TY - JOUR
T1 - The biopsy-proven benign thyroid nodule
T2 - Is long-term follow-up necessary?
AU - Lee, Sukhyung
AU - Skelton, Thomas S.
AU - Zheng, Feibi
AU - Schwartz, Katherine A.
AU - Perrier, Nancy D.
AU - Lee, Jeffrey E.
AU - Bassett, Roland L.
AU - Ahmed, Salmaan
AU - Krishnamurthy, Savitri
AU - Busaidy, Naifa L.
AU - Grubbs, Elizabeth G.
PY - 2013/7
Y1 - 2013/7
N2 - 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.
AB - 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.
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U2 - 10.1016/j.jamcollsurg.2013.03.014
DO - 10.1016/j.jamcollsurg.2013.03.014
M3 - Article
C2 - 23659946
AN - SCOPUS:84879550431
SN - 1072-7515
VL - 217
SP - 81
EP - 88
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 1
ER -