Every year in Italy, about 60,000 new cases of nodular thyroid pathology are diagnosed, of which almost 30% are cytologically indeterminate (TIR3A/3B). The risk of malignancy reported in the literature on thyroid nodules ranges from 5% to 15% for TIR3A and from 15% to 30% for TIR3B. It is suspected that these percentages are higher in practice. We performed univariate and multivariate analyses of clinical risk factors. The medical records of 291 patients who underwent surgery for cytologically indeterminate nodular thyroid disease were retrospectively reviewed. Clinical parameters and preoperative serum markers were then compared between the benign nodular thyroid disease and thyroid cancer groups. For each patient, clinical characteristics, comorbidities, neck ultrasonographic features, and histological reports were statistically analyzed using Chi-squared and Fisher’s exact tests. A total of 134 malignant neoplasms were found (46%), divided into 55 cases (35%) in the TIR3A group and 79 cases (59%) in the TIR3B group. Statistical analysis was not significant in both populations for both sex and age (TIR3Ap-value = 0.5097 andp-value = 0.1430, TIR3Bp-value = 0.5191p-value = 0.3384), while it was statistically significant in patients with TIR3A nodules associated with thyroiditis (p-value = 0.0009). In addition, the patients with TIR3A and 3B nodules were stratified by ultrasound risk for the prediction of malignancy and it was significant (p= 0.0004 andp< 0.0001). In light of these results, it emerges that surgical treatment of nodular thyroid pathology with indeterminate cytology TIR3A should always be considered, and surgery for TIR3B is mandatory.
意大利每年诊断出约6万例甲状腺结节性病变新发病例，其中近30%为细胞学不确定型（TIR3A/3B）。文献报道甲状腺结节的恶性风险率分别为：TIR3A型5%-15%，TIR3B型15%-30%。实际临床中这些比例可能更高。我们对临床危险因素进行了单变量与多变量分析，回顾性研究了291例因细胞学不确定型甲状腺结节疾病接受手术患者的病历资料，比较了良性甲状腺结节组与甲状腺癌组的临床参数及术前血清标志物。采用卡方检验与Fisher精确检验对每位患者的临床特征、合并症、颈部超声特征及组织学报告进行统计分析。 共发现134例恶性肿瘤（46%），其中TIR3A组55例（35%），TIR3B组79例（59%）。统计分析显示两组人群在性别与年龄方面均无显著差异（TIR3A组p值分别为0.5097和0.1430，TIR3B组p值分别为0.5191和0.3384），但TIR3A结节合并甲状腺炎的患者具有统计学显著性（p值=0.0009）。此外，根据超声风险对TIR3A与TIR3B结节患者进行恶性预测分层分析显示显著相关性（p值分别为0.0004和<0.0001）。基于这些结果，对于细胞学不确定型TIR3A甲状腺结节应始终考虑手术治疗，而TIR3B型结节则必须进行手术干预。
肿瘤(癌症)患者之家