Diagnostic lobectomy is not routinely required to exclude malignancy in thyroid nodules greater than four centimetres

Mariolyn D. Raj, Simon Grodski, Stacey Woodruff, Meei Yeung, Eldho Paul, Jonathan W. Serpell

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


Background: Surgical excision has been recommended as a diagnostic test for thyroid nodules ≥4cm, due to the supposedly higher rate of cancer in larger nodules and the higher reported false-negative rates of fine-needle aspiration cytology (FNAC) testing (>10%). The aims of this study are to determine the prevalence of thyroid cancer in nodules ≥4cm, to examine if a relationship between increasing nodule size and malignancy rate was present and to study the accuracy of preoperative FNAC diagnosis. Methods: Retrospective analysis of data from patients with thyroid nodules ≥4cm undergoing surgical resection between 1994 and 2008. Malignancy rates, cytology results and indications for surgery were analysed. Results: A total of 223 patients with thyroid nodules ≥4cm underwent thyroid resection between 1994 and 2008. The overall prevalence of thyroid cancer was 7.2% (95% confidence interval (CI): 4.2-11.4%). The malignancy rate did not vary significantly with increasing nodule size. The sensitivity of FNAC was 93.8% (95% CI: 69.8-99.8%), while the specificity of FNAC was 62.2% (95% CI: 54.9-69.2%). The most common indicator for surgery was compression symptoms. A positive FNAC test was the most significant indicator of underlying malignancy, with a likelihood ratio of 2.5 (95% CI: 2.0-3.1). Conclusions: Many patients with large thyroid nodules undergo thyroidectomy for symptom relief alone, regardless of their FNAC results. In such patients where other clinical indicators for thyroidectomy are not present, a benign FNAC result can reassure both patient and surgeon that mandatory surgical excision is not needed to exclude malignancy.

Original languageEnglish (US)
Pages (from-to)73-77
Number of pages5
JournalANZ Journal of Surgery
Issue number1-2
StatePublished - Jan 2012


  • Fine-needle aspiration cytology
  • Papillary thyroid cancer
  • Thyroid
  • Thyroid lobectomy
  • Thyroid nodule

ASJC Scopus subject areas

  • Surgery


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