Large thyroid nodules: should size alone matter?

Tang, Joyce Zhi'en; Chua, Jasmine Ming Er; Woon, Tian Kai; Tan, Bien Soo; Kiong, Kimberley L.

doi:10.1007/s00405-021-07151-3

Cited by 4 publications

(6 citation statements)

References 26 publications

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“…This was consistent with previous studies that showed that large nodules larger than 4.0 cm were not associated with a higher risk of malignancy. 18 , 19 For example, Tang et al 20 reported that the false-negative rate of FNAC for 563 nodules 4.0 cm or greater was 6.6%, which was not statistically significantly different from the 4.2% false-negative rate for 4419 nodules smaller than 4.0 cm.…”

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

“…We postulate that this may be attributed to the interobserver variability of pathologists on reviewing the FNAC cytology, because diagnosing follicular thyroid cancer is fraught with challenges. Hence, management decisions for large thyroid nodules should be tailored to individual patients according to clinical, sonographic, and cytological features 14,20 Nodules with ACR TI-RADS 4 to 5 scores that are 1 cm or smaller are usually not recommended for FNA owing to the challenges in obtaining sufficient material on FNAC. This practical consideration is also consistent with the American Thyroid Association guidelines, 21 which recommend that subcentimeter nodules should be considered for FNAC only when other risk factors of cancer are evident.…”

Section: Jama Network Open | Otolaryngologymentioning

confidence: 99%

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Concordance of the ACR TI-RADS Classification With Bethesda Scoring and Histopathology Risk Stratification of Thyroid Nodules

Huang,

Kao,

Lin

et al. 2023

JAMA Netw Open

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ImportanceAlthough most thyroid nodules are benign, 10% to 15% of them harbor cancer. Thyroid ultrasonography is useful for risk stratification of nodules, and American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) classification provides recommendations for fine-needle aspiration cytology (FNAC) based on objective ultrasonographic features of these nodules.ObjectiveTo validate the concordance of ACR TI-RADS classification with Bethesda classification and histopathology.Design, Setting, and ParticipantsThis retrospective cohort study was performed to evaluate the concordance of ACR TI-RADS classification with Bethesda classification and histopathology and was conducted in Singapore General Hospital Outpatient Otolaryngology clinic in March 2021 to May 2021. Data analysis was performed in May 2021.Main Outcomes and MeasuresResults were deemed concordant when ACR TI-RADS recommendations aligned with Bethesda scores. Conversely, results were classified as nonconcordant with Bethesda scores and/or histopathology results when nodules that were recommended for FNAC yielded benign results or nodules that were not recommended for FNAC yielded malignant results.ResultsA total of 446 patients (370 women [83%]; mean [range] age, 60 [24-89] years) who underwent ultrasonography of the thyroid and ultrasonography-guided thyroid FNACs were identified. A total of 492 of 630 nodules (78.1%) were benign on FNAC (Bethesda II). Score 3 ACR TI-RADS nodules yielded the highest negative predictive values: 94.6% (95% CI, 92.9%-95.9%; P &lt; .001) compared with Bethesda scoring and 100.0% (95% CI, 15.8%-100.0%; P = .003) compared with histopathology. Score 4 or 5 ACR TI-RADS nodules yielded positive predictive values of 2.8% and 16.2%, respectively, compared with Bethesda scoring and 6.1% and 66.7%, respectively, compared with histopathology. Small (&lt;1.5 cm) ACR TI-RADS nodules of scores of 4 and 5 that were not recommended for FNAC yielded a malignant risk of 5.7% and 25.0% on Bethesda 5 and 6, respectively. On surgical excision, 5 of 46 (10.9%) ACR TI-RADS 4 nodules and 15 of 21 (71.4%) of ACR TI-RADS 5 nodules were confirmed to be malignant. Among nodules initially not recommended for FNAC, histopathology-proven cancer was found in 4 of 13 (30.7%) and 3 of 6 (50.0%) of nodules, respectively.Conclusions and RelevanceThese findings suggest that ACR TI-RADS score 3 nodules have a low risk of cancer and should be considered for FNAC only if nodules are 2.5 cm or larger. Patients with small (&lt;1.5 cm) ACR TI-RADS 4 and 5 nodules should be appropriately counseled for FNAC to exclude cancer.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Jama Network Open | Otolaryngologymentioning

confidence: 99%

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Concordance of the ACR TI-RADS Classification With Bethesda Scoring and Histopathology Risk Stratification of Thyroid Nodules

