Association of Thyroid Nodule Size and Bethesda Class With Rate of Malignant Disease

Magister, Marcus J.; Chaikhoutdinov, Irina; Schaefer, Eric; Williams, Nicole; Saunders, Brian; Goldenberg, David

doi:10.1001/jamaoto.2015.1451

Cited by 37 publications

(49 citation statements)

References 33 publications

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“…The authors noted that the accuracy of FNAC increased with increasing nodule size. Similarly, Magister et al [21] performed a retrospective study of 297 patients with 326 thyroid nodules, who underwent FNAB and subsequent thyroidectomy. The overall rate of malignancy on final pathology was 43.9%.…”

Section: Discussionmentioning

confidence: 99%

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Risk of Malignancy in Thyroid Nodules 4 cm or Larger

Megwalu

2017

Endocrinol Metab

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BackgroundSeveral authors have questioned the accuracy of fine-needle aspiration cytology (FNAC) in large nodules. Some surgeons recommend thyroidectomy for nodules ≥4 cm even in the setting of benign FNAC, due to increased risk of malignancy and increased false negative rates in large thyroid nodules. The goal of our study was to evaluate if thyroid nodule size is associated with risk of malignancy, and to evaluate the false negative rate of FNAC for thyroid nodules ≥4 cm in our patient population.MethodsThis is a retrospective study of 85 patients with 101 thyroid nodules, who underwent thyroidectomy for thyroid nodules measuring ≥4 cm.ResultsThe overall risk of malignancy in nodules ≥4 cm was 9.9%. Nodule size was not associated with risk of malignancy (odds ratio, 1.02) after adjusting for nodule consistency, age, and sex (P=0.6). The false negative rate for FNAC was 0%.ConclusionNodule size was not associated with risk of malignancy in nodules ≥4 cm in our patient population. FNAC had a false negative rate of 0. Patients with thyroid nodules ≥4 cm and benign cytology should not automatically undergo thyroidectomy.

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Section: Discussionmentioning

confidence: 99%

“…This increase in false negative rates with large thyroid nodules is thought to be due to sampling error. On the other hand, several authors have demonstrated low false negative rates in large thyroid nodules, similar to those in small thyroid nodules [1718192021]. …”

Section: Introductionmentioning

confidence: 99%

Risk of Malignancy in Thyroid Nodules 4 cm or Larger

Megwalu

2017

Endocrinol Metab

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“…A classification based on ultrasound reporting and data system (Thyroid Imaging Reporting and Data System [TIRADS]) has been shown to be useful in stratifying the risk of malignancy of thyroid nodule . Nodule size, however, was not included among predictive ultrasound features because data are not consistent among different authors . Discrepancies can be explained by differences in experimental design, sample size, genetic background, levels of iodine intake, and patients' selection among studies.…”

Section: Discussionmentioning

confidence: 99%

Size of thyroid carcinoma by histotype and variants: A population-based study in a mildly iodine-deficient area

et al. 2017

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“…The predictive values of benign cytology following fine‐needle aspirations (FNA) in large thyroid nodules vary significantly between reports. The majority of authors have found FNA of large nodules to be reliable, with false negatives (FN) ranging from 0.7% to 7% . Others have found FN rates substantially higher when compared to smaller thyroid nodules …”

Section: Introductionmentioning

confidence: 99%

Follow‐up of large thyroid nodules without surgery: Patient selection and long‐term outcomes

et al. 2019

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Background The management of large thyroid nodules remains controversial. Mandatory resection is recommended by some authors. Methods All patients with thyroid nodules ≥3 cm between January 2009 and January 2013 were followed until August 2017. Follow‐up data were collected using an integrated hospital‐community system. Results A total of 141 nodules were included. Of these, 37/141 (26%) nodules were initially referred to surgery, resulting in a 32% malignancy rate (12/37). The remaining 104/141 (74%) were referred to follow‐up. During the follow‐up period, 24 additional operations were done, resulting in a 4% malignancy rate (1/24). An indication of nonbenign cytology was significantly associated with malignancy compared with other indications. Median follow‐up was 53.5 months. No patient developed regional or distal diseases. The mean change in nodule size during the follow‐up period was a 7% reduction, with no significant trend of change over time. Conclusion Careful patient selection based on clinical, sonographic, and cytologic features can reduce diagnostic surgery allowing for safe follow‐up of large thyroid nodules without surgery.

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Association of Thyroid Nodule Size and Bethesda Class With Rate of Malignant Disease

Abstract: Our results suggest that smaller TNs (smaller than about 2.0 cm) are associated with increased probabilities of malignant disease irrespective of Bethesda class. Routine diagnostic thyroid lobectomy solely owing to TN size of 3.0 cm or greater need not be performed.

Cited by 37 publications

References 33 publications

Risk of Malignancy in Thyroid Nodules 4 cm or Larger

Risk of Malignancy in Thyroid Nodules 4 cm or Larger

Size of thyroid carcinoma by histotype and variants: A population-based study in a mildly iodine-deficient area

Follow‐up of large thyroid nodules without surgery: Patient selection and long‐term outcomes

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