| Objective:For the past few years, the prevalence and detection rate of thyroid nodules (TN) have been increasing persistently, and the unnecessary operations for benign TN are also soaring, causing to much patients’ suffering and more money wasting. This study aims to analyze the epidemiological and clinical characteristics of surgically treated TN, and to identify the clinical risk factors for malignant nodules (MN) in order to establish a preoperative atraumatic assessing method for the differential diagnosis of thyroid nodules.Methods:A total of6304cases of patients with TN who underwent thyroid surgery in Qilu Hospital of Shandong University and Shandong Provincial Hospital from January2008through December2012were included in this retrospective study. The clinical and pathological data were collected to evaluate the characteristics of clinical epidemiology of patients with TN and identify the related clinical risk factors of MN. The nature of TN (Benign or Malignant) as the dependent variable, the medical records, laboratory data and imaging data of patients were analyzed statistically, and the risk factors for MN were screened by spearman rank correlation analysis and non-conditional binary logistic regression analysis. Results:1. The number of surgically treated patients with TN increased yearly by34.48%, including34.33%of patients with MN and65.67%with benign nodules (BN). However, up to56.74%of these patients underwent unnecessary surgery.2. In the MN, papillary thyroid carcinoma (PTC) accounted for93.97%, of which46.71%coexisted with benign thyroid disease,and32.28%with multiple foci; and follicular carcinoma, meduallary carcinoma, undifferentiated carcinoma and mixed carcinoma accounted respectively for2.09%,1.62%,0.37%, and0.19%; others (including metastatic carcinoma, lymphoma, etc.) accounted for1.76%,3. Single related factor analysis showed that age, work background, course of the disease, previous history with breast nodules and/or hypertension, the levels of serum thyroid-stimulating hormone (TSH), thyroglobulin antibody (TgAb), thyroid peroxidase antibody (TPoAb), and ultrasound features of TN were associated with MN.4. According to step-wise non-conditional binary logistic regression analysis, thirteen factors were substituted in the regression equation:Y=-3.012+0.663×X1+0.259×X2+0.246×X3+0.224×X4+1.165×X5+1.185×X6+0.598×X7+0.697×X8+0.485xX9+0.524×X10+0.207×X11+0.478×X12+0.272×X13. X1to X13typified respectively: age<40years old(X1), previous history with breast nodules and/or hypertension(X2), course of the disease<1month(X3), occupation(X4), hypoechoic nodule (X5), irregular nodules (X6), features of calcification (X7), solid echo nodule (X8), fuzzy boundary (X9), rich blood flow signal (X10), abnormal lymph nodes around the neck (X11), size with diameter<1cm (X12), and positive TgAb (X13).Conclusions:1. In recent5years, the number of surgically treated patients and the ratio of MN increased rapidly, indicating a marked increase in the prevalence of TN and MN. However, up to56.74%of TN patients underwent unnecessary surgery. There are practical needs to upgrade the preoperative atraumatic diagnostic level to distinguish the BN from MN. 2. Of the patients with MN, PTC accounted for most of them, and usually coexisted with benign thyroid diseases or with multiple foci.3. Age, course of thyroid disease, previous history of breast disease and/or hypertension, levels of serum TSH, TgAb, TPoAb, and ultrasound features of TN were associated with MN, which may be independent risk factors of MN and could be differentiated markers for BN/MN. |
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