Evaluation of Diagnostic Performance of Screening Thyroid Ultrasonography and Imaging Findings of Screening-Detected Thyroid Cancer
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose The purpose of this study was to evaluate the diagnostic performance and cost of screening thyroid ultrasonography (US) in an asymptomatic population and determine the US features of screening-detected thyroid cancer. Materials and Methods This study included 1,845 asymptomatic participants who underwent screening thyroid US between March and August 2012 at the screening center in our hospital. We evaluated the diagnostic performance of screening thyroid US for thyroid cancer and the average cost of diagnosis for each patient. We also determined the characteristic US features of screeningdetected thyroid cancer. Results Of the 1,845 subjects, 661 showed no abnormalities, 1,155 exhibited benign thyroid nodules, and 29 exhibited thyroid cancer. Imaging features such as solid composition, hypoechogenicity, taller-than-wide axis, and ill-defined or spiculated margins of nodules were suggestive of malignancy. The rate of detection of cancer was 1.6% (29/1,845), and the sensitivity, specificity, and positive and negative predictive values were 100% (18/18), 98.7% (1,051/1,065), 56.3% (18/32), and 100% (1,051/1,051), respectively. Of 18 patients who underwent thyroidectomy, three (16.7%) had a pathological tumor staging of T3, and four (22.2%) had a pathological nodal staging of N1a. The average cost of diagnosis for each patient with cancer was $7,319. Conclusion Screening thyroid US exhibited a good diagnostic performance, with a feasible social cost of use. This modality demonstrated significant differences in sonographic features between screening-detected cancer and benign nodules.
Abstract
Purpose The purpose of this study was to evaluate the diagnostic performance and cost of screening thyroid ultrasonography (US) in an asymptomatic population and determine the US features of screening-detected thyroid cancer. Materials and Methods This study included 1,845 asymptomatic participants who underwent screening thyroid US between March and August 2012 at the screening center in our hospital. We evaluated the diagnostic performance of screening thyroid US for thyroid cancer and the average cost of diagnosis for each patient. We also determined the characteristic US features of screeningdetected thyroid cancer. Results Of the 1,845 subjects, 661 showed no abnormalities, 1,155 exhibited benign thyroid nodules, and 29 exhibited thyroid cancer. Imaging features such as solid composition, hypoechogenicity, taller-than-wide axis, and ill-defined or spiculated margins of nodules were suggestive of malignancy. The rate of detection of cancer was 1.6% (29/1,845), and the sensitivity, specificity, and positive and negative predictive values were 100% (18/18), 98.7% (1,051/1,065), 56.3% (18/32), and 100% (1,051/1,051), respectively. Of 18 patients who underwent thyroidectomy, three (16.7%) had a pathological tumor staging of T3, and four (22.2%) had a pathological nodal staging of N1a. The average cost of diagnosis for each patient with cancer was $7,319. Conclusion Screening thyroid US exhibited a good diagnostic performance, with a feasible social cost of use. This modality demonstrated significant differences in sonographic features between screening-detected cancer and benign nodules.
