Objectives: In 2015, updated American Thyroid Association (ATA) guidelines recommended observation for suspicious sub-centimeter thyroid nodules, based on their indolent course. We aimed to evaluate the frequency of biopsy in suspicious thyroid nodules since the introduction of these guidelines, including factors contributing to clinical decision-making in a tertiary care center. Methods: Retrospective study of patients in Mayo Clinic, Rochester, MN with new, sub-centimeter suspicious thyroid nodules (by report or by sonographic features) between March 2015 and November 2017, not previously biopsied. Results: We identified 141 nodules in 129 patients: mean age 58.1 ± 14.1, 74% female, 87% Caucasian. The frequency of biopsy in suspicious thyroid nodules was 39%. Ultrasound features that were the strongest predictors for biopsy on multi-variate analysis included: nodule volume (OR 37.3 [7.5-188.7]), radiology recommendation for biopsy (OR 2.6 [1.8-3.9]) and radiology report of the nodule as "suspicious" (OR 2.1 [1.4-3.2]). Patient's age and degree of comorbidities did not change likelihood for biopsy, nor did it vary by clinician type or how the nodule was initially found (incidentally or not incidentally). Among 86 nodules that were not biopsied, 41% had no specific follow-up recommendations. Conclusions: One third of suspicious thyroid nodules underwent biopsy since release of updated ATA guidelines. Factors driving thyroid biopsy seem to be associated with nodule characteristics but not with patient factors including age and comorbidities. Further studies and development of decision aides may be helpful in providing individualized approaches for suspicious thyroid nodules.
Objectives: In 2015, updated American Thyroid Association (ATA) guidelines recommended observation for suspicious sub-centimeter thyroid nodules, based on their indolent course. We aimed to evaluate the frequency of biopsy in suspicious thyroid nodules since the introduction of these guidelines, including factors contributing to clinical decision-making in a tertiary care center. Methods: Retrospective study of patients in Mayo Clinic, Rochester, MN with new, sub-centimeter suspicious thyroid nodules (by report or by sonographic features) between March 2015 and November 2017, not previously biopsied. Results: We identified 141 nodules in 129 patients: mean age 58.1 ± 14.1, 74% female, 87% Caucasian. The frequency of biopsy in suspicious thyroid nodules was 39%. Ultrasound features that were the strongest predictors for biopsy on multi-variate analysis included: nodule volume (OR 37.3 [7.5-188.7]), radiology recommendation for biopsy (OR 2.6 [1.8-3.9]) and radiology report of the nodule as "suspicious" (OR 2.1 [1.4-3.2]). Patient's age and degree of comorbidities did not change likelihood for biopsy, nor did it vary by clinician type or how the nodule was initially found (incidentally or not incidentally). Among 86 nodules that were not biopsied, 41% had no specific follow-up recommendations. Conclusions: One third of suspicious thyroid nodules underwent biopsy since release of updated ATA guidelines. Factors driving thyroid biopsy seem to be associated with nodule characteristics but not with patient factors including age and comorbidities. Further studies and development of decision aides may be helpful in providing individualized approaches for suspicious thyroid nodules.