The British journal of radiology · 2025
Natural history and long-term follow-up of incidental thyroid nodules on CT imaging.
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Lyuman Eda, McArthur Claire
Аннотация
OBJECTIVES: Incidental thyroid nodules (ITNs) are found in up to 25% of CT scans. Increased use of cross-sectional imaging has contributed to the increased incidence of thyroid cancer worldwide. ITNs pose a management dilemma since nodule malignancy rate is 5%-15% but most cancers are indolent and prognosis in differentiated thyroid cancer is excellent. Study aims are to determine prevalence of ITNs ≥1 cm on CT scans, evaluate reporting practices, assess for emergence of clinically evident thyroid cancer during 13-year follow-up and assess interim nodule growth and clinical outcomes in nodules that were further investigated.
METHODS: Direct image review of 1499 consecutive CT scans that included the thyroid, performed during January 2009 in a large NHS health board was performed. Clinical data up to January 2022 was analysed in 150 patients with at least 1 ITN ≥1 cm.
RESULTS: ITN prevalence was 11% with mean patient age 70 years and mean nodule diameter 17.5 mm. 30% of ITNs were mentioned in the CT report. During the follow-up period 11% proceeded to thyroid ultrasound, 5% fine needle aspiration, and 2% diagnostic hemithyroidectomy with no thyroid malignancy found. One hundred twenty patients (80%) were deceased by the study endpoint, none from thyroid malignancy. No patients presented with clinically evident thyroid malignancy during follow-up.
CONCLUSIONS: None of 150 ITN cases developed clinically evident thyroid malignancy in a 13-year follow-up period with 80% of patients deceased by the study endpoint from non-thyroid causes.
ADVANCES IN KNOWLEDGE: This would suggest that ITNs detected on CT do not require further investigation unless malignant appearances or significant clinical concern for thyroid malignancy.
METHODS: Direct image review of 1499 consecutive CT scans that included the thyroid, performed during January 2009 in a large NHS health board was performed. Clinical data up to January 2022 was analysed in 150 patients with at least 1 ITN ≥1 cm.
RESULTS: ITN prevalence was 11% with mean patient age 70 years and mean nodule diameter 17.5 mm. 30% of ITNs were mentioned in the CT report. During the follow-up period 11% proceeded to thyroid ultrasound, 5% fine needle aspiration, and 2% diagnostic hemithyroidectomy with no thyroid malignancy found. One hundred twenty patients (80%) were deceased by the study endpoint, none from thyroid malignancy. No patients presented with clinically evident thyroid malignancy during follow-up.
CONCLUSIONS: None of 150 ITN cases developed clinically evident thyroid malignancy in a 13-year follow-up period with 80% of patients deceased by the study endpoint from non-thyroid causes.
ADVANCES IN KNOWLEDGE: This would suggest that ITNs detected on CT do not require further investigation unless malignant appearances or significant clinical concern for thyroid malignancy.