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Rates of Malignancy in Incidentally Discovered Thyroid Nodules Evaluated With Sonography and Fine-Needle Aspiration

Departments of Radiology (A.L., K.F.) and Otolaryngology (A.K., D.S.), Lenox Hill Hospital, New York, New York USA; and Department of Otolaryngology, New York University, New York, New York USA (A.G.S.).

Address correspondence to Amy Liebeskind, MD, Department of Radiology, Lenox Hill Hospital, 100 E 77th St, New York, NY 10021 USA.

Objective. The purpose of this study was to compare the rate of malignancy in thyroid nodules discovered incidentally on magnetic resonance imaging, computed tomography, and sonography with the rate of malignancy in nonincidentally discovered nodules. Methods. All thyroid sonographic and fine-needle aspiration (FNA) procedures performed during a 6-month period were retrospectively reviewed. Study indications were categorized as incidental (thyroid nodules found on magnetic resonance imaging, computed tomography, or sonography performed for nonthyroid indications) or nonincidental (studies prompted by abnormal physical examination findings or laboratory values or signs or symptoms suggestive of thyroid disease). Rates of malignancy in patients with incidentally discovered nodules were compared with rates in patients with nonincidental thyroid abnormalities by the Fisher exact test. Results. Of 225 thyroid sonographic studies, 35 (16%) were performed for incidentally discovered thyroid nodules, and 190 (84%) were performed for evaluation of nonincidental thyroid abnormalities. A total of 21 patients (60%) in the incidental group and 90 patients (47%) in the nonincidental group underwent FNA. The rate of malignancy in nodules examined by biopsy in the incidental group was 17% compared with 3% in the nonincidental group (P = .020). Patient sex, multiplicity of nodules, nodule size, echo texture, and presence of calcifications did not differ significantly between the groups. The mean age of patients in the incidental group was significantly higher (61 versus 51 years; P = .007); however, advanced age was not associated with a greater rate of malignancy. Conclusions. This study identified an unexpectedly high rate of malignancy in incidentally discovered thyroid nodules, suggesting that incidentally discovered thyroid nodules should be evaluated with follow-up thyroid sonography and FNA.

Key Words: thyroid biopsy • thyroid fine-needle aspiration • thyroid neoplasm • thyroid sonography

Abbreviations: CT, computed tomography • FNA, fine-needle aspiration • MRI, magnetic resonance imaging

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