The biopsy-proven benign thyroid nodule: Is long-term follow-up necessary?

Sukhyung Lee, Thomas S. Skelton, Feibi Zheng, Katherine A. Schwartz, Nancy D. Perrier, Jeffrey E. Lee, Roland L. Bassett, Salmaan Ahmed, Savitri Krishnamurthy, Naifa L. Busaidy, Elizabeth G. Grubbs

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


Background: Thyroid nodules are common, and of those biopsied by fine-needle aspiration (FNA), the majority will be benign colloid nodules (BCN). Current guidelines suggest these BCN should be followed by ultrasonographic examination (US) every 3 years, with no endpoint specified. This study evaluated if long-term follow-up of benign thyroid nodules was associated with change in treatment or improvement in diagnosing a missed malignancy compared with short-term follow-up. Study Design: All patients with FNA-based diagnosis of BCN at our institution from 1998 to 2009 were identified. Patients observed after the diagnosis were divided into short-term follow-up (<3years) and long-term follow-up (≥3years). Rates of repeat FNA, thyroidectomy, and malignancy detection were compared. Results: Of 738 patients with BCN, 92 patients underwent thyroid resection after the initial US. Six hundred forty-six patients were observed, of which 366 returned for 1 or more follow-up US: 226 in the short-term group (median 13 months) and 140 in the long-term group (median 57 months). There were more follow-up US in long-term vs short-term (medians 4 vs 2, p < 0.01), more repeat FNAs in the long-term group (18 of 140 vs 8 of 226, p < 0.01); but no difference in interval thyroidectomies (13 of 140 vs 31 of 226, p = 0.25) or malignant final pathology (0 of 13 vs 2 of 31, p > 0.99). For all patients undergoing surgery, pathology was malignant in 2 of 136 (1.5%). Conclusions: Long-term follow-up of patients with BCN is associated with increased repeat FNA and US without improvement in the malignancy detection rate. After 3 years of follow-up, consideration should be given to ceasing long-term routine follow-up of biopsy-proven BCN.

Original languageEnglish (US)
Pages (from-to)81-88
Number of pages8
JournalJournal of the American College of Surgeons
Issue number1
StatePublished - Jul 2013

ASJC Scopus subject areas

  • Surgery


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