Malignancy rates in thyroid nodules: a long-term cohort study of 17,592 patients

Abstract

Objectives Ultrasound diagnosis of thyroid nodules has greatly increased their detection rate. Their risk for malignancy is estimated between 7 and 15% in data from specialized centers which are used for guidelines recommendations. This high rate causes considerable anxiety to patients upon first diagnosis. Here we retrospectively analyzed the malignancy rate of sonographically diagnosed nodules larger 1cm from a primary/secondary care center when long-term longitudinal follow-up was included. Patients/Methods 17,592 patients were diagnosed with a thyroid nodule larger than 1cm, of whom 7,776 were assessed by fine needle aspiration cytology (FNAC) and 9,816 by sonography alone. 9568 patients were discharged following initial diagnosis due to innocent results of FNAC and/or ultrasound. In 1,904 patients definitive histology was obtained and 6,731 cases were included in long-term follow-up (up to 23 years with a median of 5 years). Results Malignancy was histologically confirmed in 189 patients (1.1% of all) when excluding accidentally diagnosed papillary microcarcinomas. 155 were diagnosed during the first year of management, 25 in years 2-5 of follow-up, 9 in years 6-10 and nil in 1,165 patients followed beyond 10 years. Conclusions Malignancy rate of thyroid nodules from primary/secondary care was much lower than that previously reported. During follow-up for more than 5 years their rate rapidly dropped to less than 1/1000 cases. This low malignancy rate may help to reassure patients first confronted with the diagnosis of a thyroid nodule, substantially reduce their anxiety and avoid unwarranted diagnostic and therapeutic procedures

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