Background
Studies indicate that incidentally discovered thyroid nodules ≥1 cm in size may have
a higher rate of malignancy (7% to 29%) than traditionally discovered nodules (5%).
We sought to determine the rate of malignancy in incidental thyroid nodules in patients
with other malignancies, and examine the accuracy of ultrasound (US) versus computed
tomography (CT) in determining nodule size.
Methods
We evaluated 41 patients with history of another known malignancy (gastrointestinal,
23; breast, 11; other, 7) referred with an incidental thyroid nodule. Patients underwent
office-based US and biopsy of nodules ≥1 cm. Surgical intervention was based on biopsy
results. We compared nodule size at pathology with size seen on CT or US.
Results
Thirty-five patients met criteria for biopsy. Of the 35, 20 (57%) had atypical biopsy
results warranting resection. Sixteen of those 20 underwent surgery. Pathology yielded
4 papillary thyroid cancers (PTC), 4 microPTC, 2 metastatic cancers, and 7 benign
lesions. Ultrasound measurement of nodules compared to size measured at pathology
had an r2 correlation value of 0.90 with P value <.0001. CT scan had an r2 value of 0.83 and P value of .005.
Conclusions
Incidental thyroid nodules in patients with another primary malignancy warranted resection
in 57%. The rate of malignancy in incidental thyroid nodules was 24%, which is above
the expected rate of 5% seen in traditionally discovered nodules. US correlation with
nodule size at pathology was excellent and superior to CT scan. Incidentally discovered
thyroid nodules ≥1 cm, seen in patients with another malignancy, warrant further evaluation.
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Article info
Publication history
Accepted:
June 9,
2007
Identification
Copyright
© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
