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Thyroid Nodule Size is Not a Predictor of Malignancy: A Focus on Fine-needle Aspiration Cytology Findings
Van Bang Nguyen1,2, Hau Nguyen Van Vy2, Binh Le Trong3
1Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam.
Background:
This study aimed to evaluate the relationship between thyroid nodule size and various factors and malignancy risk, using fine-needle aspiration cytology (FNAc) as the diagnostic standard.
Methods:
A retrospective analysis was conducted on 760 patients with 850 thyroid nodules who underwent ultrasound (US) and US-guided FNAc from June 2023 to July 2024. Nodules were assessed using the ACR-Thyroid Imaging Reporting and Data Systems (TIRADS) classification and classified cytologically according to the 2017 Bethesda System. Statistical analyses included logistic regression to evaluate the association between variables and malignancy risk.
Results:
Malignant nodules were predominantly observed in TIRADS category 5 (72.7%), while benign nodules were more frequent in categories 3 and 4. Higher TIRADS scores were significantly associated with malignancy, each unit increase in score was associated with a 5.86 - fold increase in odds (P = 0.0001). Malignancies were more common in younger patients, with risk decreasing by 2% per additional year of age (P = 0.028). Nodule size was not an independent predictor of malignancy.
Conclusion:
TIRADS is an effective tool for predicting thyroid malignancy and stratifying risk, aiding clinical decision-making. Younger age is a significant risk factor, while nodule size alone should not be used as a predictor of malignancy.
