Large Thyroid Nodules Carry Higher Pretest Malignancy Probability

Do large thyroid nodules have a higher pre-test probability of malignancy than smaller thyroid nodules?

Background: Thyroid nodules affect 4% to 10% of the U.S. adult population, with 4% to 5% of nodules ultimately proving malignant. Fine needle aspiration (FNA) biopsy is the prevalent diagnostic modality for evaluating a thyroid nodule, but there is variability in cytology reporting schemes, indeterminate values sorting, and statistical calculations. Large thyroid nodules may be associated with higher risk of malignancy and less accurate FNA results, but there is currently no overarching consensus.

Study design: Review of 15 criterion-meeting studies (two prospective studies, two retrospective analyses of prospective databases, 11 retrospective studies) with a total of 13,180 participants published through July 2013.

Setting: PubMed, Embase, Cochrane Library.

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