Yıl: 2021 Cilt: 6 Sayı: 3 Sayfa Aralığı: 248 - 256 Metin Dili: İngilizce DOI: 10.4274/BMB.galenos.2021.12.086 İndeks Tarihi: 17-01-2022

Rates of Incidental Thyroid Nodule and Thyroid Cancer Detection in Routine Check-up Examinations: A Single-center Study

Öz:
Objective: Check-up examinations have gained importance in the last decade and become a common reason for people to refer to healthcare institutions to seek medical help. Thyroid nodules are frequently detected during check-up examinations. This study aimed to determine the frequency of thyroid nodules and the rate of thyroid cancer development in patients presenting for a check-up and to define the role of variables in thyroid cancer detection. Method: The computer database of the patients, who applied for a check-up examination, was systematically screened, and the records of thyroid ultrasonography (US) were accessed. Patients with any known history of thyroid disease or thyroid cancer and those using medication for an existing thyroid disease were excluded. The demographic data, thyroid US reports, cytology and histopathology results, and free t3 (fT3), free t4 (fT4), and thyroid-stimulating hormone (TSH) levels were evaluated and recorded. Body mass index (BMI) was calculated. Data were analyzed using SPSS v. 25. Results: Of the 30,449 check-up patients, 24,362 were evaluated. Incidental thyroid nodules were detected in 5.645 (23.17%) patients. The mean BMI of these patients was 56±2.01 kg/m², and their mean TSH, fT3 and fT4 values were 2.87±0.45 mIU/mL, 3.76±0.87 pg/mL and 1.23±0.24 pg/mL, respectively. The mean nodule size was 1.31±0.56 mm. While 2.936 (52.01%) of the nodules were solid, 1.377 (24.39%) were cystic and 1.332 (23.59%) were mixed. Of all the nodules, 1.916 (33.94%) were in the TIRADS 2 category, 3.273 (57.98%) in the TIRADS 3 category, 234 (4.31%) in the TIRADS 4a category, 114 (1.27%) in the TIRADS 4b category, 72 (1.27%) in the TIRADS 4c category, and 36 (0.63%) in the TIRADS 5 category. For 392 patients that underwent a biopsy, the results were reported as benign for 224 (57.14%), suspected malignancy for 100 (25.51%), and malignant for 68 (17.34%). The rates of patients diagnosed with papillary, follicular and medullary thyroid cancers were 63.15%, 34.21% and 2.63%, respectively. When the multinominal logistic regression analysis was applied to all significant variables in the univariate analysis, the risk of thyroid cancer was increased 1.7-fold by increased BMI [odds ratio (OR): 1.71, 95% confidence interval (CI): 1.43-2.96], 1.8- fold by female gender [OR: 1.79, (CI): 1.21-2.67], 1.6-fold by solid structure nodule type [OR: 1.62, (CI): 1.27-3.54], 2.7-fold by increased nodule size [OR: 2.71, (CI): 1.11-3.31], and 4.7-fold by increased TIRADS [OR: 4.73, (CI): 1.76-7.31]. Conclusion: The main difficulty in evaluating and managing thyroid nodules is to avoid the inappropriate overuse of thyroid US, thyroid biopsy, and surgery while trying to identify clinically significant malignant nodules. Concerning the diagnosis of thyroid cancer through a checkup examination, the data obtained as a result of more detailed studies should be evaluated, and it should be kept in mind that the increase in the incidence of thyroid cancer in the last three decades may be due to not only overdiagnosis but also a real increase in incidence. However, considering that early diagnosis of thyroid cancer without lymph node involvement can reduce both surgical complications and prevent the risks of radioactive iodine treatment, it is concluded that thyroid cancer being detected at an early stage constitutes an important advantage for the healthy population undergoing a check-up.
