Thyroid nodule size as an indicator for surgery
DOI:
https://doi.org/10.18203/2349-2902.isj20182756Keywords:
Biopsy, Diagnostic accuracy, Fine-needle, Large nodules, Thyroid neoplasms, Thyroid noduleAbstract
Background: Several authors have questioned the accuracy of fine- needle aspiration cytology (FNAC) in large thyroid nodules. It's the current practice to provide thyroidectomy to patient with thyroid nodules 4 cm or larger regardless of the FNAC results. The aim of the study is to answer two questions: is the size of nodule associated with higher risk of malignancy and is the size indication for surgery.
Methods: Authors conducted a retrospective review of 201 patients who underwent thyroidectomy between 2011 and 2017 at Bahrain defense force hospital. Authors compared all thyroid nodules with benign FNAC and their final histopathology reports. Patients were divided into two groups based on the size of the nodule (< 4cm or >4cm) and indication of surgery.
Results: 201 patients with thyroid nodule underwent thyroid surgery. 136 patients had nodule <4cm and 65 patients were ≥4 cm. For patients with nodules <4 cm, 37 patients (18.4%) had a malignancy, and for those with nodules ≥4 cm, 13 patients (6.4%) had a malignancy. comparison between size of the nodule, FNAC result and final histopathology: FNAC diagnosed 55 cases (27.3%) are malignant, final histopathology reported only 50 cases are malignant. But for benign cases FNAC and histopathology reports are showing same results, (p<0.05).
Conclusions: Thyroid nodules ≥4 cm are not risk factor of malignancy. Thyroid nodules ≥4 cm with benign FNAC should not undergo thyroidectomy as false negative rate is low. Therefore, the decision for surgery ought not to be taken based on the size of the nodule.
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References
Jiang H, Tian Y, Yan W, Kong Y, Wang H, Wang A, et al. The prevalence of thyroid nodules and an analysis of related lifestyle factors in Beijing communities. Int J Environmental Research Public Health. 2016 Apr 22;13(4):442.
Jammah A. Evaluation of the accuracy of fine-needle aspiration cytology in the diagnosis of thyroid nodules: a retrospective analysis of data from a tertiary care hospital in Saudi Arabia/ Tiroid Nodullerinin Tanisinda Ince Igne Aspirasyon Sitolojisinin Dogrulugunun Degerlendirilmesi: Suudi Arabistan'da Ucuncu Basamak Bir Hastanenin Verilerinin Retrospektif Analizi. Turkish J Endocrinol Metabol. 2012 Jun 1;16(2):30-4.
Tan GH, Gharib H. Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Annals Internal Med. 1997 Feb 1;126(3):226-31.
Shi H, Bobanga I, McHenry CR. Are large thyroid nodules classified as benign on fine needle aspiration more likely to harbor cancer?. The Am J Surgery. 2017 Mar 1;213(3):464-6.
Khalife S, Bouhabel S, Forest VI, Hier MP, Rochon L, Tamilia M, et al. The McGill Thyroid Nodule Score’s (MTNS+) role in the investigation of thyroid nodules with benign ultrasound guided fine needle aspiration biopsies: a retrospective review. J Otolaryngol- Head Neck Surgery. 2016 Dec;45(1):29.
Koo DH, Song K, Kwon H, Bae DS, Kim JH, Min HS, et al. Does tumor size influence the diagnostic accuracy of ultrasound-guided fine-needle aspiration cytology for thyroid nodules?. Int J Endocrinol. 2016;2016.
Kaliszewski K, Diakowska D, Wojtczak B, Strutyńska-Karpińska M, Domosławski P, Sutkowski K, et al. Fine-needle aspiration biopsy as a preoperative procedure in patients with malignancy in solitary and multiple thyroid nodules. PloS one. 2016 Jan;11(1):e0146883.
Megwalu UC. Risk of malignancy in thyroid nodules 4 cm or larger. Endocrinol Metabol. 2017 Mar 1;32(1):77-82.
Godazandeh G, Kashi Z, Zargarnataj S, Fazli M, Ebadi R, Kerdabadi EH. Evaluation the relationship between thyroid nodule size with malignancy and accuracy of fine needle aspiration biopsy (FNAB). Acta Informatica Medica. 2016 Oct;24(5):347.
