Some incidentally detected thyroid nodules
are carcinomas
(March 2004)
The background
of the study. Thyroid nodules may
be detected incidentally, or by ultrasonography or other imaging
procedures done to evaluate nonthyroid problems. The importance
of these incidentally detected nodules is uncertain. This study
defined the frequency of thyroid carcinoma and its extent in patients
with incidentalomas.
How the study was done.
The study subjects were 267 patients (209 women and 58 men) who
had thyroid nodules detected by ultrasonography for other reasons.
None of the nodules was palpable. The nodules were biopsied with
ultrasound guidance. The biopsy samples were categorized as benign,
suspicious for or consistent with papillary thyroid carcinoma, or
indeterminate (possible carcinoma) or inadequate (too few cells
for diagnosis).
The results of the study.
Three hundred seventeen nodules, which ranged in size from 0.2 to
1.5 cm in longest dimension, were biopsied in 267 patients. Among
them, 49 percent had a solitary nodule and 51 percent had multiple
nodules. Among the 25 nodules <0.5 cm in size, 44 percent were
benign, 8 percent were carcinomas, and the biopsy was indeterminate
or inadequate in 48 percent. Among the 153 nodules 0.5 to 0.9 cm
in size, 40 percent were benign, 16 percent were carcinomas, and
the biopsy was indeterminate or inadequate in 44 percent. Among
the 139 nodules 1.0 cm or larger, 48 percent were benign, 13 percent
were carcinomas, and 39 percent were indeterminate or inadequate.
The biopsy diagnosis was carcinoma in 8 percent of the <0.5-cm
nodules, 15 percent of the 0.5- to 1.0-cm nodules, and 14 percent
in the >1.0- to 1.5-cm nodules. All of the patients with a biopsy
diagnosis of papillary carcinoma who had surgery had a thyroid carcinoma.
The conclusions of the study.
Among patients with incidentally detected thyroid nodules, a substantial
minority have a thyroid carcinoma.
The original article.
Nam-Goong IS, Kim HY, Gong G, Lee HK, Hong SJ, Kim WB, Shong YK.
Ultrasonography-guided fine-needle aspiration of thyroid incidentaloma:
correlation with pathological findings. Clin Endocrinol (Oxf) 2004;60:21-8.
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