计算机断层扫描偶发性甲状腺结节：流行率、随访与恶性风险的系统综述与Meta分析

背景：计算机断层扫描（CT）应用的增加导致甲状腺偶发结节的检出率升高。目前尚无广泛认可的管理指南。本研究旨在调查由CT检测到的甲状腺偶发结节的流行率、随访实践及恶性风险（ROM）。方法：我们在PubMed、Embase和Cochrane数据库中进行全面检索，筛选2024年4月12日之前发表的相关研究（PROSPERO编号#42024535501）。纳入报道CT检测到的甲状腺偶发结节的流行率、随访及恶性风险的研究。采用随机效应模型进行合并比例分析。偏倚风险通过Cochrane随机试验偏倚风险工具（RoB 2）和纽卡斯尔-沃伦斯标准（NOS）评估。根据结节大小、CT区域和研究人群年龄等特征进行亚组分析。结果：共纳入38项研究，涉及195,959例患者，发现CT中的甲状腺偶发结节流行率为8.3%（95%置信区间[CI]，7.4-9.3）。颈部CT的检出率（16.5%，CI，11.0-22.1）高于胸部CT（6.6%，CI，5.3-7.9）。多发结节占27.0%（CI，12.9-41.1）。其中，≥1cm的结节占46.3%（CI，32.3-60.3），≥1.5cm占28.6%（CI，19.9-37.3）。行超声、活检和手术的比例分别为34.9%（CI，26.1-43.7）、28.4%（CI，19.9-36.9）和8.2%（CI，2.1-14.4）。另外，25项研究中涉及6,272例患者，报道CT检测到的结节恶性率（ROM）为3.9%（CI，3.0-4.9）。≥1cm（11.7%，CI，3.9-19.4）和≥1.5cm（24.9%，CI，0-52.7）的结节ROM显著高于<1cm（0.1%，CI，0-0.8）和<1.5cm（0%，CI，0-0.2）。结论：大多数CT检测到的甲状腺偶发结节为良性。建议放射科医生与甲状腺专家合作制定管理高危结节的规范流程，以确保合理随访和优化患者护理。

Background: The increased utilization of computed tomography (CT) has led to a higher detection rate of thyroid incidentalomas. Currently, there are no widely agreed-upon guidelines for managing these incidentalomas. This study aims to investigate the prevalence, follow-up practices, and malignancy rates of thyroid incidentalomas detected by CT. Methods: We conducted a comprehensive search of PubMed, Embase, and Cochrane databases to identify relevant studies published before April 12, 2024 (PROSPERO #42024535501). Studies reporting on the prevalence, follow-up, and risk of malignancy (ROM) of thyroid incidentalomas detected by CT were included. Combined outcomes were analyzed using pooled proportion with a random-effects model. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2) and the Newcastle-Ottawa Scale tool. Subgroup analyses were conducted based on characteristics including size of the incidentaloma, CT area, and age of the study population. Results: Thirty-eight studies involving 195,959 patients were included in the prevalence analysis, revealing a prevalence of thyroid incidentalomas on CT of 8.3% (confidence interval [CI], 7.4-9.3). The prevalence was higher in neck CT (16.5%, CI, 11.0-22.1) compared with chest CT (6.6%, CI, 5.3-7.9). Multiple incidentalomas were found in 27.0% (CI, 12.9-41.1) of patients. Of the nodules, 46.3% (CI, 32.3-60.3) were ≥1 cm, and 28.6% (CI, 19.9-37.3) were ≥1.5 cm. Thyroid ultrasounds, biopsies, and surgeries were performed in 34.9% (CI, 26.1-43.7), 28.4% (CI, 19.9-36.9), and 8.2% (CI, 2.1-14.4) of cases, respectively. Additionally, 25 studies with 6272 patients reported a ROM of 3.9% (CI, 3.0-4.9) for thyroid incidentalomas detected on CT. A higher ROM was observed in incidentalomas ≥1 cm (11.7%, CI, 3.9-19.4) and ≥1.5 cm (24.9%, CI, 0-52.7) compared with those <1 cm (0.1%, CI, 0-0.8) and <1.5 cm (0%, CI, 0-0.2). Conclusions: Most thyroid incidentalomas identified on CT are benign. Implementing a collaborative protocol between radiologists and thyroid specialists to manage high-risk thyroid incidentalomas can ensure appropriate follow-up and optimal patient care.