计算机断层扫描上的偶然甲状腺结节：系统评价和荟萃分析，检查患病率，随访和恶性风险

背景：计算机断层扫描（CT）的利用率增加导致甲状腺偶然瘤的检测率更高。目前，尚无广泛商定的指导方针来管理这些杂物。这项研究旨在调查CT检测到的甲状腺偶然瘤的患病率，随访实践和恶性率。方法：我们对PubMed，Embase和Cochrane数据库进行了全面搜索，以确定2024年4月12日之前发布的相关研究（Prospero＃42024535501）。包括有关CT检测到的甲状腺杂瘤的患病率，随访和风险（ROM）的研究。使用随机效应模型的合并比例分析了组合结果。使用Cochrane的风险风险工具（ROB 2）和Newcastle-Ottawa量表工具评估了偏见的风险。根据临时瘤，CT区域和研究人群的年龄的大小，进行亚组分析。结果：涉及195,959例患者的38项研究被包括在患病率分析中，揭示了CT上甲状腺事件的患病率为8.3％（置信区间[CI]，7.4-9.3）。与胸部CT相比，颈部CT的患病率更高（16.5％，CI，11.0-22.1）（6.6％，CI，5.3-7.9）。在27.0％（CI，12.9-41.1）的患者中发现了多个偶然瘤。在结节中，有46.3％（CI，32.3-60.3）为≥1cm，28.6％（CI，19.9-37.3）≥1.5cm。在34.9％（CI，26.1-43.7），28.4％（CI，19.9-36.9）和8.2％（CI，2.1-14.4）的情况下，进行甲状腺超声，活检和手术。此外，针对6272例患者的25例研究报告了CT检测到的甲状腺偶然瘤的ROM为3.9％（CI，3.0-4.9）。与<1 cm（0.1％，CI，0-0.8）和<1％，CI，0-0-0.2）相比，在附带瘤≥1cm（11.7％，CI，3.9-19.4）和≥1.5cm（24.9％，CI，0-52.7）中观察到了较高的ROM（24.9％，CI，0-52.7）。结论：CT上确定的大多数甲状腺偶然瘤是良性的。在放射科医生和甲状腺专家之间实施协作方案来管理高风险的甲状腺杂瘤，可以确保适当的随访和最佳的患者护理。

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.