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Diagnostic lobectomy is not routinely required to exclude malignancy in thyroid nodules greater than four centimetres.
MedLine Citation:
PMID:  22507501     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Background:  Surgical excision has been recommended as a diagnostic test for thyroid nodules ≥4 cm, due to the supposedly higher rate of cancer in larger nodules and the higher reported false-negative rates of fine-needle aspiration cytology (FNAC) testing (>10%). The aims of this study are to determine the prevalence of thyroid cancer in nodules ≥4 cm, to examine if a relationship between increasing nodule size and malignancy rate was present and to study the accuracy of preoperative FNAC diagnosis. Methods:  Retrospective analysis of data from patients with thyroid nodules ≥4 cm undergoing surgical resection between 1994 and 2008. Malignancy rates, cytology results and indications for surgery were analysed. Results:  A total of 223 patients with thyroid nodules ≥4 cm underwent thyroid resection between 1994 and 2008. The overall prevalence of thyroid cancer was 7.2% (95% confidence interval (CI): 4.2-11.4%). The malignancy rate did not vary significantly with increasing nodule size. The sensitivity of FNAC was 93.8% (95% CI: 69.8-99.8%), while the specificity of FNAC was 62.2% (95% CI: 54.9-69.2%). The most common indicator for surgery was compression symptoms. A positive FNAC test was the most significant indicator of underlying malignancy, with a likelihood ratio of 2.5 (95% CI: 2.0-3.1). Conclusions:  Many patients with large thyroid nodules undergo thyroidectomy for symptom relief alone, regardless of their FNAC results. In such patients where other clinical indicators for thyroidectomy are not present, a benign FNAC result can reassure both patient and surgeon that mandatory surgical excision is not needed to exclude malignancy.
Authors:
Mariolyn D Raj; Simon Grodski; Stacey Woodruff; Meei Yeung; Eldho Paul; Jonathan W Serpell
Publication Detail:
Type:  Journal Article     Date:  2011-02-15
Journal Detail:
Title:  ANZ journal of surgery     Volume:  82     ISSN:  1445-2197     ISO Abbreviation:  ANZ J Surg     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-04-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101086634     Medline TA:  ANZ J Surg     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  73-7     Citation Subset:  IM    
Copyright Information:
© 2011 The Authors. ANZ Journal of Surgery © 2011 Royal Australasian College of Surgeons.
Affiliation:
Monash University Endocrine Surgery Unit, Alfred Hospital Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia.
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