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Clinical utility of sonographic features in indeterminate pediatric thyroid nodules.

超声特征在不确定儿童甲状腺结节中的临床应用。

  • 影响因子:5.04
  • DOI:10.1530/EJE-20-1480
  • 作者列表:"Richman DM","Cherella CE","Smith JR","Modi BP","Zendejas B","Frates MC","Wassner AJ
  • 发表时间:2021-05-01
Abstract

Objective:Surgical resection is recommended for cytologically indeterminate pediatric thyroid nodules due to their intermediate malignancy risk. We evaluated the utility of ultrasound characteristics for refining malignancy risk to inform the management of these nodules. Design:Retrospective cohort study (2004-2019). Methods:We analyzed consecutive thyroid nodules with indeterminate fine-needle aspiration cytology (Bethesda category III, IV, or V) in pediatric patients (<19 years). We assessed the association of demographic and sonographic characteristics with malignancy risk among all indeterminate nodules and within each Bethesda category. Results:Eighty-seven cytologically indeterminate nodules were identified in 78 patients. Bethesda category was III in 56 nodules (64%), IV in 12 (14%), and V in 19 (22%). The malignancy rate was 46/87 (53%) overall, and 23/56 (41%), 8/12 (75%), and 15/19 (79%) in Bethesda III, IV, and V nodules, respectively. Malignancy rate was higher in solitary nodules (67% vs 37%, P = 0.004) and nodules with irregular margins (100% vs 44%, P < 0.001) or calcifications (82% vs 43%, P = 0.002). American College of Radiology Thyroid Imaging, Reporting and Data System (ACR TI-RADS) risk level TR5 was associated with a higher rate of malignancy than lower TI-RADS risk levels (80% vs 42%, P = 0.002). Within individual Bethesda categories, TI-RADS risk level was not associated with malignancy. No sonographic feature had a negative predictive value for malignancy greater than 80%. Conclusions:In pediatric thyroid nodules with indeterminate cytology, some sonographic features - including higher ACR TI-RADS risk level - are associated with malignancy, but these associations are unlikely to alter clinical management in most cases.

摘要

目的: 对于细胞学不确定的儿童甲状腺结节,由于其中间恶性风险,推荐手术切除。我们评估了超声特征对改善恶性肿瘤风险的效用,以告知这些结节的管理。 设计: 回顾性队列研究 (2004-2019)。 方法: 我们分析了在儿科患者 (<19岁) 中使用不确定细针穿刺细胞学检查 (Bethesda类别III、IV或V) 的连续甲状腺结节。我们评估了所有不确定结节和每个贝塞斯达类别内的人口统计学和超声特征与恶性肿瘤风险的相关性。 结果: 在78例患者中发现了87个细胞学不确定的结节。Bethesda分类在56个结节中为III (64%),IV为12 (14%),V为19 (22%)。总体恶性率为46/87 (53%),贝塞斯达III、IV和V结节的恶性率分别为23/56 (41%) 、8/12 (75%) 和15/19 (79%)。孤立性结节 (67% vs 37%,P = 0.004) 和边缘不规则结节 (100% vs 44%,P <0.001) 或钙化结节 (82% vs 43%,P = 0.002) 的恶性率较高。美国放射学会甲状腺成像、报告和数据系统 (ACR ti-rads) 风险水平TR5与较低ti-rads风险水平的恶性肿瘤发生率相关 (80% vs 42%,P = 0.002)。在个体贝塞斯达类别中,ti-rads风险水平与恶性肿瘤无关。没有超声特征对恶性肿瘤的阴性预测值大于80%。 结论: 在细胞学不确定的儿童甲状腺结节中,一些超声特征 (包括较高的ACR ti-rads风险水平) 与恶性肿瘤相关,但这些相关性在大多数情况下不太可能改变临床治疗。

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