Anahtar Kelime:

Rutin Check-up Muayenesi ile İnsidental Tiroid Nodulü ve Tiroid Kanseri Saptanma Oranı: Tek Merkezli Çalışma

Öz:
Amaç: Check-up muayeneleri son on yılda önem kazanmış ve tıbbi yardım isteme amaçlı sağlık kurumlarına başvuruların en yaygın nedenleri arasında yerini almıştır. Tiroid nodülleri, check-up muayenesi sırasında sıklıkla tespit edilmektedir. Çalışmamızın amacı, check-up muayenesine başvuran bireylerde tiroid nodülü sıklığını ve tiroid kanseri gelişme oranını belirlemek ve tiroid kanseri saptanmasında değişkenlerin rolünü tanımlamaktır. Yöntem: Check-up muayenesi için başvuran hastaların bilgisayar database kayıtları sistematik biçimde taranarak, tiroid ultrasonografisi (USG) yapılan hasta kayıtlarına erişildi. Öncesinde bilinen herhangi bir tiroid hastalığı veya tiroid kanseri öyküsü olan ve mevcut bir tiroid hastalığı için ilaç kullanan hastalar çalışma dışı bırakıldı. Hasta grubunun demografik bilgileri, tiroid USG raporları, sitoloji ve histopatoloji sonuçları ile serbest T3 (sT3), serbest T4 (sT4) ve tiroid stimulan hormon (TSH) düzeyleri değerlendirilerek kaydedildi. Vücut kitle indeksleri (VKİ) hesaplandı. Veriler, SPSS 25 istatistik paket programı ile analiz edildi. Bulgular: Otuz bin dört yüz kırk dokuz check-up hastasının 24.362’si değerlendirildi. Beş bin altı yüz kırk beş (%23,17) hastada insidental tiroid nodülü saptandı. Bu hastaların ortalama VKİ’si 56±2,01 kg/m², TSH değeri 2,87±0,45 mIU/mL, sT3 değeri 3,76±0,87 pg/mL ve sT4 değeri 1,23±0,24 pg/mL idi. Ortalama nodül boyutu 1,31±0,56 mm iken, nodüllerin 2,936’sı (%52,01) solid nodül, 1,377’si (%24,39) kistik nodül, 1,332’si (%23,59) mikst nodül olarak gözlendi. Nodüllerin 1,916’sı (%33,94) TIRADS 2, 3,273’ü (%57,98) TIRADS 3,234’ü (%4,31) TIRADS 4a, 114’ü (%1,27) TIRADS 4b, 72’si (%1,27) TIRADS 4c ve 36’sı (%0,63) TIRADS 5 kategorisindeydi. Biyopsi yapılan 392 hastanın 224’ünün (%57,14) sonucu benign, 100’ünün (%25,51) şüpheli malign ve 68’inin (%17,34) malign olarak raporlandı. Papiller tiroid kanseri tanısı konulan hastaların oranı %63,15, foliküler tiroid kanseri %34,21 ve medüller tiroid kanseri %2,63 olarak tespit edildi. Univariate analizlerde anlamlı bulunan tüm değişkenlere multinominal lojistik regresyon analizi uygulandığında artan VKİ’nin 1,7 kat [olasılık oranı (OO): 1,71, %95 güven aralığı (GA): 1,43-2,96], kadın cinsiyetin 1,8 kat [OO: 1,79, (GA): 1,21-2,67], solid nodül yapısının 1,6 kat [OO: 1,62, (GA): 1,27-3,54], artan nodül çapının 2,7 kat [OO: 2,71, (GA): 1,11-3,31], ve artan TIRADS skorunun 4,7 kat [OO: 4,73, (GA): 1,76-7,31] tiroid kanseri gelişimini artırıcı etkisi olduğu tespit edildi. Sonuç: Tiroid nodüllerini değerlendirme ve yönetmedeki ana zorluk bir yandan tiroid US, tiroid biyopsisi ve cerrahinin uygunsuz aşırı kullanımından kaçınırken, diğer yandan klinik olarak önemli malign olanları tanımlamaya çalışmaktır. Check-up muayenesi ile tiroid kanseri tanısı koyma ile ilgili olarak, daha ayrıntılı çalışmaların sonucunda elde edilen veriler değerlendirilmeli ve son otuz yılda tiroid kanseri insidansının artmasının sadece aşırı tanıdan değil, gerçek bir insidans artışından kaynaklanabileceği akılda tutulmalıdır. Öte yandan lenf nodu tutulumsuz erken tanı tiroid kanseri ile hem cerrahi komplikasyonların azaltılabileceği hem de radyoaktif iyot tedavisinin risklerinden korunabileceği göz önünde bulundurulduğunda, evrece erken yakalanmış tiroid kanserlerinin, checkup amacıyla başvuran sağlıklı popülasyon için önemli bir avantaj olduğu kanısına varılmıştır.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
0
0
0
  • 1. Mehrotra A, Zaslavsky AM, Ayanian JZ. Preventive health examinations and preventive gynecological examinations in the United States. Arch Intern Med 2007;167(17):1876-1883.
  • 2. Sox HC. The health checkup: Was it ever effective? Could it be effective? JAMA 2013;309(23):2496-2497.
  • 3. Song CY, Shen Y, Lu YQ. Role of routine check-up in the prognosis of patients with pancreatic cancer: A puzzling phenomenon. Hepatobiliary Pancreat Dis Int 2021;20(1):67-73.
  • 4. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 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 2016;26(1):1-133.
  • 5. Guth S, Theune U, Aberle J, Galach A, Bamberger CM. Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur J Clin Invest 2009;39(8):699-706.
  • 6. Hegedus L. Clinical practice. The thyroid nodule. N Engl J Med 2004;351(17):1764-1771.
  • 7. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin 2020;70(1):7-30.
