Indeterminate thyroid nodules (ITNs) are characterized by an expected malignancy ranging from 5% to 30%, with most patients undergoing a diagnostic, rather than therapeutic, operation. The aim of our study was to compare the approach to ITNs across different regions of the world. In this retrospective, multicentric, international study, according to the WHO classification, we identified the South East Asian Region (SEAR), the Americas Region (AMR), the Eastern Mediterranean Region (EMR), the Europe Region (EUR), and the Western Pacific Region (WPR). One high-volume thyroid centre was included for each region. Demographic, preoperative, and pathologic data were compared among the different regions. Overall, 5737 patients from five high-volume thyroid centres were included in this study. We found that the proportion of ITNs over the global activity for thyroid disease was higher in the EUR (37.6%) than in the other regions (21.1–23.6%). In the EMR, the patients were significantly younger (with a mean of 43.1 years) than in the other regions (range, 48.8–57.4 years). The proportion of lobectomy was significantly higher in the WPR, where 83.2% (114/137) of patients received this treatment, than in the other regions, where lobectomies were performed in 44.1–58.1% of patients. The pathological diagnosis of malignancy was significantly higher in the SEAR centre, being over 60%, than in centres of the other regions, where it ranged from 26.3% to 41.3%. The occurrence of lymph node metastases was higher in the WPR (27.8%), AMR (26.9%), and EMR (20%) centres than in the EUR and SEAR centres, where it was lower than 10%. In summary, we found in our study different approaches and outcomes in the diagnosis and treatment of ITNs among countries. Overall, almost 60% of patients with ITNs who underwent surgery actually presented a benign disease, potentially undergoing an unnecessary operation.
不确定甲状腺结节（ITNs）的预期恶性率在5%至30%之间，大多数患者接受的是诊断性而非治疗性手术。本研究旨在比较全球不同地区对ITNs的处理策略。这项回顾性、多中心国际研究根据世界卫生组织（WHO）分类，纳入了东南亚区域（SEAR）、美洲区域（AMR）、东地中海区域（EMR）、欧洲区域（EUR）和西太平洋区域（WPR），每个区域各选取一个高手术量甲状腺中心。比较各区域间的人口统计学、术前及病理学数据。总体纳入了来自五个高手术量甲状腺中心的5737例患者。结果显示，EUR区域ITNs占甲状腺疾病总体诊疗比例（37.6%）高于其他区域（21.1%-23.6%）。EMR区域患者平均年龄显著更低（43.1岁），其他区域患者平均年龄为48.8-57.4岁。WPR区域接受叶切除术的比例显著更高（83.2%，114/137），而其他区域该比例为44.1%-58.1%。SEAR中心病理诊断恶性比例超过60%，明显高于其他区域（26.3%-41.3%）。淋巴结转移发生率在WPR（27.8%）、AMR（26.9%）和EMR（20%）中心均高于EUR和SEAR中心（均低于10%）。本研究结果显示，各国在ITNs的诊断和治疗方面存在显著差异。总体而言，接受手术治疗的ITNs患者中近60%最终诊断为良性疾病，可能接受了不必要的手术治疗。
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