram。结果:模型的交叉验证AUC为0.831(95%置信区间为0.787 ~ 0.874)。高危突变或恶性分子标记患者发生恶性肿瘤的几率(152.79倍)明显高于突变阴性或良性分子标记患者。最大结节为50 ~ 5cm的患者恶性肿瘤的发生几率是0 ~ 2cm患者的4.34倍。核异型的存在使恶性肿瘤的发生几率增加了4.26倍,而超声诊断恶性肿瘤危险类别5比类别1-3增加了2.89倍。阳性触诊发现增加了1.83倍的几率。从回归模型估计的综合ROM与手术类型显著相关(p < 0.001)。在低ROM(0-30%)和中ROM(31-70%)类别中,仅肺叶切除术是最常见的手术(分别为61%和70%),而在高ROM (bb0 -70%)类别中,甲状腺全切除术占主导地位(62%)。结论:尽管在我们的研究人群中,MT单独在决定监测还是手术方面发挥了重要作用,但将MT结果与其他临床变量相结合可以提高ITNs的恶性风险预测。我们的研究结果强调了综合跨学科甲状腺结节诊断途径中MT结果的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Development of a Nomogram to Integrate Molecular Testing and Clinical Variables to Improve Malignancy Risk Assessment Among Cytologically Indeterminate Thyroid Nodules.

Background: The introduction of molecular testing (MT) of cytologically indeterminate thyroid nodules (ITNs) alone has not impacted thyroidectomy rates. Due to this, we evaluated the incremental diagnostic value of various clinical variables in addition to MT results, in predicting the risk of malignancy (ROM) among ITNs. Methods: This prospective observational study included 1024 consecutive ITNs that underwent reflexive ThyroSPEC MT between Jul 30, 2020, and Oct 30, 2023. A multivariable logistic regression model was built to assess the relationship between histology outcomes and clinical variables, including nodule discovery by palpation, ultrasound risk categories, maximum nodule size, Bethesda category, Bethesda atypia, and ThyroSPEC categories. A total of 332 out of 1024 patients who underwent surgery and had complete data for all variables were included in the model. A nomogram was subsequently developed based on the model. Results: The model achieved a cross-validated AUC of 0.831 (95% confidence intervals: 0.787-0.874). Patients with high-risk mutations or malignant molecular markers exhibited significantly higher odds (152.79 times) of malignancy compared to those with mutation-negative or benign molecular marker results. Patients with maximum nodule size >5 cm have 4.34 times higher odds of malignancy than those 0-2 cm. The presence of nuclear atypia increased the odds of malignancy by 4.26 times, while ultrasound malignancy risk category 5 increased the odds of malignancy by 2.89 times compared to categories 1-3. Positive palpation discovery increased the odds by 1.83 times. The integrated ROM estimated from the regression model is significantly associated with the surgery type (p < 0.001). In the low (0-30%) and intermediate ROM (31-70%) categories, lobectomy alone is the most common surgery (61% and 70%, respectively), while in the high ROM (>70%) category, total thyroidectomy dominates (62%). Conclusions: Although MT alone played an important role in decision-making regarding surveillance versus surgery in our study population, integrating MT results with additional clinical variables improved the malignancy risk prediction for ITNs. Our results highlight the importance of contextualizing MT results within an integrated interdisciplinary thyroid nodule diagnostic pathway.

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来源期刊
Thyroid
Thyroid 医学-内分泌学与代谢
CiteScore
12.30
自引率
6.10%
发文量
195
审稿时长
6 months
期刊介绍: This authoritative journal program, including the monthly flagship journal Thyroid, Clinical Thyroidology® (monthly), and VideoEndocrinology™ (quarterly), delivers in-depth coverage on topics from clinical application and primary care, to the latest advances in diagnostic imaging and surgical techniques and technologies, designed to optimize patient care and outcomes. Thyroid is the leading, peer-reviewed resource for original articles, patient-focused reports, and translational research on thyroid cancer and all thyroid related diseases. The Journal delivers the latest findings on topics from primary care to clinical application, and is the exclusive source for the authoritative and updated American Thyroid Association (ATA) Guidelines for Managing Thyroid Disease.
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