Thyroid nodule size irrelevant when it comes to malignancy:
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Large thyroid nodules in asymptomatic patients show malignancy and false-negative rates on fine needle aspiration (FNA) that are similar to those of small nodules, suggesting that nodule size alone should not be a reason for surgical resection, according to findings from a new meta-analysis published in the journal Thyroid.

"Based on these data, surgical resection of large cytologically benign nodules is not recommended in the absence of other clinical indications," for thyroidectomy, the authors write.

With conflicting data on whether larger nodule size is associated with a greater risk of malignancy and false-negative FNA rates, some surgeons choose to err on the side of caution and resect larger thyroid nodules, regardless of FNA results.

But the issue is controversial. Surgery itself is associated with potential risks, including increased physical and psychological morbidity, as well as a heavier financial burden, compared with the alternative approach of close clinical follow-up of cytologically benign nodules.

To assess the existing evidence, the researchers analyzed findings from 35 studies that stratified thyroid nodules by size and included data on benign and other cytology. The analysis included more than 20,000 nodules, of which more than 7000 had benign cytology.

Of 21 datasets that allowed for comparison of malignancy rates by thyroid nodule size, 81% showed malignancy rates of larger nodules to be similar to or lower than rates of smaller nodules. The overall malignancy rate of large nodules (3 cm or greater) was 13% compared with 19% among nodules 3 cm or smaller.

Of note, papillary thyroid carcinoma and non-invasive encapsulated follicular variant of papillary thyroid carcinoma were the most commonly reported false-negative diagnoses.

"Close follow-up (including repeat ultrasound and/or FNA) can identify patients who ultimately require resection, and those with indolent disease may avoid surgery for cytologically benign but large thyroid nodules," they conclude.

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The original research paper can be read here: