Issue: January 2013
December 31, 2012
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Thyroid nodule size predictive of risk for follicular carcinoma

Issue: January 2013
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Researchers from Brigham and Women’s Hospital and Harvard Medical School in Boston suggest that follicular carcinoma is more likely in larger nodules, according to data published in the Journal of Clinical Endocrinology and Metabolism.

“Papillary carcinoma is largely predetermined at its inception and not influenced by growth or cellular expansion. In contrast, follicular carcinoma is much more likely in larger nodules,” researchers wrote. “Although the significance of this remains uncertain, this implies the current histologic parameters used to distinguish follicular adenomas and carcinomas may be an incomplete assessment of malignant potential.”

The researchers conducted a retrospective cohort analysis utilizing medical records of 4,955 patients evaluated between 1995 and 2009. Using ultrasound and ultrasound-guided fine-needle aspiration (FNA) of nodules larger than 1 cm, the researchers examined how the increasing thyroid nodule size affects the risk for cancer.

According to data, 927 (13%) of 7,348 evaluated nodules were found to be cancerous. Additionally, 10.5% of nodules between 1 and 1.9 cm in diameter were cancerous. The researchers reported that 15% of nodules >2 cm were cancerous (P<.01).

Nodules sized 2 cm to 2.9 cm (14%), 3 cm to 3.9 cm (16%) and larger than 4 cm (15%) were cancerous (P=.14). These data confirm no significant increase in risk for cancer in nodules larger than 2 cm, they wrote.

Moreover, the relative proportion of papillary carcinoma decreased when nodules were malignant, researchers wrote (P<.01). However, follicular carcinoma increased as nodules grew in size (1 cm to 1.9 cm, 6%; 2 cm to 2.9 cm, 7%; 3 cm to 3.9 cm, 12%; >4cm, 16%; P<.01), they added.

The researchers conclude that further molecular analysis is warranted to study the accuracy of thyroid cancer diagnosis.

Disclosure: The researchers report no relevant financial disclosures.