Endocrinol Metab.  2017 Mar;32(1):77-82. 10.3803/EnM.2017.32.1.77.

Risk of Malignancy in Thyroid Nodules 4 cm or Larger

Affiliations
  • 1Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA. megwaluu@yahoo.com
  • 2Department of Otolaryngology, Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
  • 3Department of Otolaryngology, Queens Hospital Center, Jamaica, NY, USA.

Abstract

BACKGROUND
Several authors have questioned the accuracy of fine-needle aspiration cytology (FNAC) in large nodules. Some surgeons recommend thyroidectomy for nodules ≥4 cm even in the setting of benign FNAC, due to increased risk of malignancy and increased false negative rates in large thyroid nodules. The goal of our study was to evaluate if thyroid nodule size is associated with risk of malignancy, and to evaluate the false negative rate of FNAC for thyroid nodules ≥4 cm in our patient population.
METHODS
This is a retrospective study of 85 patients with 101 thyroid nodules, who underwent thyroidectomy for thyroid nodules measuring ≥4 cm.
RESULTS
The overall risk of malignancy in nodules ≥4 cm was 9.9%. Nodule size was not associated with risk of malignancy (odds ratio, 1.02) after adjusting for nodule consistency, age, and sex (P=0.6). The false negative rate for FNAC was 0%.
CONCLUSION
Nodule size was not associated with risk of malignancy in nodules ≥4 cm in our patient population. FNAC had a false negative rate of 0. Patients with thyroid nodules ≥4 cm and benign cytology should not automatically undergo thyroidectomy.

Keyword

Thyroid nodule; Thyroid neoplasms; Biopsy, fine-needle; Diagnostic accuracy; Large nodules

MeSH Terms

Biopsy, Fine-Needle
Humans
Retrospective Studies
Surgeons
Thyroid Gland*
Thyroid Neoplasms
Thyroid Nodule*
Thyroidectomy
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