Huang,

Kao,

Lin

et al. 2023

JAMA Netw Open

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“…In contrast, of the 114 patients who had lesions smaller than 1 cm, 90.4% were revealed to have malignant tumors. While these findings suggest that larger thyroid lesions, whether cancerous or noncancerous, are negatively associated with malignant tumors, several studies find size to have no significant relationship with tumor malignancy, 40‐42 and others associate the increase in tumor size with higher chances of malignancy 43,44 . Thus, thyromegaly alone, without considering the pathological aspect of existing lesions, can be misleading in terms of distinguishing between low‐ and high‐risk patients.…”

Section: Discussionmentioning

confidence: 99%

Demographic, clinical, and surgical features of patients undergoing thyroidectomy due to thyroid lesions in Southern Iran: A cross‐sectional study

Mardani,

Koulaian,

Fouladi

et al. 2024

Health Science Reports

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Background and AimsThe incidence of thyroid cancer has witnessed a significant global increase and stands as one of the most prevalent cancers in Iran. This surge is primarily attributed to the escalating incidence of papillary thyroid cancer (PTC), with overdiagnosis emerging as an equally noteworthy factor. Consequently, this study aims to ascertain the incidence of thyroid cancer, along with its clinical presentation, demographic characteristics, and surgical features in patients undergoing thyroid surgery.MethodsThis cross‐sectional study involved the evaluation of patient files from referral centers in Shiraz spanning the years 2015−2020. Demographic and clinical information pertaining to thyroid cancer was extracted and subsequently analyzed using SPSS software.ResultsA total of 533 documented cases of thyroid cancer undergoing surgery revealed an annual rate of 89 cases in our location. The average age of the patients was 43.9 ± 13.4 years (ranging from 13 to 92), with females constituting 429 (83.5%) of the cases, and 278 (54.1%) being malignant. Conventional PTC emerged as the most prevalent pathology, accounting for 239 (45.0%) of the cases. Patients with thyromegaly exhibited significantly higher incidences of nonmalignant tumors (p = 0.01), while those with malignant tumors were notably younger than those with nonmalignant tumors (p = 0.001).ConclusionOur study revealed a progressive rise in the number of patients undergoing thyroidectomy over the years, with PTC constituting the majority of cases. Malignant cases were more frequently observed in younger patients, and in smaller lesion sizes, highlighting the importance of early screening and optimizing detection methods, especially in high‐risk populations.

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“…However, in some other studies, it has been reported that the malignancy rates are not higher in nodules larger than 4 cm compared to nodules smaller than 4 cm, and nodules larger than 4 cm should be individualized according to clinical, ultrasonographic, and cytological characteristics rather than routine surgical resection based on size alone. [ 82 , 83 ]…”

Section: Other Cross-sectional Imaging Methodsmentioning

confidence: 99%

Management of Thyroid Nodules

Uludag

2023

Sisli Etfal

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Thyroid nodules are common and the prevalence varies between 4 and 7% by palpation and 19–68% by high-resolution USG. Most thyroid nodules are benign, and the malignancy rate varies between 7 and 15% of patients. Thyroid nodules are detected incidentally during clinical examination or, more often, during imaging studies performed for another reason. All detected thyroid nodules should be evaluated clinically. The main test in evaluating thyroid function is thyroid stimulating hormone (TSH). If the serum TSH level is below the normal reference range, a radionuclide thyroid scan should be performed to determine whether the nodule is hyperfunctioning. If the serum TSH level is normal or high, ultrasonography (US) should be performed to evaluate the nodule. US is the most sensitive imaging method in the evaluation of thyroid nodules. Computed tomography (CT) and magnetic resonance imaging are not routinely used in the initial evaluation of thyroid nodules. There are many risk classification systems according to the USG characteristics of thyroid nodules, and the most widely used in clinical practice are the American Thyroid Association guideline and the American College of Radiology Thyroid Imaging Reporting and Data System. Fine needle aspiration biopsy (FNAB) is the gold standard method in the evaluation of nodules with indication according to USG risk class. In the cytological evaluation of FNAB, the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is the most frequently applied cytological classification. TBSRTC is a simplified, 6-category reporting system and was updated in 2023. The application of molecular tests to FNAB specimens, especially those diagnosed with Bethesda III and IV, is increasing to reduce the need for diagnostic surgery. Especially in Bethesda III and IV nodules, different methods are applied in the treatment of nodules according to the malignancy risk of each category, these are follow-up, surgical treatment, radioactive iodine treatment, and non-surgical ablation methods.

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Large thyroid nodules: should size alone matter?

Cited by 4 publications

References 26 publications

Concordance of the ACR TI-RADS Classification With Bethesda Scoring and Histopathology Risk Stratification of Thyroid Nodules

Concordance of the ACR TI-RADS Classification With Bethesda Scoring and Histopathology Risk Stratification of Thyroid Nodules

Demographic, clinical, and surgical features of patients undergoing thyroidectomy due to thyroid lesions in Southern Iran: A cross‐sectional study

Management of Thyroid Nodules

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