Advertisement

Endocrine

, Volume 66, Issue 2, pp 249–253 | Cite as

Thyroid nodules over 4 cm do not have higher malignancy or benign cytology false-negative rates

  • Muhammed Kizilgul
  • Rupendra Shrestha
  • Angela Radulescu
  • Maria R. Evasovich
  • Lynn A. BurmeisterEmail author
Original Article

Abstract

Purpose

Whether thyroid nodules 4 cm or larger with benign cytology carry a higher risk of malignancy, and should be managed differently than smaller nodules remains controversial. We aimed to evaluate the malignancy rate and benign cytology false-negative rate in thyroid nodules ≥4 cm compared with those <4 cm.

Methods

All thyroidectomies between January 2010 and December 2014 were reviewed. Patient demographics, preoperative sonographic nodule size, fine needle aspiration cytology (FNAC), and final surgical pathology results were compared for index nodules ≥4 vs. <4 cm.

Results

A total of 490 index nodules with preoperative FNAC were identified. A total of 137 nodules were ≥4 cm and 353 nodules were <4 cm. The prevalence of carcinoma was lower (23 vs. 53%) in nodules ≥4 vs. <4 cm (p < 0.0001). The false-negative rate of benign FNAC for ≥4 and <4 cm index nodule was 5.2% and 5.9%, respectively (p = 1.000).

Conclusions

This study shows that thyroid nodules ≥4 cm do not have a higher malignancy rate at surgery nor higher benign cytology false-negative rate than smaller nodules. Thyroid nodules over 4 cm do not require resection, to rule out malignancy, based on size alone.

Keywords

Thyroid nodule ≥4 cm Thyroid carcinoma False-negative rate Size 

Notes

Funding

This study was funded by the National Institutes of Health’s National Center for Advancing Translational Sciences, grant UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health’s National Center for Advancing Translational Sciences. Muhammed Kizilgul was supported by a grant from The Scientific and Technical Research Council of Turkey (TUBITAK).

Compliance with ethical standards

Conflict of interest

The authors delare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the University of Minnesota Institutional Review Board.

