Thyroid Nodules (≥4 cm): Can Ultrasound and Cytology Reliably Exclude Cancer?
Laura I. Wharry
Department of Surgery, University of Pittsburgh School of Medicine, Suite 101 - 3471 Fifth Avenue, 15213 Pittsburgh, PA, USA
Search for more papers by this authorKelly L. McCoy
Department of Surgery, University of Pittsburgh School of Medicine, Suite 101 - 3471 Fifth Avenue, 15213 Pittsburgh, PA, USA
Search for more papers by this authorMichael T. Stang
Department of Surgery, University of Pittsburgh School of Medicine, Suite 101 - 3471 Fifth Avenue, 15213 Pittsburgh, PA, USA
Search for more papers by this authorMichaele J. Armstrong
Department of Surgery, University of Pittsburgh School of Medicine, Suite 101 - 3471 Fifth Avenue, 15213 Pittsburgh, PA, USA
Search for more papers by this authorShane O. LeBeau
Department of Endocrinology, University of Pittsburgh, Pittsburgh, PA, USA
Search for more papers by this authorMitch E. Tublin
Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
Search for more papers by this authorBiatta Sholosh
Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
Search for more papers by this authorAri Silbermann
Department of Surgery, University of Pittsburgh School of Medicine, Suite 101 - 3471 Fifth Avenue, 15213 Pittsburgh, PA, USA
Search for more papers by this authorN. Paul Ohori
Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
Search for more papers by this authorYuri E. Nikiforov
Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
Search for more papers by this authorSteven P. Hodak
Department of Endocrinology, University of Pittsburgh, Pittsburgh, PA, USA
Search for more papers by this authorSally E. Carty
Department of Surgery, University of Pittsburgh School of Medicine, Suite 101 - 3471 Fifth Avenue, 15213 Pittsburgh, PA, USA
Search for more papers by this authorCorresponding Author
Linwah Yip
- [email protected]
- 412-647-0467 | Fax: 412-648-9551
Department of Surgery, University of Pittsburgh School of Medicine, Suite 101 - 3471 Fifth Avenue, 15213 Pittsburgh, PA, USA
Tel.: 412-647-0467, Fax: 412-648-9551, [email protected]Search for more papers by this authorLaura I. Wharry
Department of Surgery, University of Pittsburgh School of Medicine, Suite 101 - 3471 Fifth Avenue, 15213 Pittsburgh, PA, USA
Search for more papers by this authorKelly L. McCoy
Department of Surgery, University of Pittsburgh School of Medicine, Suite 101 - 3471 Fifth Avenue, 15213 Pittsburgh, PA, USA
Search for more papers by this authorMichael T. Stang
Department of Surgery, University of Pittsburgh School of Medicine, Suite 101 - 3471 Fifth Avenue, 15213 Pittsburgh, PA, USA
Search for more papers by this authorMichaele J. Armstrong
Department of Surgery, University of Pittsburgh School of Medicine, Suite 101 - 3471 Fifth Avenue, 15213 Pittsburgh, PA, USA
Search for more papers by this authorShane O. LeBeau
Department of Endocrinology, University of Pittsburgh, Pittsburgh, PA, USA
Search for more papers by this authorMitch E. Tublin
Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
Search for more papers by this authorBiatta Sholosh
Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
Search for more papers by this authorAri Silbermann
Department of Surgery, University of Pittsburgh School of Medicine, Suite 101 - 3471 Fifth Avenue, 15213 Pittsburgh, PA, USA
Search for more papers by this authorN. Paul Ohori
Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
Search for more papers by this authorYuri E. Nikiforov
Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
Search for more papers by this authorSteven P. Hodak
Department of Endocrinology, University of Pittsburgh, Pittsburgh, PA, USA
Search for more papers by this authorSally E. Carty
Department of Surgery, University of Pittsburgh School of Medicine, Suite 101 - 3471 Fifth Avenue, 15213 Pittsburgh, PA, USA
Search for more papers by this authorCorresponding Author
Linwah Yip
- [email protected]
- 412-647-0467 | Fax: 412-648-9551
Department of Surgery, University of Pittsburgh School of Medicine, Suite 101 - 3471 Fifth Avenue, 15213 Pittsburgh, PA, USA
Tel.: 412-647-0467, Fax: 412-648-9551, [email protected]Search for more papers by this authorAbstract
Background
Whether a threshold nodule size should prompt diagnostic thyroidectomy remains controversial. We examined a consecutive series of patients who all had thyroidectomy for a ≥4 cm nodule to determine (1) the incidence of thyroid cancer (TC) and (2) if malignant nodules could accurately be diagnosed preoperatively by ultrasound (US), fine needle aspiration biopsy (FNAB) cytology and molecular testing.
Methods
As a prospective management strategy, 361 patients with 382 nodules ≥4 cm by preoperative US had thyroidectomy from 1/07 to 3/12.
Results
The incidence of a clinically significant TC within the ≥4 cm nodule was 22 % (83/382 nodules). The presence of suspicious US features did not discriminate malignant from benign nodules. Moreover, in 86 nodules ≥4 cm with no suspicious US features, the risk of TC within the nodule was 20 %. US-guided FNAB was performed for 290 nodules, and the risk of malignancy increased stepwise from 10.4 % for cytologically benign nodules, 29.6 % for cytologically indeterminate nodules and 100 % for malignant FNAB results. Molecular testing was positive in 9.3 % (10/107) of tested FNAB specimens, and all ten were histologic TC.
Conclusions
In a large consecutive series in which all ≥4 cm nodules had histology and were systematically evaluated by preoperative US and US-guided FNAB, the incidence of TC within the nodule was 22 %. The false negative rate of benign cytology was 10.4 %, and the absence of suspicious US features did not reliably exclude malignancy. At minimum, thyroid lobectomy should be strongly considered for all nodules ≥4 cm.
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