Tai JD, Yang JL, Wu SC, Wang BW, Chang CJ. Risk factors for malignancy in patients with solitary thyroid nodules and their impact on the management. J Cancer Research Therapeutics. 2012 Jul 1;8(3):379.
Iqbal A, Ismail M, Israr M, Ali N, Zaman J. Management of solitary thyroid nodule. J Postgraduate Med Institute (Peshawar-Pakistan). 2011 Jun 10;19(1).
Alexopoulou O, Beguin C, Buysschaert M, Squifflet JP, De Burbure C, De Nayer P, et al. Predictive factors of thyroid carcinoma in non-toxic multinodular goitre. Acta Clinica Belgica. 2004 Apr 1;59(2):84-9.
McCoy KL, Jabbour N, Ogilvie JB, Ohori NP, Carty SE, Yim JH. The incidence of cancer and rate of false-negative cytology in thyroid nodules greater than or equal to 4 cm in size. Surgery. 2007; 142(6): 837-44.
Cappelli C, Castellano M, Pirola I, Gandossi E, De Martino E, Cumetti D, et al. Thyroid nodule shape suggests malignancy.European journal of endocrinology. 2006; 155(1): 27-31.
Sahin M, Gursoy A, Tutuncu N, Guvener D. Prevalence and prediction of malignancy in cytologically indeterminate thyroid nodules. Clinical Endocrinol. 2006; 65(4): 514-8.
Pinchot SN, Al-Wagih H, Schaefer S, Sippel R, Chen H. Accuracy of fine-needle aspiration biopsy for predicting neoplasm or carcinoma in thyroid nodules 4 cm or larger. Arch Surg. 2009; 144(7): 649-55.
McHenry CR, Huh ES, Machekano RN. Is nodule size an independent predictor of thyroid malignancy? Surgery. 2008; 144(6): 1062-9.
Kamran SC, Marqusee E, Kim MI, Frates MC, Ritner J, Peters H, et al. Thyroid nodule size and prediction of cancer. The J Clinical Endocrinol Metabol. 2012; 98(2): 564-70.
Kuru B, Gulcelik NE, Gulcelik MA, Dincer H. The false-negative rate of fine-needle aspiration cytology for diagnosing thyroid carcinoma in thyroid nodules. Langenbeck’s Archives Surgery. 2010; 395(2): 127-32.
Raj MD, Grodski S, Woodruff S, Yeung M, Paul E, Serpell JW. Diagnostic lobectomy is not routinely required to exclude malignancy in thyroid nodules greater than four centimetres. ANZ J Surg. 2012;82:73-7.
Berker D, Aydin Y, Ustun I, Gul K, Tutuncu Y, Isik S, et al. The value of fine-needle aspiration biopsy in subcentimeter thyroid nodules. Thyroid. 2008; 18(6): 603-8.
Carrillo JF, Frias-Mendivil M, Ochoa-Carrillo FJ, Ibarra M. Accuracy of fine-needle aspiration biopsy of the thyroid combined with an evaluation of clinical and radiologic factors. Otolaryngol- Head Neck Surgery. 2000; 122(6): 917-21.
Rausei S, Dionigi G, Frattini F, Castano P, Leotta A, Rovera F, et al. Nodule size and fine-needle aspiration biopsy: diagnostic challenges for thyroid malignancy. The Am J Surgery. 2011; 201(4): 525-30.
Brito JP, Gionfriddo MR, Al Nofal A, Boehmer KR, Leppin AL, Reading C, et al. The accuracy of thyroid nodule ultrasound to predict thyroid cancer: systematic review and meta- analysis. The J Clinical Endocrinol Metabol. 2013; 99(4):1253-63.
Bestepe N, Ozdemir D, Tam AA, Dellal FD, Kilicarslan A, Parlak O, et al. Malignancy risk and false-negative rate of fine needle aspiration cytology in thyroid nodules≥ 4.0 cm. Surgery. 2016.
Shrestha M, Crothers BA, Burch HB. The impact of thyroid nodule size on the risk of malignancy and accuracy of fine-needle aspiration: a 10-year study from a single institution. Thyroid. 2012;22:1251-6.
Magister MJ, Chaikhoutdinov I, Schaefer E, Williams N, Saunders B, Goldenberg D. Association of thyroid nodule size and Bethesda class with rate of malignant disease. JAMA Otolaryngol- Head Neck Surgery. 2015 Dec 1;141(12):1089-95.
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