Is patient age associated with risk of malignancy in a ≥4 cm cytologically benign thyroid nodule?

Abstract

Background: Current data regarding the risk of malignancy in a large thyroid nodule with benign fineneedle aspiration biopsy(FNAB) is conflicting. We investigated the impact of patient age on the risk of malignancy in nodules4 cm with benign cytology. Methods: We performed a single-institution retrospective review of patients who underwent surgery from 07/2008e08/2019 for a cytologically benign thyroid nodule 4 cm. The relationship between malignant histopathology and patient and ultrasound features was assessed with multivariable logistic regression. Results: Of 474 nodules identified, 25(5.3%) were malignant on final pathology. In patients <55 years old, 21/273(7.7%) nodules were malignant, compared to 4/201(2.0%) in patients 55. Patient age 55 was independently associated with significantly lower risk of malignancy(OR:0.2,95%CI:0.1e0.7,p ¼ 0.011). Increasing nodule size >4 cm and high-risk ultrasound features were not associated with risk of malignancy(OR:1.0,95%CI:0.7e1.4,p ¼ 0.980, and OR:9.6,95%CI:0.9e107.8,p ¼ 0.066, respectively). Conclusions: Patients <55 years old are 3.7-fold more likely to have a falsely benign FNA biopsy in a nodule4 cm.

The Utility of ACR TI-RADS in Predicting False-Negative Fine Needle Aspiration for Thyroid Cancer

“…17 In addition, age <55 years was found to be 3.7-fold more likely to have a false-negative FNA in nodules >4 cm. 18 This study supports that younger patients are at a higher risk of false-negative FNA. Given that incidence of malignancy in nodules is higher in younger patients and who are at a higher risk of false negatives, age should be considered when interpreting FNA results and counseling patients on benign findings.…”

Unilateral Benign Thyroid Lesion Management with Histopathology Results Following Surgery Was a Malignancy

“…The peak age for patients with thyroid lesions is 75 years, if the patient does not have comorbid thyroid disease, the incidence of thyroid carcinoma can be prevented. [10]…”

“…Patients under 55 years of age with a lesion larger than 4 cm had a 3.7 times higher false negative rate of malignancy from biopsy than those over 55, hence surgery to remove the gland in question is essential to prevent thyroid carcinoma after benign lesions. [10] Based on histological findings, this patient was diagnosed with papillary thyroid cancer after surgery. A more thorough examination is carried out (Thyroid and neck ultrasound including lateral and central compartments) or Biopsy of enlarged lymph nodes or contralateral lesions.…”

Do large thyroid nodules (≥4 cm) without suspicious cytology need surgery?

“…First, larger nodules are often heterogeneous and contain areas of both benign and tissues. Therefore, a small sample obtained using FNAB may miss the malignant portion of the nodule, leading to false-negative results (26,27). Second, larger nodules may have a more complex architecture, making it difficult for pathologists to correctly interpret biopsy samples.…”