过度诊断的乳腺甲状腺癌的乳腺甲状腺癌
David O Francis1,2, Louise Davies1,2,3, Yichi Zhang4
1Department of Otolaryngology Head & Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison.
JAMA network open
|February 24, 2026
概括
在美国,乳头甲状腺癌 (PTC) 的过度诊断严重,影响高达94%的病例. 减少甲状腺超声波检查非触摸性结节可以降低发病率而不会影响死亡率.
科学领域:
- 在瘤学瘤学.
- 诊断成像 诊断成像 诊断成像
- 公共卫生 公共卫生
背景情况:
- 在美国,甲状腺癌的过度诊断以前没有得到量化,尽管它可能会产生影响.
- 减少甲状腺超声波的使用对过度诊断率的影响仍然没有计算.
研究的目的:
- 为了估计美国人口水平的乳头甲状腺癌 (PTC) 过度诊断.
- 为了确定减少甲状腺超声波的使用对PTC发病率和整体死亡率的影响.
主要方法:
- 一个经过验证的模拟模型 (甲状腺瘤小模拟模型) 用于分析1991年至2019年美国成年人群中的PTC发病率.
- 该模型估计了按性别分层的过度诊断率,并预测了在减少超声波使用的情况下发生率和死亡率的变化.
主要成果:
- 在1991年至2019年期间,美国估计有72%至94%的PTC病例被过度诊断.
- 女性的过度诊断率比男性高,无论是比例还是绝对.
- 减少33%或67%的非触摸性结节的甲状腺超声波可以分别减少17%或41%的PTC发病率,对整体死亡率的影响最小.
结论:
- 美国甲状腺癌的过度诊断是显著的,甚至会导致真正的发病率增加.
- 减少不必要的甲状腺超声波转诊,特别是对于非触摸性结节,可以降低诊断和治疗危害,而不会增加死亡率.
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