Prognosis of patients with benign thyroid nodules: a population-based study
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ORIGINAL ARTICLE
Prognosis of patients with benign thyroid nodules: a populationbased study Naykky Singh Ospina1,2 • Spyridoula Maraka1,2 • Ana Elena Espinosa de Ycaza2 Juan P. Brito1,2 • M. Regina Castro2 • John C. Morris2 • Victor M. Montori1,2
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Received: 24 February 2016 / Accepted: 18 April 2016 Ó Springer Science+Business Media New York 2016
Abstract Most thyroid nodules are benign. The ideal follow-up of these patients should reflect their prognosis, which has been scarcely investigated. We aimed to evaluate the prognosis of patients with initial benign thyroid cytology. A population-based study, using the Rochester Epidemiology Project, identifying patients with benign thyroid cytology diagnosed between 2003 and 2006 and completely followed to 2014 using linked medical records. We identified 363 thyroid nodules with benign cytology in 327 patients after fine-needle aspiration biopsy. Patients were on average 53 years old (standard deviation 17), and 80 % were women. The median nodule size was 1.6 cm (interquartile range 1.2–2.4); 26 % had at least one suspicious ultrasound feature. During a median follow-up of 8 years, 54 patients (17 %) with 57 benign nodules underwent thyroidectomy, mostly due to compressive symptoms (44 %). Thyroidectomy was more likely in younger patients [hazard ratio (HR) 0.97, 95 % CI 0.96–0.99] and patients with larger nodules (HR 1.3, 95 % CI 1.16–1.48). Two patients were found to have follicular thyroid cancer in the index nodule (0.6 %) and 6 patients had papillary thyroid cancer detected in other nodules (1.8 %). No patient died from thyroid cancer. Patients with benign thyroid nodules are unlikely to suffer morbidity or mortality due to thyroid cancer. Follow-up strategies for these patients should consider this excellent prognosis and
& Victor M. Montori [email protected] 1
Knowledge and Evaluation Research Unit in Endocrinology (KER-Endo), Mayo Clinic, Rochester, MN, USA
2
Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
avoid causing unnecessary fear in patients and adding unneeded expense and burden to the healthcare system. Keywords Thyroid nodule Fine-needle aspiration biopsy Thyroid cancer Benign thyroid nodule Thyroidectomy
Introduction The widespread use of imaging technology has partly fueled an increased detection and diagnosis of thyroid cancer over the last decade [1, 2]. This increase in thyroid cancer detection and the potential harm associated with overtreatment of indolent thyroid cancer represents only a part of the problem created by increased detection of thyroid nodules (since most nodules will be found to be benign). After a thyroid nodule is discovered, our current diagnostic strategies rely on ultrasound (US) features and ultrasound-guided fine-needle aspiration biopsy (USFNA) results to guide further management [3]. However, even in the case of benign thyroid nodules, the most common result after USFNA, there is still uncertainty regarding the ideal follow-up strategy [3, 4]. For exa
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