  • 8. Davies L, Welch HG. Current thyroid cancer trends in the United States. JAMA Otolaryngol Head Neck Surg 2014;140(4):317-322.
  • 9. Leenhardt L, Bernier MO, Boin-Pineau MH, Conte DB, Maréchaud R, Niccoli-Sire P, et al. Advances in diagnostic practices affect thyroid cancer incidence in France. Eur J Endocrinol 2004;150(2):133-139.
  • 10. Brito JP, Al Nofal A, Montori V, Hay ID, Morris JC. The impact of subclinical disease and mechanism of detection on the rise in thyroid cancer incidence: a population-based study in Olmsted County, Minnesota during 1935 through 2012. Thyroid 2015;25(9):999-1007.
  • 11. Singh Ospina N, Iñiguez-Ariza NM, Castro MR. Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment. BMJ 2020;368:l6670.
  • 12. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19(11):1167-1214.
  • 13. Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedüs L, et al. AACE/ACE/AME Task Force on Thyroid Nodules. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules--2016 Update. Endocr Pract 2016;22(5):622-639.
  • 14. Jameson JL, De Groot JL. Endocrinology adult and pediatric. In: Thyroid Neoplasia, Pacini F, Marchisotta S, De Groot JL (editors). 6th ed., Philadelphia: Saunders Elsevier, 2010:1668-1701.
  • 15. Krogsbøll LT, Jørgensen KJ, Grønhøj Larsen C, Gøtzsche PC. General health checks in adults for reducing morbidity and mortality from disease: cochrane systematic review and meta-analysis. BMJ 2012;345:e7191. doi: 10.1136/bmj.e7191.
  • 16. Gøtzsche PC, Jørgensen KJ, Krogsbøll LT. General health checks don’t work. BMJ 2014;348:g3680. doi: 10.1136/bmj.g3680.
  • 17. Ahn HS, Kim HJ, Welch HG. Korea’s thyroid-cancer “epidemic”- screening and overdiagnosis. N Engl J Med 2014;371(19):1765- 1767.
  • 18. Roman BR, Morris LG, Davies L. The thyroid cancer epidemic, 2017 perspective. Curr Opin Endocrinol Diabetes Obes 2017;24(5):332- 336.
  • 19. Figge JJ. Epidemiology of thyroid cancer. In Thyroid Cancer: A Comprehensive Guide to Clinical Management. 2nd ed., New York: Springer, 2006:9-13.
  • 20. Preston-Martin S, Franceschi S, Ron E, Negri E. Thyroid cancer pooled analysis from 14 case–control studies: What have we learned? Cancer Causes Control 2003;14(8):787-789.
  • 21. Rago T, Fiore E, Scutari M, Santini F, Di Coscio G, Romani R, et al. Male sex, single nodularity, and young age are associated with the risk of finding a papillary thyroid cancer on fine-needle aspiration cytology in a large series of patients with nodular thyroid disease. Eur J Endocrinol 2010;162(4):763-770.
  • 22. Bessey LJ, Lai NB, Coorough NE, Chen H, Sippel RS. The incidence of thyroid cancer by fine needle aspiration varies by age and gender. J Surg Res 2013;184(2):761-765.
  • 23. Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, et al. Thyroid imaging reporting and data system for US features of nodules: A step in establishing better stratification of cancer risk. Radiology 2011;260(3):892-899.
  • 24. Chow SM, Law SC, Au SK, Leung TW, Chan PT, Mendenhall WM, et al. Differentiated thyroid carcinoma: comparison between papillary and follicular carcinoma in a single institute. Head Neck 2002;24(7):670-677.
  • 25. Kamran SC, Marqusee E, Kim MI, Frates MC, Ritner J, Peters H, et al. Thyroid nodule size and prediction of cancer. J Clin Endocrinol Metab 2013;98(2):564-570.
  • 26. Raparia K, Min SK, Mody DR, Anton R, Amrikachi M. Clinical outcomes for “suspicious” category in thyroid fine-needle aspiration biopsy: patient’s sex and nodule size are possible predictors of malignancy. Arch Pathol Lab Med 2009;133(5):787- 790.
  • 27. Cavallo A, Johnson DN, White MG, Siddiqui S, Antic T, Mathew M, et al. Thyroid nodule size at ultrasound as a predictor of malignancy and final pathologic size. Thyroid 2017;27(5):641-650.
  • 28. Frates MC, Benson CB, Doubilet PM, Kunreuther E, Contreras M, Cibas ES, et al. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. J Clin Endocrinol Metab 2006;91(9):3411-3417.
  • 29. Zafón C, Obiols G, Mesa J. Preoperative TSH level and risk of thyroid cancer in patients with nodular thyroid disease: Nodule size contribution. Endocrinol Nutr 2015;62(1):24-28.
