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Risk Stratification and Long-Term Outcome of Benign Thyroid Nodules - An 11-Year Cohort Study
Sapir Pinhas1, Jonathan Cohen1, Raviv Allon1
1Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
Summary
The risk of malignancy in benign thyroid nodules is low, particularly for those under 2 cm. Long-term follow-up and repeat fine-needle aspiration (FNA) for certain benign nodules may not be necessary.
Area of Science:
- Endocrinology
- Oncology
- Radiology
Background:
- Optimal follow-up strategies for benign thyroid nodules are not well-defined.
- The utility of repeat fine-needle aspiration (FNA) and long-term surveillance requires clarification.
Purpose of the Study:
- To evaluate long-term follow-up and management outcomes for benign thyroid nodules.
- To assess the risk of malignancy (ROM) in initially benign nodules over time.
Main Methods:
- Retrospective analysis of 1224 benign thyroid nodules from 1071 patients (2010-2014).
- Data collection included demographics, sonographic features, follow-up adherence, repeat FNA results, and pathology.
- Risk of malignancy (ROM) defined by malignant pathology or repeat cytology (Bethesda System for Reporting Thyroid Cytopathology III-VI).
Main Results:
- Average follow-up was 9.48 years; 0.65% lost to follow-up.
- Overall ROM was 3.43%.
- Nodules >2 cm had significantly higher ROM (5.3%) compared to smaller nodules (1.3%, P<.001). Most malignancies (80.49%) occurred in nodules >2 cm and were diagnosed within 3 years.
Conclusions:
- Benign thyroid nodules, especially those <2 cm, have a low risk of malignancy.
- Long-term follow-up and repeat FNA for Bethesda System for Reporting Thyroid Cytopathology II nodules without suspicious features warrant reconsideration.
