Malignancy risk of initially benign thyroid nodules: validation with various Thyroid Imaging Reporting and Data...

Area of Science:

• Endocrinology
• Radiology
• Oncology

Background:

• Repeated biopsy of benign thyroid nodules offers limited diagnostic benefit.
• Integration of Thyroid Imaging Reporting and Data System (TIRADS) guidelines with initial biopsy for benign thyroid nodule diagnosis has not been previously detailed.

Purpose of the Study:

• Investigate malignancy rates and probabilities in initially biopsy-proven benign thyroid nodules using various stratification systems.
• Determine the clinical relevance of these systems in managing benign thyroid nodules.

Main Methods:

• Retrospective analysis of 2747 thyroid nodules from 6493 patients with initial biopsy and over 1 year of follow-up.
• Calculated malignancy probability using Korean-TIRADS, ATA guideline, French-TIRADS, and web-based TIRADS risk stratification systems.

Main Results:

• Overall thyroid malignancy rate was 8.3%.
• Initially benign nodules with "low suspicion" (K-TIRADS, ATA) or "very probably benign" (French-TIRADS) showed ≤3.0% malignancy probability.
• Low-suspicion nodules by various TIRADS guidelines had low malignancy probability.

Conclusions:

• A single biopsy is sufficient for initially benign thyroid nodules.
• Imaging surveillance is recommended for benign nodules with low suspicion and low malignancy probability based on TIRADS guidelines.
• Repetitive biopsy is reserved for nodules with imaging-pathology mismatch, enabling personalized management.