在一个高流量中心对经细胞学诊断为滤泡性肿瘤的甲状腺肿瘤的管理:使用血清甲状腺球蛋白水平、肿瘤大小、超声检测和细胞学诊断的评分系统的实用性。

IF 1.3 4区 医学 Q4 ENDOCRINOLOGY & METABOLISM Endocrine journal Pub Date : 2024-10-29 DOI:10.1507/endocrj.EJ24-0364
Yasuhiro Ito, Makoto Kawakami, Mitsuyoshi Hirokawa, Masashi Yamamoto, Minoru Kihara, Naoyoshi Onoda, Akihiro Miya, Akira Miyauchi, Takashi Akamizu
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引用次数: 0

摘要

经细胞学诊断为滤泡性肿瘤(FN)的甲状腺结节的治疗对患者和临床医生来说都具有挑战性。最近引入了基因面板检测来确定 FN 的治疗策略,但在日本还没有这种检测方法。在本研究中,我们对 FN 的治疗进行了评估。本研究纳入了 2012 年至 2018 年期间确诊的 2067 名患者的 2,144 例 FN。其中,952 例(44.5%)肿瘤接受了积极监测,1188 例(55.6%)接受了即刻手术(IS)。年轻患者(4厘米)的肿瘤、非亲氧细胞学、细胞学结果倾向于恶性和多发性的肿瘤更常接受IS手术。在 1412 例接受手术的肿瘤中,分别有 279 例(19.8%)和 1133 例(80.2%)经病理诊断为恶性肿瘤、良性肿瘤或低危肿瘤。高 Tg 水平、非良性超声检查结果、倾向于恶性的细胞学检查结果、非单核细胞细胞学检查结果和肿瘤体积大与恶性病理相关,但肿瘤体积增大与恶性病理无关。在多变量逻辑分析中,前三者是恶性肿瘤的独立预测因素。在将有利于恶性和其他的细胞学结果分别定为 2 分和 1 分后,接受者操作特征曲线分析表明,3 分是预测恶性诊断的最佳临界值;但曲线下面积仍然很低,仅为 0.642。准确预测 FN 的恶性病理变化具有挑战性,诱导基因面板检测将有助于管理 FN 肿瘤。我们的评分系统也有助于估计恶性肿瘤的风险。
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Management of thyroid tumors diagnosed cytologically as follicular neoplasms in a high-volume center: utility of a scoring system using serum thyroglobulin level, tumor size, ultrasound testing, and cytological diagnosis.

Managing thyroid nodules diagnosed cytologically as follicular neoplasms (FN) is challenging for patients and clinicians. Gene panel testing was recently introduced to determine the management strategy for FN; however, it is unavailable in Japan. In this study, we assessed FN management. This study included 2,144 FNs from 2,067 patients diagnosed between 2012 and 2018. Of these, 952 (44.5%) tumors underwent active surveillance, and 1,188 (55.6%) underwent immediate surgery (IS). Tumors of young patients (<55 years), male patients, and patients with serum thyroglobulin (Tg) ≥500 ng/mL, ultrasound diagnoses as FN or malignancy, large tumors (>4 cm), non-oxyphilic cytology, and cytological findings favoring malignancy and multiplicity underwent IS more frequently. Of the 1,412 tumors that underwent surgery, 279 (19.8%) and 1,133 (80.2%) were pathologically diagnosed as malignant and benign tumors or low-risk neoplasms, respectively. High Tg levels, non-benign ultrasound findings, cytological findings favoring malignancy, non-oncocytic cytology, and large tumor size were related to malignant pathology; however, tumor enlargement was not. The former three were independent predictors of malignancy in the multivariate logistic analysis. After assigning scores of 2 and 1 for cytological findings favoring malignancy and others, respectively, a receiver operating characteristic curve analysis indicated a score of 3 as the optimal cutoff for predicting malignant diagnosis; however, the area under the curve remained low, at 0.642. Accurately predicting the malignant pathology of FNs is challenging, and inducing gene panel testing will be helpful for managing FN tumors. Our scoring system would also be useful in estimating the risk of malignancy.

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来源期刊
Endocrine journal
Endocrine journal 医学-内分泌学与代谢
CiteScore
4.30
自引率
5.00%
发文量
224
审稿时长
1.5 months
期刊介绍: Endocrine Journal is an open access, peer-reviewed online journal with a long history. This journal publishes peer-reviewed research articles in multifaceted fields of basic, translational and clinical endocrinology. Endocrine Journal provides a chance to exchange your ideas, concepts and scientific observations in any area of recent endocrinology. Manuscripts may be submitted as Original Articles, Notes, Rapid Communications or Review Articles. We have a rapid reviewing and editorial decision system and pay a special attention to our quick, truly scientific and frequently-citable publication. Please go through the link for author guideline.
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