CONTEXT: Thyroid nodule size is routinely measured, although its impact on thyroid cancer risk is unclear. OBJECTIVE: Our objective was to evaluate the association of nodule size upon cancer risk. DESIGN, SETTING, AND PATIENTS: We conducted a retrospective cohort analysis at an academic hospital with 4955 consecutive patients evaluated between 1995 and 2009. INTERVENTION: Ultrasound and ultrasound-guided fine-needle aspiration of nodules >1 cm was done. Indeterminate and malignant nodules were referred for surgery, and histopathology was reviewed. MAIN OUTCOME MEASURE: The presence and histological subtype of cancer was evaluated. RESULTS: Of 7348 evaluated nodules, 927 (13%) were cancerous. Of those 1.0 to 1.9 cm in diameter, 10.5% were cancerous. In contrast, of those >2.0 cm, 15% were cancerous (P < .01). However, nodules 2.0 to 2.9, 3.0 to 3.9, and >4 cm were cancerous in 14%, 16%, and 15% of cases (P = .14), respectively, demonstrating no graded increase in risk beyond the 2-cm threshold. When malignant, the proportion of papillary carcinoma decreased (nodules 1.0-1.9 cm, 92% of cases; 2.0-2.9 cm, 88%; 3.0-3.9 cm, 83%; >4 cm, 74% [P < .01]), while follicular carcinoma increased (1.0-1.9 cm, 6%; 2.0-2.9 cm, 7%; 3.0-3.9 cm, 12%; >4 cm, 16% [P < .01]) as nodules enlarged. Nodules size did not influence cytology distribution or risk of false-negative aspirates. CONCLUSIONS: Increasing thyroid nodule size impacts cancer risk in a nonlinear fashion. A threshold is detected at 2.0 cm, beyond which cancer risk is unchanged. However, the risk of follicular carcinomas and other rare thyroid malignancies increases as nodules enlarge.
CONTEXT: Thyroid nodule size is routinely measured, although its impact on thyroid cancer risk is unclear. OBJECTIVE: Our objective was to evaluate the association of nodule size upon cancer risk. DESIGN, SETTING, AND PATIENTS: We conducted a retrospective cohort analysis at an academic hospital with 4955 consecutive patients evaluated between 1995 and 2009. INTERVENTION: Ultrasound and ultrasound-guided fine-needle aspiration of nodules >1 cm was done. Indeterminate and malignant nodules were referred for surgery, and histopathology was reviewed. MAIN OUTCOME MEASURE: The presence and histological subtype of cancer was evaluated. RESULTS: Of 7348 evaluated nodules, 927 (13%) were cancerous. Of those 1.0 to 1.9 cm in diameter, 10.5% were cancerous. In contrast, of those >2.0 cm, 15% were cancerous (P < .01). However, nodules 2.0 to 2.9, 3.0 to 3.9, and >4 cm were cancerous in 14%, 16%, and 15% of cases (P = .14), respectively, demonstrating no graded increase in risk beyond the 2-cm threshold. When malignant, the proportion of papillary carcinoma decreased (nodules 1.0-1.9 cm, 92% of cases; 2.0-2.9 cm, 88%; 3.0-3.9 cm, 83%; >4 cm, 74% [P < .01]), while follicular carcinoma increased (1.0-1.9 cm, 6%; 2.0-2.9 cm, 7%; 3.0-3.9 cm, 12%; >4 cm, 16% [P < .01]) as nodules enlarged. Nodules size did not influence cytology distribution or risk of false-negative aspirates. CONCLUSIONS: Increasing thyroid nodule size impacts cancer risk in a nonlinear fashion. A threshold is detected at 2.0 cm, beyond which cancer risk is unchanged. However, the risk of follicular carcinomas and other rare thyroid malignancies increases as nodules enlarge.
Authors: Konstantinos D Papapostolou; Catherine C Evangelopoulou; Ioannis A Ioannidis; Georgia N Kassi; Konstantinos S Morfas; Nikolaos I Karaminas; Helen J Karga Journal: In Vivo Date: 2020 Jul-Aug Impact factor: 2.155
Authors: Kepal N Patel; Trevor E Angell; Joshua Babiarz; Neil M Barth; Thomas Blevins; Quan-Yang Duh; Ronald A Ghossein; R Mack Harrell; Jing Huang; Giulia C Kennedy; Su Yeon Kim; Richard T Kloos; Virginia A LiVolsi; Gregory W Randolph; Peter M Sadow; Michael H Shanik; Julie A Sosa; S Thomas Traweek; P Sean Walsh; Duncan Whitney; Michael W Yeh; Paul W Ladenson Journal: JAMA Surg Date: 2018-09-01 Impact factor: 14.766
Authors: Muhammed Kizilgul; Rupendra Shrestha; Angela Radulescu; Maria R Evasovich; Lynn A Burmeister Journal: Endocrine Date: 2019-05-29 Impact factor: 3.633
Authors: Trevor E Angell; Mary C Frates; Marco Medici; Xiaoyun Liu; Norra Kwong; Edmund S Cibas; Matthew I Kim; Ellen Marqusee Journal: J Clin Endocrinol Metab Date: 2015-09-09 Impact factor: 5.958