Should thyroid nodules be tracked regularly? Are you worried about false negatives with fine needle aspiration? A picture to understand the necessity of inspection
Nearly 4% of adults have thyroid nodules? Is surgery necessary if thyroid nodules are found?
“Thyroid nodules” were found during a health check-up. Should I worry about thyroid cancer? Thyroid nodules are one of the most common thyroid problems. Dr. Liu Hanwen from the Department of Metabolism of Wanfang Hospital said that the prevalence of thyroid nodules in palpation examination is about 2-6%, and ultrasound examination is about 19-35%. It shows that the proportion of thyroid nodules in the adult population is not low, although the majority Most are benign, but a few are diagnosed as malignant tumors. The need for subsequent treatment and follow-up will be evaluated based on the nodule characteristics or biopsy results.
Dr. Liu Hanwen said that thyroid nodules are quite common in clinical practice. Most of them are benign nodules, and a small number of them are thyroid cancer. Benign thyroid nodules are usually invisible in appearance and do not affect thyroid function. Just like thyroid nodules found under ultrasound, most people do not require special treatment.
If the nodule shows the possibility of malignancy on ultrasound images, it is necessary to undergo a thyroid “fine needle aspiration” to check whether there are malignant cells. If malignant cells are suspected after the aspiration, surgical resection is required to confirm the diagnosis and as a treatment for thyroid cancer. .
Is there a chance of false negatives with fine needle aspiration? How to track benign thyroid nodules
Do benign thyroid nodules also need regular follow-up? Dr. Liu Hanwen pointed out that according to the 2015 guidelines of the American Thyroid Association, thyroid nodules will be classified into very low risk, low to moderate risk, and highly suspected malignant risk based on the imaging characteristics of thyroid nodules under ultrasound. The frequency and method vary.
For nodules with extremely low malignant risk, ultrasound tracking is of little benefit, and ultrasound should be performed at an interval of 2 years; for nodules with low to moderate malignant risk, ultrasound tracking should be performed every 1-2 years. If the nodule becomes larger, including an increase of 2 mm or a 50% increase in volume, or new malignant features appear, repeat fine-needle aspiration or continuous ultrasound tracking can be performed. Nodules with a high suspicion of malignancy should be followed within one year with ultrasound and fine-needle aspiration.
Fine needle aspiration usually extracts cells from thyroid nodules under ultrasound guidance. Do we need to worry about the risk of missing thyroid cancer because malignant cells are not extracted? Dr. Liu Hanwen said that the false negative rate of fine-needle aspiration is actually quite low. If two fine-needle aspiration tests have been performed and both show benign, current guidelines suggest that there is no need to perform ultrasound tracking in the future.
Do thyroid nodules require long-term follow-up examination? Doctor: Don’t panic within 1 centimeter
If you are diagnosed with thyroid nodules, you may not need to undergo fine needle aspiration examination? Dr. Liu Hanwen explained that if the ultrasound imaging characteristics and size of the thyroid nodule do not meet the need for fine-needle aspiration, the follow-up time will usually be recommended based on the imaging characteristics.
For very low-risk nodules (including cavernous or simple cysts) below 1 cm, routine follow-up ultrasound is not required; for very low-risk nodules (including cavernous or simple cysts) larger than 1 cm, the benefit of regular follow-up is unknown , if you want to follow up the ultrasound, the interval should be at least 2 years. For nodules with low to moderate risk of malignancy, consider follow-up ultrasound within 1 to 2 years. For nodules that are highly suspected of being malignant, follow-up ultrasound is recommended after 6-12 months.
However, treatment guidelines are sometimes different from clinical conditions, especially the recommendation that “two aspiration needle punctures are benign and no further follow-up is required”. Dr. Liu Hanwen said that although the false negative rate of fine needle aspiration is very low, after all, the probability of hidden cancer is not absolutely 0. Some patients are diagnosed with thyroid cancer after several punctures. Therefore, many people have repeated fine-needle aspiration examinations every 1-2 years, and continue to follow up even if the two examinations are benign.
Dr. Liu Hanwen pointed out that if it is a simple cyst or a nodule with a very low risk of malignancy, and the size is less than 1 cm, there is no need to even follow up with ultrasound. When a thyroid nodule is detected during a health checkup, there is no need to panic. If you have any concerns, you can consult a specialist in the metabolism department, who will evaluate whether regular follow-up examinations are needed.
Further reading:
