Supplementary Material for: Thyroid incidentalomas; incidence and oncological implication in patients with esophageal cancer

Thyroid incidentalomas are often encountered during imaging performed for the workup of esophageal cancer. Their oncological significance is unknown. This study aimed to establish incidence and etiology of thyroid incidentalomas found during the diagnostic workup of esophageal cancer. All esophageal cancer patients referred to or diagnosed in the Amsterdam UMC between January 2012 and December 2016 were included. Radiology and multidisciplinary team meeting reports were reviewed for presence of thyroid incidentalomas. When present, the 18FDG-PET/CT or CT was reassessed by a radiologist. Primary outcome was the incidence and etiology of thyroid incidentalomas. In total, 1,110 esophageal cancer patients were included. Median age was 66 years, most were male (77.2%) and had an adenocarcinoma (69.4%). For 115 patients (10.4%) a thyroid incidentaloma was reported. Two thyroidal lesions proved malignant. One esophageal cancer metastasis (0.9%) and one was a primary thyroid carcinoma (0.9%). Only the primary thyroid carcinoma resulted in treatment alteration. The other malignant thyroid incidentaloma was in the context of disseminated esophageal disease and ineligible for curative treatment. In this study, thyroid incidentalomas were only very rarely oncologically significant. Further etiological examination should only be considered in accordance with the according to the TI-RADS classification system and when clinical consequences are to be expected.

在针对食管癌开展诊疗的影像学检查中，甲状腺偶发瘤（thyroid incidentalomas）常被偶然检出。其肿瘤学意义目前尚不明确。本研究旨在明确食管癌诊断性检查中发现的甲状腺偶发瘤的发生率与病因学。本研究纳入了2012年1月至2016年12月期间在阿姆斯特丹大学医学中心（Amsterdam UMC）接诊或确诊的全部食管癌患者。对影像学报告及多学科团队会议记录进行回顾性筛查，以确认是否存在甲状腺偶发瘤。若检出该类病变，则由放射科医师重新评估患者的18FDG-PET/CT或CT影像。本研究的主要结局指标为甲状腺偶发瘤的发生率与病因学。最终共纳入1110例食管癌患者，中位年龄为66岁，其中多数为男性（77.2%），病理类型以腺癌为主（69.4%）。115例患者（10.4%）检出甲状腺偶发瘤，其中2例甲状腺病变被证实为恶性：1例为食管癌转移灶（占比0.9%），另1例为甲状腺原发性癌（占比0.9%）。仅甲状腺原发性癌导致了治疗方案的调整；另一例恶性甲状腺偶发瘤患者合并播散性食管癌，无法接受根治性治疗。本研究结果显示，甲状腺偶发瘤的肿瘤学临床意义仅极为罕见。未来仅应依据甲状腺影像报告和数据系统（TI-RADS，Thyroid Imaging Reporting and Data System）分类标准，且在预计可产生临床获益的前提下，才考虑开展进一步的病因学检查。