No long-term follow-up for benign thyroid nodules

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1. Ultrasound (US) follow-up for longer than three years did not yield increased cancer detection after a benign fine-needle aspiration (FNA) of a thyroid nodule. 

2. Patients with a benign biopsy who were followed for longer than three years had significantly more ultrasounds and FNAs. 

Evidence Rating Level: 2 (Good) 

Study Rundown: The American Thyroid Association (ATA) recommends, after an initial detection of a benign nodule, that ultrasound be repeated at varying intervals and then every three to five years to detect any changes. This retrospective analysis demonstrated no improvement in malignancy detection with follow up longer than three years. Additionally, patients underwent significantly more timely and costly procedures. Although this well-designed study demonstrates significant and possibly practice-changing results, it is limited by its restriction to one cancer center and its small sample size. FNA has a false-negative rate that is reported to be as high as 12% in some studies, and its quality is dependent on the skills of the aspirator and pathologist. Because of this, it is likely that a long-established cancer center like MD Anderson has a much lower false-negative rate and thus a smaller percentage of missed malignancies possible to catch on follow-up. 

Journal of the American College of Surgeons

Relevant Reading: Current Guidelines for the Management of Thyroid Nodules

In-Depth [retrospective cohort study]: This study looked at 738 patients treated at MD Anderson between 1998 to 2009 with a benign US-guided FNA of a thyroid nodule. Most were middle aged (median age was 50), female (4:1 women to men ration) and found to have a palpable nodule. Those who did not have surgery immediately following their biopsy and had at least one follow-up at the institution were split into at short-term follow-up group (<3 years) that consisted of 226 patients and a long-term follow-up group (3 or more years) of 140 patients. The long-term group had significantly more ultrasounds (p <0.01) and more repeat FNAs (p < 0.01). The number of nodules surgically resected (p = 0.25) and found to be malignant (p > 0.99) was similar between the two cohorts. Only three malignancies were found: one in a patient who was operated on immediately after FNA and two in the short-term follow-up group.

By Asya Ofshteyn and Allen Ho

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