Core Concepts
Nonsurgical options like radiofrequency ablation may be suitable for more large thyroid nodule patients than previously thought.
Abstract
The content discusses the false negative rates in large thyroid nodules and the potential for nonsurgical options for patients. It highlights the importance of considering patients who do not have surgery indications and suggests conservative follow-up strategies. The study presented at the American Thyroid Association meeting challenges the high false negative rates reported in previous studies and emphasizes the need for a better understanding of benign rates in large nodules.
False Negative Rates in Large Thyroid Nodules
- False negative rates in FNA biopsies of large thyroid nodules are lower when considering all nodules, not just those operated on.
- Concerns about high false negative rates in nodules over 4 cm classified as benign.
Study Findings and Recommendations
- Retrospective chart review of patients with nodules over 4 cm and Bethesda II cytology.
- False negative rate for large nodules was 4.3% when including all patients.
- Recommendations for conservative follow-up strategies for large benign nodules.
Clinical Implications and Cost Considerations
- Concerns about discontinuing follow-up on large benign nodules leading to late cancer diagnosis.
- Surgical procedures like thyroidectomy should be used cautiously when benefits outweigh risks.
Insights from Other Experts
- Paparodis suggests careful sonographic evaluation and FNA of suspicious nodules before surgical management.
Stats
"While the false negative rate for thyroid nodules in general is approximately 3%, the rate for large nodules over 4 cm has been reported as high as 35%."
"Overall, the false negative rate including all patients was 4.3%."
Quotes
"Clinicians should consider following these patients more conservatively, either with a second FNA to confirm [the] nodule is benign, or with ultrasound follow-up for 5 years with intervention only if [there are] significant changes on imaging."
"Therefore, we suggest that careful sonographic evaluation of all thyroid nodules is warranted prior to deciding and planning the extent of surgical management for multinodular goiter."