Natural History of Benign Thyroid Nodules.

[Argirios Argiriou]

March 10, 2015

Allan S. Brett, MD reviewing Durante C et al. JAMA 2015 Mar 3. Cappola AR and Mandel SJ. JAMA 2015 Mar 3.

In a prospective study, cancer was diagnosed in only 0.3% of nodules during 5 years of follow-up.

The dearth of high-quality evidence on the natural history of benign thyroid nodules is surprising. In this prospective study from eight Italian referral centers, researchers assembled a cohort of 992 consecutive euthyroid patients with 1567 thyroid nodules that measured 4 to 40 mm in largest diameter. All nodules were either cytologically benign on fine-needle aspirate (FNA) or were <10 mm in size with benign characteristics on ultrasound. During 5 years of annual thyroid ultrasound examinations, FNA was performed if a previously benign-appearing nodule developed suspicious features on ultrasound or if a nodule grew substantially (11% of nodules increased in volume by at least 50% during follow-up).

Thyroid cancer was diagnosed during follow-up in five of the original nodules (0.3%). In four of these cases, the baseline ultrasound had revealed at least one suspicious finding (hypoechogenicity, irregular margins, taller-than-wide shape, intranodular vascular spots, or microcalcifications), but cytology was benign on FNA. Only one cancer was diagnosed in a patient with initial nodule size <10 mm and no suspicious sonographic characteristics.
Comment

In this 5-year study of thyroid nodules, malignancy ultimately was diagnosed in only a tiny fraction of cases. Four of the five “missed” cancers occurred in patients with suspicious ultrasound findings but benign FNA on baseline examinations. This observation leads editorialists to suggest that patients with both benign FNA and no suspicious ultrasound features do not require repeated ultrasonographic surveillance. If that suggestion is adopted, it would be a departure from current guidelines that recommend repeat ultrasound examination at 6 to 18 months after initial FNA for all patients (Thyroid 2009; 19:1167).

Editor Disclosures at Time of Publication

    Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose

Citation(s):

    Durante C et al. The natural history of benign thyroid nodules. JAMA 2015 Mar 3; 313:926. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

    PubMed abstract (Free)
    Cappola AR and Mandel SJ.Improving the long-term management of benign thyroid nodules. JAMA 2015 Mar 3; 313:903. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

    PubMed abstract (Free)

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