Incidental Thyroid Nodules: Incidence, Evaluation, and Outcome

Chaikhoutdinov, Irina; Mitzner, Ron; Goldenberg, David

doi:10.1177/0194599814524705

Cited by 20 publications

(6 citation statements)

References 22 publications

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“…The detection of thyroid nodules found on imaging obtained for non-thyroid reasons, termed thyroid incidentalomas, has been proposed as a significant source of the rising incidence of thyroid cancer (5). Reviews of cross-sectional imaging in patients with known non-thyroid cancers or healthy volunteers have demonstrated an incidentaloma prevalence of 6–18% depending on the imaging modality studied (6–14). These data, however, were obtained primarily in studies in which the radiologist reviewed images specifically looking for thyroid nodules .…”

Section: Introductionmentioning

confidence: 99%

Benign and Malignant Thyroid Incidentalomas Are Rare in Routine Clinical Practice: A Review of 97,908 Imaging Studies

Uppal

White

Nagar

et al. 2015

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Purpose Thyroid nodules incidentally identified on imaging are thought to contribute to the increasing incidence of thyroid cancer. We aim to determine the true rate of incidental thyroid nodule reporting, malignancies rates of these nodules, and to compare these findings to rates of detection by dedicated radiology review. Methods A cross sectional analysis was done to determine the prevalence of thyroid nodules in radiologist reports by analyzing all reports for CT, PET, and MRI scans of the head, neck and chest as well neck ultrasounds performed at a tertiary care center from 2007 to 2012. Retrospective chart review was performed on patients with a reported thyroid nodule to determine clinical outcomes of these nodules. Radiology reports were compared with dedicated radiology review of 500 randomly selected CT scans from the study group to determine the difference between clinical reporting and actual prevalence of thyroid nodules. Results 97,908 imaging studies met inclusion criteria, 387 (0.4%) thyroid incidentalomas were identified on radiology report. 163 (42.1%) of these nodules were worked up with FNA, diagnosing 27 thyroid cancers (0.03% of all studies, 7.0% of reported incidentalomas). The prevalence of incidentalomas clinically reported was 142/100,000 CT scans, 638/100,000 MRIs, 358/100,000 PET scans, and 6,594/100,000 ultrasounds. In contrast, review of CT scans screening for thyroid nodules had a prevalence of 10%. Conclusion Routine clinical reporting of incidental thyroid nodules is far less common than on dedicated review. Impact These data, contradict the notion that incidentalomas contribute significantly to rising thyroid cancer rates.

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Section: Introductionmentioning

confidence: 99%

Benign and Malignant Thyroid Incidentalomas Are Rare in Routine Clinical Practice: A Review of 97,908 Imaging Studies

Uppal

White

Nagar

et al. 2015

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Computed tomography is responsible for 35% to 78% of incidental thyroid nodules that receive workup. [10][11][12][13][14] At CT, the nodule is visible but not sufficiently characterized. No imaging findings at CT distinguish between a benign and a malignant nodule.…”

Section: Scenario and The Clinical Dilemmamentioning

confidence: 99%

“…The typical scenario consists of a patient in whom CT imaging of the chest or neck detects an incidental thyroid nodule that is reported by the radiologist (Figure 1). Computed tomography is responsible for 35% to 78% of incidental thyroid nodules that receive workup . At CT, the nodule is visible but not sufficiently characterized.…”

Section: Scenario and The Clinical Dilemmamentioning

confidence: 99%

Understanding the Risks and Harms of Management of Incidental Thyroid Nodules

Hoang

Nguyen

2017

JAMA Otolaryngol Head Neck Surg

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“…Incidentalomas are mostly discovered on neck US or CT-scans and less often on magnetic resonance imaging (MRI) or 18 F-fluorodeoxyglucose-positron emission tomography (FDG-PET) scans [ 12 ]. Generally, they are smaller than 2 cm [ 13 , 14 , 15 , 16 ]. The risk for malignancy in incidentalomas is presumed to be lower than that of palpable nodules [ 13 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics, Diagnostic Approach and Outcome of Thyroid Incidental Findings vs. Clinically Overt Thyroid Nodules: An Observational Single-Centre Study

Jansen

Stikkelbroeck

Ven

et al. 2023

Cancers

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Context: Thyroid nodules are common and can present as clinically overt nodules (visible, palpable or symptomatic nodules) and so-called incidentalomas (coincidental findings on imaging techniques). The majority are benign but recognizing clinically relevant nodules remains a challenge. Current Dutch guidelines recommend to refrain from additional diagnostic testing in incidentalomas other than FDG-PET-incidentalomas, unless there are suspicious clinical and/or sonographic features. However, there is no consensus on the further approach and no “real-life” data on the outcome of such an approach. Objective: To compare clinical characteristics, diagnostic approaches and clinical outcome between patients referred with thyroid incidentalomas and non-incidentalomas at one academic referral thyroid clinic. Methods: Clinical and demographical characteristics, diagnostic and therapeutic approaches and outcome were retrospectively obtained from the files of all patients newly referred because of thyroid incidentalomas or non-incidentalomas to our institution (between March 2011 and January 2017). Subsequently, the data were compared between both groups. Results: In total, 351 patients (64.3%) were referred because of non-incidentalomas and 195 (35.7%) because of incidentalomas. Incidentalomas were smaller (48.7% <2 cm) than non-incidentalomas (23.4% <2 cm). Furthermore, incidentalomas were less often symptomatic (15.9 vs. 42.7% p < 0.001). Fine-needle aspiration was performed in a similar percentage of the patients in the two groups (62.6% of incidentalomas vs. 69.8% in non-incidentaloma, p = 0.08). Significantly less malignancies were found among incidentalomas compared to non-incidentalomas (5.1% vs. 11.1%, p = 0.019). Moreover, significantly more malignancies occurred in PET-incidentalomas than non-PET-incidentalomas (11.8% vs. 2.8%, p = 0.023). In fact, the proportion of malignancies in PET-incidentalomas and non-incidentalomas was similar (11.8% vs. 11.1%, p = 0.895). Stability or decrease in size was observed in 96.5% of nodules receiving ultrasound follow-up. Conclusions: Patients with small asymptomatic thyroid incidentalomas represent an important proportion of the patients referred for additional diagnostic evaluation. The risk of malignancy in these patients is lower than in those with symptomatic palpable lesions, particularly in the patients with incidentalomas discovered on CT, MRI or US. Our findings support the current recommendations from the Dutch guidelines to not indiscriminately perform additional analysis and treatment on all incidentalomas, but prioritize this to FDG-PET-incidentalomas and clinically relevant non-PET-incidentalomas. Moreover, US features can further refine the selection of the patients who require immediate FNAC and/or surgery.

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Incidental Thyroid Nodules: Incidence, Evaluation, and Outcome

Abstract: We identified a malignancy of at least 13.3% in IDTNs, reaffirming that IDTNs should undergo thorough workup.

Cited by 20 publications

References 22 publications

Benign and Malignant Thyroid Incidentalomas Are Rare in Routine Clinical Practice: A Review of 97,908 Imaging Studies

Benign and Malignant Thyroid Incidentalomas Are Rare in Routine Clinical Practice: A Review of 97,908 Imaging Studies

Understanding the Risks and Harms of Management of Incidental Thyroid Nodules

Clinical Characteristics, Diagnostic Approach and Outcome of Thyroid Incidental Findings vs. Clinically Overt Thyroid Nodules: An Observational Single-Centre Study

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