This Article Full Text Full Text (PDF) All Versions of this Article: 91/9/3411    most recent Author Manuscript (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Frates, M. C. Articles by Alexander, E. K. Search for Related Content PubMed PubMed Citation Articles by Frates, M. C. Articles by Alexander, E. K. Related Collections Endocrine Oncology Thyroid

Prevalence and Distribution of Carcinoma in Patients with Solitary and Multiple Thyroid Nodules on Sonography

Department of Radiology (M.C.F., C.B.B., P.M.D., M.C.); Thyroid Section, Division of Endocrinology, Hypertension and Diabetes, Department of Medicine (E.K., J.O., P.R.L., E.M., E.K.A.); Department of Pathology (E.S.C.); and Department of Surgery (F.D.M), Brigham & Women’s Hospital and Harvard Medical School, Boston, Massachusetts 02115

Address all correspondence and requests for reprints to: Erik K. Alexander, M.D., Thyroid Section, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, 75 Francis Street, PBB-B4, Boston, Massachusetts 02115. E-mail: ekalexander{at}partners.org.

Context: Controversy remains as to the optimal management of patients with multiple thyroid nodules.

Objective: The objective of this study was to determine the prevalence, distribution, and sonographic features of thyroid cancer in patients with solitary and multiple thyroid nodules.

Design: We describe a retrospective observational cohort study that was carried out from 1995 to 2003.

Setting: The study was conducted in a tertiary care hospital.

Patients: Patients with one or more thyroid nodules larger than 10 mm in diameter who had ultrasound-guided fine needle aspiration (FNA) were included in the study.

Main Outcome Measures: The main outcome measures were prevalence and distribution of thyroid cancer and the predictive value of demographic and sonographic features.

Results: A total of 1985 patients underwent FNA of 3483 nodules. The prevalence of thyroid cancer was similar between patients with a solitary nodule (175 of 1181 patients, 14.8%) and patients with multiple nodules (120 of 804, 14.9%) (P = 0.95, ²). A solitary nodule had a higher likelihood of malignancy than a nonsolitary nodule (P < 0.01). In patients with multiple nodules larger than 10 mm, cancer was multifocal in 46%, and 72% of cancers occurred in the largest nodule. Multiple logistic regression analysis of statistically significant features demonstrates that the combination of patient gender (P < 0.02), whether a nodule is solitary vs. one of multiple (P < 0.002), nodule composition (P < 0.01), and presence of calcifications (P < 0.001) can be used to assign risk of cancer to each individual nodule. Risk ranges from a 48% likelihood of malignancy in a solitary solid nodule with punctate calcifications in a man to less than 3% in a noncalcified predominantly cystic nodule in a woman.

Conclusions: In a patient with one or more thyroid nodules larger than 10 mm in diameter, the likelihood of thyroid cancer per patient is independent of the number of nodules, whereas the likelihood per nodule decreases as the number of nodules increases. For exclusion of cancer in a thyroid with multiple nodules larger than 10 mm, up to four nodules should be considered for FNA. Sonographic characteristics can be used to prioritize nodules for FNA based on their individual risk of cancer.

This article has been cited by other articles:

				W.-J. Moon, S. L. Jung, J. H. Lee, D. G. Na, J.-H. Baek, Y. H. Lee, J. Kim, H. S. Kim, J. S. Byun, and D. H. Lee Benign and Malignant Thyroid Nodules: US Differentiation--Multicenter Retrospective Study Radiology, April 10, 2008; (2008) 2473070944. [Abstract] [Full Text]

				M. C. Frates and C. B. Benson Thyroid Calcifications J. Ultrasound Med., February 1, 2008; 27(2): 312 - 312. [Full Text] [PDF]

				M. J. Yeung and J. W. Serpell Management of the Solitary Thyroid Nodule Oncologist, February 1, 2008; 13(2): 105 - 112. [Abstract] [Full Text] [PDF]

				J. E. Langer, J. K. Hoang, W. K. Lee, and S. Farrell Invited Commentary * Authors' Response RadioGraphics, May 1, 2007; 27(3): 861 - 865. [Full Text] [PDF]

				R Jones, R Spendiff, S Fareedi, and P S Richards The role of ultrasound in the management of nodular thyroid disease Imaging, March 1, 2007; 19(1): 28 - 38. [Abstract] [Full Text] [PDF]

				D. S. Ross Predicting thyroid malignancy. J. Clin. Endocrinol. Metab., November 1, 2006; 91(11): 4253 - 4255. [Full Text] [PDF]