References

  1. 1.
    D.S. Dean, H. Gharib, Epidemiology of thyroid nodules. Best Pract. Res Clin. Endocrinol. Metab. 22(6), 901–911 (2008)CrossRefGoogle Scholar
  2. 2.
    S. Guth, U. Theune, J. Aberle, A. Galach, C.M. Bamberger, Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur. J. Clin. Invest. 39(8), 699–706 (2009)CrossRefGoogle Scholar
  3. 3.
    B.R. Haugen, E.K. Alexander, K.C. Bible et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 26(1), 1–133 (2016)CrossRefGoogle Scholar
  4. 4.
    H. Gharib, E. Papini, R. Paschke et al. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules. J. Endocrinol. Invest. 33(5 Suppl), 1–50 (2010)PubMedGoogle Scholar
  5. 5.
    J.F. Carrillo, M. Frias-Mendivil, F.J. Ochoa-Carrillo, M. Ibarra, Accuracy of fine-needle aspiration biopsy of the thyroid combined with an evaluation of clinical and radiologic factors. Otolaryngol. Head Neck Surg. 122(6), 917–921 (2000)CrossRefGoogle Scholar
  6. 6.
    K.L. McCoy, N. Jabbour, J.B. Ogilvie, N.P. Ohori, S.E. Carty, J.H. Yim, The incidence of cancer and rate of false-negative cytology in thyroid nodules greater than or equal to 4 cm in size. Surgery 142(6), 837–844 (2007). discussion 844.e1–e3CrossRefGoogle Scholar
  7. 7.
    C.R. McHenry, E.S. Huh, R.N. Machekano, Is nodule size an independent predictor of thyroid malignancy? Surgery 144(6), 1062–1068 (2008)CrossRefGoogle Scholar
  8. 8.
    B. Kuru, N.E. Gulcelik, M.A. Gulcelik, H. Dincer, The false-negative rate of fine-needle aspiration cytology for diagnosing thyroid carcinoma in thyroid nodules. Langenbeck’s. Arch. Surg. 395(2), 127–132 (2010)CrossRefGoogle Scholar
  9. 9.
    D.H. Koo, K. Song, H. Kwon et al. Does tumor size influence the diagnostic accuracy of ultrasound-guided fine-needle aspiration cytology for thyroid nodules? Int. J. Endocrinol. 2016, 1–6 (2016)CrossRefGoogle Scholar
  10. 10.
    W.H. Giles, R.A. Maclellan, A.A. Gawande et al. False negative cytology in large thyroid nodules. Ann. Surg. Oncol. 22(1), 152–157 (2015)CrossRefGoogle Scholar
  11. 11.
    G. Godazandeh, Z. Kashi, S. Zargarnataj, M. Fazli, R. Ebadi, E.H. Kerdabadi, Evaluation the relationship between thyroid nodule size with malignancy and accuracy of fine needle aspiration biopsy (FNAB). Acta Inf. Med. 24(5), 347–351 (2016)CrossRefGoogle Scholar
  12. 12.
    S. Khalife, S. Bouhabel, V.I. Forest 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. 45(1), 1–7 (2016)Google Scholar
  13. 13.
    N. Bestepe, D. Ozdemir, A.A. Tam et al. Malignancy risk and false-negative rate of fine needle aspiration cytology in thyroid nodules ≥ 4.0 cm. Surgery 160(2), 405–412 (2016)CrossRefGoogle Scholar
  14. 14.
    O. Bozbiyik, S. Ozturk, M. Unver, V. Erol, U. Bayol, C. Aydin, Reliability of fine needle aspiration biopsy in large thyroid nodules. Turk. J. Surg. 33(1), 10–13 (2017)CrossRefGoogle Scholar
  15. 15.
    N.A. Cipriani, M.G. White, P. Angelos, R.H. Grogan, Large cytologically benign thyroid nodules do not have high rates of malignancy or false-negative rates and clinical observation should be considered: a meta-analysis. Thyroid 28(12), 1595–1608 (2018)CrossRefGoogle Scholar
  16. 16.
    S.N. Pinchot, H. Al-Wagih, S. Schaefer, R. Sippel, H. Chen, Accuracy of fine-needle aspiration biopsy for predicting neoplasm or carcinoma in thyroid nodules 4 cm or larger. Arch. Surg. 144(7), 649–655 (2009)CrossRefGoogle Scholar
  17. 17.
    P.P. Parikh, B.J. Allan, J.I. Lew, Sex variability of fine-needle aspiration reliability in the diagnosis of malignancy in thyroid nodules ≥ 4 cm. Am. J. Surg. 206(5), 778–782 (2013)CrossRefGoogle Scholar
  18. 18.
    L.I. Wharry, K.L. McCoy, M.T. Stang et al. Thyroid nodules (≥4 cm): can ultrasound and cytology reliably exclude cancer? World J. Surg. 38(3), 614–621 (2014)CrossRefGoogle Scholar
  19. 19.
    P.W. Rosario, D.S. Salles, B. Bessa, S. Purisch, Low false-negative rate of cytology in thyroid nodules > or = 4 cm. Arq. Bras. Endocrinol. Metabol. 53(9), 1143–1145 (2009)CrossRefGoogle Scholar
  20. 20.
    M. Shrestha, B.A. Crothers, H.B. Burch, 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 22(12), 1251–1256 (2012)CrossRefGoogle Scholar
  21. 21.
    M.D. Raj, S. Grodski, S. Woodruff, M. Yeung, E. Paul, J.W. Serpell, Diagnostic lobectomy is not routinely required to exclude malignancy in thyroid nodules greater than four centimetres. ANZ J. Surg. 82(1-2), 73–77 (2012)CrossRefGoogle Scholar
  22. 22.
    M.B. Albuja-Cruz, M. Goldfarb, S.S. Gondek, B.J. Allan, J.I. Lew, Reliability of fine-needle aspiration for thyroid nodules greater than or equal to 4 cm. J. Surg. Res. 181(1), 6–10 (2013)CrossRefGoogle Scholar
  23. 23.
    S.C. Kamran, E. Marqusee, M.I. Kim et al. Thyroid nodule size and prediction of cancer. J. Clin. Endocrinol. Metab. 98(2), 564–570 (2013)CrossRefGoogle Scholar
  24. 24.
    J.H. Kim, N.K. Kim, Y.L. Oh, et al., The validity of ultrasonography-guided fine needle aspiration biopsy in thyroid nodules 4 cm or larger depends on ultrasonography characteristics. Endocrinol. Metab. 29, 545–552 (2014).CrossRefGoogle Scholar
  25. 25.
    H. Shi, I. Bobanga, C.R. McHenry, Are large thyroid nodules classified as benign on fine needle aspiration more likely to harbor cancer? Am. J. Surg. 213(3), 464–466 (2017)CrossRefGoogle Scholar
  26. 26.
    U.C. Megwalu, Risk of malignancy in thyroid nodules 4 cm or larger. Endocrinol. Metab. 32(1), 77–82 (2017)CrossRefGoogle Scholar
  27. 27.
    A. Ozpek, C.C. Goret, C.S. Topal, Comparison of FNAC and histopathological results for 4 cm oR Larger Benign Thyroid Nodules. J. Coll. Physicians Surg. Pak. 28(9), 703–706 (2018)CrossRefGoogle Scholar
  28. 28.
    M.A. Hatem, S. Farheen, Thyroid nodule size as an indicator for surgery. Int Surg. J. 5(7), 2401–2405 (2018)CrossRefGoogle Scholar
  29. 29.
    R. Varshney, V.-I. Forest, F. Zawawi et al. Ultrasound-guided fine-needle aspiration of thyroid nodules: does size matter? Am. J. Otolaryngol. 35(3), 373–376 (2014)CrossRefGoogle Scholar
  30. 30.
    A.E. Uçar, S.M. Sarikaya, Ö. Parlak, A. Yalçin, Effect of nodule size on the reliability of fine-needle aspiration biopsy in thyroid nodules. Turk. J. Med. Sci. 44(6), 1002–1009 (2014)CrossRefGoogle Scholar
  31. 31.
    R. Kulstad, Do all thyroid nodules >4 cm need to be removed? an evaluation of thyroid fine-needle aspiration biopsy in large thyroid nodules. Endocr. Pract. 22(7), 791–798 (2016)CrossRefGoogle Scholar
  32. 32.
    E.S. Cibas, S.Z. Ali, N.C.I. Thyroid, FNA state of the science conference. The bethesda system for reporting thyroid cytopathology. Am. J. Clin. Pathol. 132(5), 658–665 (2009)CrossRefGoogle Scholar
  33. 33.
    L. Bohacek, M. Milas, J. Mitchell, A. Siperstein, E. Berber, Diagnostic accuracy of surgeon-performed ultrasound-guided fine-needle aspiration of thyroid nodules. Ann. Surg. Oncol. 19(1), 45–51 (2012)CrossRefGoogle Scholar
  34. 34.
    M.C. Frates, C.B. Benson, P.M. Doubilet et al. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. J. Clin. Endocrinol. Metab. 91(9), 3411–3417 (2006)CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of MedicineSurgery University of MinnesotaMinneapolisUSA
  2. 2.Department of Endocrinology and MetabolismUHS Diskapi Training and Research HospitalAnkaraTurkey

Personalised recommendations