Back to Search Start Over

Diagnostic lobectomy is not routinely required to exclude malignancy in thyroid nodules greater than four centimetres.

Authors :
Raj MD
Grodski S
Woodruff S
Yeung M
Paul E
Serpell JW
Source :
ANZ journal of surgery [ANZ J Surg] 2012 Jan-Feb; Vol. 82 (1-2), pp. 73-7. Date of Electronic Publication: 2011 Feb 15.
Publication Year :
2012

Abstract

Background: Surgical excision has been recommended as a diagnostic test for thyroid nodules ≥ 4 cm, due to the supposedly higher rate of cancer in larger nodules and the higher reported false-negative rates of fine-needle aspiration cytology (FNAC) testing (>10%). The aims of this study are to determine the prevalence of thyroid cancer in nodules ≥ 4 cm, to examine if a relationship between increasing nodule size and malignancy rate was present and to study the accuracy of preoperative FNAC diagnosis.<br />Methods: Retrospective analysis of data from patients with thyroid nodules ≥ 4 cm undergoing surgical resection between 1994 and 2008. Malignancy rates, cytology results and indications for surgery were analysed.<br />Results: A total of 223 patients with thyroid nodules ≥ 4 cm underwent thyroid resection between 1994 and 2008. The overall prevalence of thyroid cancer was 7.2% (95% confidence interval (CI): 4.2-11.4%). The malignancy rate did not vary significantly with increasing nodule size. The sensitivity of FNAC was 93.8% (95% CI: 69.8-99.8%), while the specificity of FNAC was 62.2% (95% CI: 54.9-69.2%). The most common indicator for surgery was compression symptoms. A positive FNAC test was the most significant indicator of underlying malignancy, with a likelihood ratio of 2.5 (95% CI: 2.0-3.1).<br />Conclusions: Many patients with large thyroid nodules undergo thyroidectomy for symptom relief alone, regardless of their FNAC results. In such patients where other clinical indicators for thyroidectomy are not present, a benign FNAC result can reassure both patient and surgeon that mandatory surgical excision is not needed to exclude malignancy.<br /> (© 2011 The Authors. ANZ Journal of Surgery © 2011 Royal Australasian College of Surgeons.)

Details

Language :
English
ISSN :
1445-2197
Volume :
82
Issue :
1-2
Database :
MEDLINE
Journal :
ANZ journal of surgery
Publication Type :
Academic Journal
Accession number :
22507501
Full Text :
https://doi.org/10.1111/j.1445-2197.2011.05667.x