What Happens in a 5-Year Follow-Up of Benign Thyroid Nodules

Negro, Roberto

doi:10.1155/2014/459791

Cited by 15 publications

(9 citation statements)

References 18 publications

(16 reference statements)

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“…At our institution the malignancy rate among nodules with documented growth is quite low (i.e. 1-2%), in agreement with other papers reporting thyroid lesions followed-up after an initial benign assessment [21][22][23][24]. Finally, in our series PTC/ FTC ratio was 72:1 (216/3 cases).…”

Section: Discussionsupporting

confidence: 91%

Early diagnosis by FNA cytology should not influence the outcome of differentiated thyroid cancer

et al. 2016

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Section: Discussionsupporting

confidence: 91%

Early diagnosis by FNA cytology should not influence the outcome of differentiated thyroid cancer

et al. 2016

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“…A new diagnosis of thyroid cancer was found in only 2 patients, none presenting with metastatic disease at baseline or developing recurrence during follow-up. These findings are compatible with previous reports (Table 4) suggesting an overall excellent prognosis for patients with a benign thyroid nodule using different sampling methodologies (e.g., single-center, multicenter, and population-based studies) and follow-up times [8, 9, 12–15]. …”

Section: Discussionsupporting

confidence: 93%

Prognosis of patients with benign thyroid nodules: a population-based study

et al. 2016

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Most thyroid nodules are benign. The ideal follow-up of these patients should reflect their prognosis, which has been scarcely investigated. We aimed to evaluate the prognosis of patients with initial benign thyroid cytology. A population-based study, using the Rochester Epidemiology Project, identifying patients with benign thyroid cytology diagnosed between 2003 and 2006 and completely followed to 2014 using linked medical records. We identified 363 thyroid nodules with benign cytology in 327 patients after fine-needle aspiration biopsy. Patients were on average 53 years old (standard deviation 17), and 80 % were women. The median nodule size was 1.6 cm (interquartile range 1.2–2.4); 26 % had at least one suspicious ultrasound feature. During a median follow-up of 8 years, 54 patients (17 %) with 57 benign nodules underwent thyroidectomy, mostly due to compressive symptoms (44 %). Thyroidectomy was more likely in younger patients [hazard ratio (HR) 0.97, 95 % CI 0.96–0.99] and patients with larger nodules (HR 1.3, 95 % CI 1.16–1.48). Two patients were found to have follicular thyroid cancer in the index nodule (0.6 %) and 6 patients had papillary thyroid cancer detected in other nodules (1.8 %). No patient died from thyroid cancer. Patients with benign thyroid nodules are unlikely to suffer morbidity or mortality due to thyroid cancer. Follow-up strategies for these patients should consider this excellent prognosis and avoid causing unnecessary fear in patients and adding unneeded expense and burden to the healthcare system.

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“…Little data are available on the optimal time interval for repeat evaluation of a cytologically benign nodule. Negro et al [ 19 ] described 249 patients with benign nodular disease who were followed for 5 years and documented the timing of relevant events, including the risk of repeat FNA, thyroidectomy or newly diagnosed thyroid malignancy. Unfortunately, due to the limited number of patients, this study was underpowered to stratify for follow-up time and did not investigate the outcomes at various time intervals.…”

Section: Discussionmentioning

confidence: 99%

Long- versus short-interval follow-up of cytologically benign thyroid nodules: a prospective cohort study

Medici

Liu

Kwong

et al. 2016

BMC Med

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BackgroundThyroid nodules are common, and most are benign. Given the risk of false-negative cytology (i.e. malignancy), follow-up is recommended after 1–2 years, though this recommendation is based solely on expert opinion. Sonographic appearance may assist with planning, but is limited by large inter-observer variability. We therefore compared the safety and efficacy of long- versus short-interval follow-up after a benign initial aspiration, regardless of sonographic appearance.MethodsThis study evaluated all patients referred to the Brigham and Women’s Hospital Thyroid Nodule Clinic, between 1999 and 2010, with a cytologically benign nodule >1 cm and who had returned for follow-up sonographic evaluation. Despite standard clinical recommendations, variation in patient compliance resulted in variable follow-up intervals from time of initial aspiration to the first repeat evaluation. Main outcome measures included nodule growth, repeat fine needle aspiration (FNA), thyroidectomy, malignancy, and disease-specific mortality.ResultsWe evaluated 1,254 patients with 1,819 cytologically benign nodules, with a median time to first follow-up of 1.4 years (range, 0.5–14.1 years). The longer the follow-up interval, the more nodules grew and the more repeat FNAs were performed (P <0.001). The most clinical meaningful endpoints of malignancy or mortality, however, did not differ between the various follow-up intervals. The risk of a thyroidectomy (usually because of compressive symptoms) increased when time to first follow-up exceeded >3 years (4.9 % vs. 1.2 %, P = 0.0001), though no difference in malignancy risk was identified (0.2–0.8 %, P = 0.77). No (0 %) thyroid cancer-specific deaths were identified in either cohort.ConclusionsWhile expert opinion currently recommends repeat evaluation of a cytologically benign nodule at 1–2 years, these are the first data to demonstrate that this interval can be safely extended to 3 years without increased mortality or patient harm. Nodule growth can be expected, though detection of malignancies is unchanged. While replication of these data in large prospective multicenter studies is needed, this extension in follow-up interval would reduce unnecessary visits and medical interventions for millions of affected patients worldwide, leading to healthcare savings.Please see related commentary article: http://dx.doi.org/10.1186/s12916-016-0559-9 and research article: http://dx.doi.org/10.1186/s12916-015-0419-z.

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What Happens in a 5-Year Follow-Up of Benign Thyroid Nodules

Cited by 15 publications

References 18 publications

Early diagnosis by FNA cytology should not influence the outcome of differentiated thyroid cancer

Early diagnosis by FNA cytology should not influence the outcome of differentiated thyroid cancer

Prognosis of patients with benign thyroid nodules: a population-based study

Long- versus short-interval follow-up of cytologically benign thyroid nodules: a prospective cohort study

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