Abstract
Objectives:
Examine patients with incidentally discovered thyroid nodules (IDTNs) with focus on identification, evaluation, surgical intervention, and rates of malignancy.
Methods:
Retrospective chart review performed at a tertiary care medical center. Patients were identified by cross-referencing thyroid diagnosis codes with ultrasound (US) codes, identifying a total of 1408 thyroid patients evaluated between July 2008 and June 2009. Information regarding demographics, follow-up, and outcomes was extracted from the medical record.
Results:
A total of 249 patients with IDTNs were identified. Most were identified on chest CT (44.6%). Most commonly, imaging was obtained for evaluation of an unrelated malignancy (26.9%). Initial evaluation of IDTNs was performed by US in 62.2% and US with fine needle aspiration (FNA) in 36.1% of patients. Patients with US as the initial study appeared to undergo more studies than patients who underwent US/FNA. 170 (68.3%) underwent ultrasound (US)/FNA. The most common pathology was benign follicular nodule (64.1%) and papillary thyroid cancer (PTC) (13.5%). Fifty-five (22.1%) patients underwent thyroidectomy. Forty-seven patients underwent surgery for suspicion of malignancy. Preoperative FNA pathology was PTC in 22 patients, followed by follicular neoplasm in 17 patients. On final pathology, 33 malignancies were present. Of these, 28 were PTC. The overall malignancy rate for incidental thyroid nodules was 13.3%.
Conclusions:
This study identified a surprisingly high rate of malignancy of at least 13.3% in IDTNs, reaffirming that incidental thyroid nodules should undergo thorough workup. Obtaining US/FNA early in the workup appears to decrease the number of studies ordered.
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