Author(s): Durante C, Costante G, Lucisano G, Bruno R, Meringolo D,
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Abstract IMPORTANCE: Detection of asymptomatic thyroid nodules has increased. Consensus is lacking regarding the optimal follow-up of cytologically proven benign lesions and sonographically nonsuspicious nodules. Current guidelines recommend serial ultrasound examinations and reassessment of cytology if significant growth is observed. OBJECTIVE: To determine the frequency, magnitude, and factors associated with changes in thyroid nodule size. DESIGN, SETTING, AND PARTICIPANTS: Prospective, multicenter, observational study involving 992 consecutive patients with 1 to 4 asymptomatic, sonographically or cytologically benign thyroid nodules. Patients were recruited from 8 hospital-based thyroid-disease referral centers in Italy between 2006 and 2008. Data collected during the first 5 years of follow-up, through January 2013, were analyzed. MAIN OUTCOMES AND MEASURES: Baseline nodule growth (primary end point) was assessed with yearly thyroid ultrasound examinations. Size changes were considered significant for growth if an increase of 20\% or more was recorded in at least 2 nodule diameters, with a minimum increase of 2 mm. Baseline factors associated with growth were identified. Secondary end points were the sonographic detection of new nodules and the diagnosis of thyroid cancer during follow-up. RESULTS: Nodule growth occurred in 153 patients (15.4\% [95\% CI, 14.3\%-16.5\%]). One hundred seventy-four of the 1567 original nodules (11.1\% [95\% CI, 10.3\%-11.9\%]) increased in size, with a mean 5-year largest diameter increase of 4.9 mm (95\% CI, 4.2-5.5 mm), from 13.2 mm (95\% CI, 12.1-14.2 mm) to 18.1 mm (95\% CI, 16.7-19.4 mm). Nodule growth was associated with presence of multiple nodules (OR, 2.2 [95\% CI 1.4-3.4] for 2 nodules; OR, 3.2 [95\% CI, 1.8-5.6 for 3 nodules; and OR, 8.9 [95\% CI, 4.4-18.0] for 4 nodules), main nodule volumes larger than 0.2 mL (OR, 2.9 [95\% CI, 1.7-4.9] for volumes >0.2 to <1 mL and OR, 3.0 [95\% CI, 1.8-5.1] for volumes ≥1 mL), and male sex (OR, 1.7 [95\% CI, 1.1-2.6]), whereas an age of 60 years or older was associated with a lower risk of growth than age younger than 45 years (OR, 0.5 [95\% CI 0.3-0.9]). In 184 individuals (18.5\% [95\% CI, 16.4\%-20.9\%]), nodules shrank spontaneously. Thyroid cancer was diagnosed in 5 original nodules (0.3\% [95\% CI, 0.0\%-0.6\%]). Only 2 had grown. An incidental cancer was found at thyroidectomy in a nonvisualized nodule. New nodules developed in 93 patients (9.3\% [95\% CI, 7.5\%-11.1\%]), with detection of one cancer. CONCLUSIONS AND RELEVANCE: Among patients with asymptomatic, sonographically or cytologically benign thyroid nodules, the majority of nodules exhibited no significant size increase during 5 years of follow-up and thyroid cancer was rare. These findings support consideration of revision of current guideline recommendations for follow-up of asymptomatic thyroid nodules.
This article was published in JAMA
and referenced in Journal of Blood Disorders & Transfusion