참고문헌 (30)
- Vander JB, "The significance of nontoxic thyroid nodules. Final report of a 15-year study of the incidence of thyroid malignancy", Ann Intern Med., 69, pp.537~540 (1968)[DOI]
- Ezzat S, "Thyroid incidentalomas: prevalencee by palpation and ultrasonography", Arch Intern Med, 154, pp.1838~1840 (1994)[DOI]
- Mortensen JD, "Gross and micro-scopic findings in clinically normal thyroid glands", J Clin Endocrinol Metab, 15, pp.1270~1280 (1955)[DOI]
- Watters DA, "Role of ultrasound in the management of thyroid nodules", Am J Surg, 164, pp.654~657 (1992)[DOI]
- Steele SR, "The significance of incidental thyroid abnormalities identified during carotid duplex ultrasonography", Arch Surg, 140, pp.981~985 (2005)[DOI]
- Frates MC, "Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement", Radiology, 237, pp.794~800 (2005)[DOI]
- Kilfoy BA, "International patterns and trends in thyroid cancer incidence, 1973-2002", Cancer Causes Control, 20, pp.525~531 (2009)[DOI]
- Davies L, "Increasing incidence of thyroid cancer in the United States, 1973-2002", JAMA, 295, pp.2164~2167 (2006)[DOI]
- Ahn HS, "Korea's thyroid-cancer "epidemic": screening and overdiagnosis", N Engl J Med, 371, pp.1765~1767 (2014)[DOI]
- Chen AY, "Increasing incidence of differentiated thyroid cancer in the United States, 1988-2005", Cancer, 115, pp.3801~3807 (2009)[DOI]
- Morris LG, "Improved detection does not fully explain the rising incidence of well-differentiated thyroid cancer: a population-based analysis", Am J Surg, 200, pp.454~461 (2010)[DOI]
- Wartofsky L, "Increasing world incidence of thyroid cancer: increased detection or higher radiation exposure?", Hormones(Athens), 9, pp.103~108 (2010)
- 정규원, "Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2012", Cancer Research and Treatment, 47(2), pp.127~141 (2015), 대한암학회[DOI]
- 이가희, "갑상선암 검진 권고안", 대한의사협회지, 58(4), pp.302~312 (2015), 대한의사협회[DOI]
- Kim JY, "Radiologic and pathologic findings of nonpalpable thyroid carcinomas detected by ultrasonography in a medical screening center", J Ultrasound Med, 27, pp.215~223 (2008)[DOI]
- 최윤정, "Prevalence of Thyroid Cancer at a Medical Screening Center: Pathological Features of Screen-detected Thyroid Carcinomas", Yonsei Medical Journal, 49(5), pp.748~756 (2008), 연세대학교의과대학
- Liel Y, "Screening without evidence of efficacy: thyroid ultrasonography is another example", BMJ, 328, pp.521~ (2004)
- 문원진, "Ultrasonography and the Ultrasound-Based Management of Thyroid Nodules: Consensus Statement and Recommendations", Korean Journal of Radiology, 12(1), pp.1~14 (2011), 대한영상의학회
- Cibas ES, "The Bethesda System For Reporting Thyroid Cytopathology", Am J Clin Pathol, 132, pp.658~665 (2009)[DOI]
- Kang HW, "Prevalence, clinical and ultrasonographic characteristics of thyroid incidentalomas", Thyroid, 14, pp.29~33 (2004)[DOI]
- Haugen BR, "2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer", Thyroid, 26, pp.1~133 (2016)[DOI]
- Russ G, "Thyroid incidentalomas: epidemiology, risk stratification with ultrasound and workup", Eur Thyroid J, 3, pp.154~163 (2014)[DOI]
- Nam-Goong IS, "Ultrasonography-guided fine-needle aspiration of thyroid incidentaloma: correlation with pathological findings", Clin Endocrinol (Oxf), 60, pp.21~28 (2004)[DOI]
- Kim DW, "Sonographic differentiation of asymptomatic diffuse thyroid disease from normal thyroid: a prospective study", AJNR Am J Neuroradiol, 31, pp.1956~1960 (2010)[DOI]
- Berg WA, "Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer", JAMA, 299, pp.2151~2163 (2008)[DOI]
- Moon HJ, "Comparison of cancer yields and diagnostic performance of screening mammography vs. supplemental screening ultrasound in 4394 women with average risk for breast cancer", Ultraschall Med, 36, pp.255~263 (2015)
- Solares CA, "Occult papillary thyroid carcinoma in postmortem species: prevalence at autopsy", Am J Otolaryngol, 26, pp.87~90 (2005)[DOI]
- Neuhold N, "Latent carcinoma of the thyroid in Austria: a systematic autopsy study", Endocr Pathol, 12, pp.23~31 (2001)[DOI]
- Lee J, "Frequent, aggressive behaviors of thyroid microcarcinomas in korean patients", Endocr J, 53, pp.627~632 (2006)[DOI]
- Ito Y, "An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid", Thyroid, 13, pp.381~387 (2003)[DOI]