  • 30. Pischon T, Nimptsch K. Obesity and risk of cancer: an introductory overview. Recent Results Cancer Res 2016;208:1-15.
  • 31. Han JM, Kim TY, Jeon MJ, Yim JH, Kim WG, Song DE, et al. Obesity is a risk factor for thyroid cancer in a large, ultrasonographically screened population. Eur J Endocrinol 2013;168(6)879-886.
  • 32. Oh SW, Yoon YS, Shin SA. Effects of excess weight on cancer incidences depending on cancer sites and histologic findings among men: Korea National Health Insurance Corporation Study. J Clin Oncol 2005;23(21):4742-4754.
  • 33. Rinaldi S, Lise M, Clavel-Chapelon F, Boutron-Ruault MC, Guillas G, Overvad K, et al. Body size and risk of differentiated thyroid carcinomas: findings from the EPIC study. Int J Cancer 2012;131(6):E1004-E10014. doi: 10.1002/ijc.27601
APA arğun d, Basim P (2021). Rates of Incidental Thyroid Nodule and Thyroid Cancer Detection in Routine Check-up Examinations: A Single-center Study. , 248 - 256. 10.4274/BMB.galenos.2021.12.086
Chicago arğun derya,Basim Pelin Rates of Incidental Thyroid Nodule and Thyroid Cancer Detection in Routine Check-up Examinations: A Single-center Study. (2021): 248 - 256. 10.4274/BMB.galenos.2021.12.086
MLA arğun derya,Basim Pelin Rates of Incidental Thyroid Nodule and Thyroid Cancer Detection in Routine Check-up Examinations: A Single-center Study. , 2021, ss.248 - 256. 10.4274/BMB.galenos.2021.12.086
AMA arğun d,Basim P Rates of Incidental Thyroid Nodule and Thyroid Cancer Detection in Routine Check-up Examinations: A Single-center Study. . 2021; 248 - 256. 10.4274/BMB.galenos.2021.12.086
Vancouver arğun d,Basim P Rates of Incidental Thyroid Nodule and Thyroid Cancer Detection in Routine Check-up Examinations: A Single-center Study. . 2021; 248 - 256. 10.4274/BMB.galenos.2021.12.086
IEEE arğun d,Basim P "Rates of Incidental Thyroid Nodule and Thyroid Cancer Detection in Routine Check-up Examinations: A Single-center Study." , ss.248 - 256, 2021. 10.4274/BMB.galenos.2021.12.086
ISNAD arğun, derya - Basim, Pelin. "Rates of Incidental Thyroid Nodule and Thyroid Cancer Detection in Routine Check-up Examinations: A Single-center Study". (2021), 248-256. https://doi.org/10.4274/BMB.galenos.2021.12.086
APA arğun d, Basim P (2021). Rates of Incidental Thyroid Nodule and Thyroid Cancer Detection in Routine Check-up Examinations: A Single-center Study. Bağcılar Tıp Bülteni, 6(3), 248 - 256. 10.4274/BMB.galenos.2021.12.086
Chicago arğun derya,Basim Pelin Rates of Incidental Thyroid Nodule and Thyroid Cancer Detection in Routine Check-up Examinations: A Single-center Study. Bağcılar Tıp Bülteni 6, no.3 (2021): 248 - 256. 10.4274/BMB.galenos.2021.12.086
MLA arğun derya,Basim Pelin Rates of Incidental Thyroid Nodule and Thyroid Cancer Detection in Routine Check-up Examinations: A Single-center Study. Bağcılar Tıp Bülteni, vol.6, no.3, 2021, ss.248 - 256. 10.4274/BMB.galenos.2021.12.086
AMA arğun d,Basim P Rates of Incidental Thyroid Nodule and Thyroid Cancer Detection in Routine Check-up Examinations: A Single-center Study. Bağcılar Tıp Bülteni. 2021; 6(3): 248 - 256. 10.4274/BMB.galenos.2021.12.086
Vancouver arğun d,Basim P Rates of Incidental Thyroid Nodule and Thyroid Cancer Detection in Routine Check-up Examinations: A Single-center Study. Bağcılar Tıp Bülteni. 2021; 6(3): 248 - 256. 10.4274/BMB.galenos.2021.12.086
IEEE arğun d,Basim P "Rates of Incidental Thyroid Nodule and Thyroid Cancer Detection in Routine Check-up Examinations: A Single-center Study." Bağcılar Tıp Bülteni, 6, ss.248 - 256, 2021. 10.4274/BMB.galenos.2021.12.086
ISNAD arğun, derya - Basim, Pelin. "Rates of Incidental Thyroid Nodule and Thyroid Cancer Detection in Routine Check-up Examinations: A Single-center Study". Bağcılar Tıp Bülteni 6/3 (2021), 248-256. https://doi.org/10.4274/BMB.galenos.2021.12.086