基于超声评估甲状腺结节的体积与直径自然变化特点:一项为期49个月的随访研究OA

Objective To investigate the natural change characteristics of the volume and diameter of thyroid nodules stratified by different American College of Radiology Thyroid Imaging Reporting and Data System(ACR-TIRADS)categories assessed by ultrasound,as well as their clinical significance.Methods A retrospec-tive cohort study was conducted.A total of 5 963 patients with thyroid nodules(13 815 nodules in total)who visited The First Medical Center of Chinese PLA General Hospital in the first month of each quarter from January 2018 to September 2025 and completed an ultrasound follow-up were enrolled.The detection rate of significantly enlarged nodules,their natural growth patterns,and the malignancy detection rate were ana-lyzed under the volume-based criterion(VBC)and diameter-based criterion(DBC).Results The mean fol-low-up duration was(49.2±4.8)months.At baseline,the mean age of patients was(49.9±13.4)years,with fe-males accounting for 74.0％(4 410/5 963),and 83.7％(4 993/5 963)of patients having multiple nodules.During follow-up,25.6％(3 538/13 815)of the nodules were significantly enlarged,61.4％(8 485/13 815)re-mained stable,11.1％(1 533/13 815)shrank significantly,and 1.9％(259/13 815)resolved completely.Further analysis showed that the detection rate of significantly enlarged nodules was higher under VBC than under DBC,with 24.7％(3 409/13 815)vs 22.9％(3 164/13 815),respectively(P<0.05).During the 49-month ob-servation period,all significantly enlarged nodules with different ACR-TIRADS categories presented a"slow-fast-slow"growth pattern.The peak growth period of nodules in ACR-TIRADS categories 1～3 occurred at 24～36 months of follow-up,while that of nodules in ACR-TIRADS categories 4 and 5 occurred at 12～24 months.In addition,a total of 577 nodules(324 in the stable group and 253 in the significantly enlarged group)under-went fine-needle aspiration biopsy during follow-up.The detection rate of papillary thyroid carcinoma in the significantly enlarged group was much higher than that in the stable group,at 25.3％(64/253)vs 6.5％(21/324),respectively.Among the significantly enlarged nodules,the papillary thyroid carcinoma detection rates under VBC and DBC were comparable,at 25.4％(60/236)vs 26.0％(57/219),respectively.Conclusions VBC has a higher detection sensitivity for significantly enlarged nodules than DBC,while the papillary thyroid car-cinoma detection efficacy is comparable between the two criteria.Temporal heterogeneity exists in the growth patterns of nodules with different ACR-TIRADS risk stratifications,which can provide evidence-based refer-ence for the development of individualized clinical follow-up strategies.