Ultrasound Q. Indeed, several prior investigators have argued that histologically benign nodules that harbor known oncogenic mutations (such as RAS or PAX8:PPARg mutations) may be best characterized as carcinoma in situ (24). Thyroid nodule size is routinely measured, although its impact on thyroid cancer risk is unclear. Specifically, all thyroid FNAs were classified into one of the following categories: nondiagnostic, negative for malignant cells (benign), atypical cells of undetermined significance, suggestive of a follicular neoplasm, suggestive of a Hurthle cell neoplasm, suspicious for malignancy, and positive for malignant cells. A thyroid ultrasound is painless. Hyperthyroidism. New masking guidelines are in effect starting April 24. You should be able to eat and drink normally before the procedure. Most removed nodules could have simply been observed or treated medically. You then lie on a table while a special camera produces an image of your thyroid on a computer screen. Table 1. Even more aggressive surgeons use a threshold of 3 cm [16]. In: Conn's Current Therapy 2019. Thyroid nodules. The thyroid gland. Neither a thyroid scan nor radioiodine treatment should ever be given to a pregnant woman. In these circumstances, clinical concern (based on all available clinical, biologic, and sonographic data) was used to decide upon need for nodule removal, or they were removed as part of a multinodular goiter. AJR Am J Roentgenol. 2023 Dotdash Media, Inc. All rights reserved. Thyroid fine needle aspiration biopsy (FNAB): a simple procedure that is done in the doctors office to determine if a thyroid nodule is benign (non-cancerous) or cancer. Young age and male sex increase the risk a nodule may prove cancerous (8, 9). Al Hassan MS, El Ansari W, El Baba H, Petkar M, Abdelaal A. Int J Surg Case Rep. 2022 Feb;91:106751. doi: 10.1016/j.ijscr.2021.106751. But cancerous nodules in this area are more likely to spread outside the thyroid. Accessed Dec. 6, 2019. The vast majority more than 95% of thyroid nodules are benign (noncancerous). If concern arises about the possibility of cancer, the doctor may simply recommend monitoring the nodule over time to see if it grows. Ultrasound can help evaluate a thyroid nodule and determine the need for biopsy. This enables your healthcare provider to guide the needle to exactly the right spot. Your thyroid specialist will help determine the correct amount to take because it may require more than hormone replacement to manage your cancer risk. Malignant nodules occur in roughly 5% of all nodules. HHS Vulnerability Disclosure, Help Thyroid nodules are much more common in women than in men. A total of 4955 consecutive patients with 9339 thyroid nodules 1 cm presented for evaluation between 1995 and 2009. Cancer risk can differ based on whether nodules are found in the isthmus or the lobar (winged) areas of the thyroid. In the past, it was standard to remove a majority of thyroid tissue a procedure called near-total thyroidectomy. We can also help you find other free or low-cost resources available. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. In the case of aggressive disease, a patient may qualify for clinical trials with newer therapies such as targeted chemotherapies. Treatment depends on the type of thyroid nodule you have. Frates MC , Benson CB , Doubilet PM, et al. This lends further support for the use of molecular analysis to better understand the underlying mechanisms of disease and to improve the accuracy of thyroid cancer diagnosis. Not everyone who has a thyroid nodule needs a fine needle aspiration biopsy. Endocrine Web. Specifically, increasing nodule size was associated with a lower proportion of of papillary carcinomas (P < .01). Nodules that produce too much thyroid hormone are almost always benign. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Our large-scale, epidemiologic data support this hypothesis. American Thyroid Association. From 1995 through 2009, this database has grown to include nearly 5000 patients with over 9000 nodules. Some surgeons recommend thyroidectomy for nodules 4 cm even in the setting of benign FNAC, due to increased risk of malignancy and increased false negative rates in large thyroid nodules [12,13,14,15]. . 2021 Jan;10(1):307-318. doi: 10.21037/gs-20-612. Certain problems with the thyroid gland, like Hashimoto thyroiditis, may increase your chances of getting a thyroid nodule. High-risk clinical features such as new-onset hoarseness of voice (albeit rare) also predict malignancy. Epub 2020 Feb 7. Multiple (more than one nodule). There are a number of well-established predictors of malignancy in thyroid nodules, but Nonetheless, this cohort represents the largest available analysis of consecutive patients referred for ultrasound assessment and ultrasound-guided FNA of all clinically relevant nodules. Rate of non-invasive follicular thyroid neoplasms with papillary-like nuclear features depends on pathologist's criteria: a multicentre retrospective Southern European study with prolonged follow-up. Six percent of the nodules 1 to 1.9 cm were considered suspicious, as were 8 to 9% of nodules in the larger size groups. Endocrine. If your doctor thinks a biopsy is needed, the simplest way to find out if a thyroid lump or nodule is cancerous is with a fine needle aspiration (FNA) of the thyroid nodule. After the removal of the needle, these cells will be placed on a slide. The rate of thyroid cancer in women is about three times that of men. It may take several days to get your test results from the pathology lab. However, the primary influence of this association was the low malignancy rate in nodules 1.0 to 1.9 cm. However, about 10-20 percent of biopsy specimens are interpreted as inconclusive or inadequate, that is, the pathologist cannot be certain whether the nodule is cancerous or benign. Thyroid scan. WebOut of the 378 nodules (756 US images) analyzed in this study, 147 were malignant and 231 were benign. Accessed Oct. 31, 2019. Nodules size did not influence cytology distribution or risk of false-negative aspirates. However, due in part to adoption of more stringent criteria for diagnosing thyroid cancer, the incidence rate has declined by about 2% each year since 2014. This risk increases with a higher body mass index (BMI). Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. A correlation study of ACR TI-RADS with FNA cytology in the evaluation of thyroid nodules. MeSH Most thyroid nodules are benign, which means they arent cancerous. The nodule is impairing the thyroid, making it underactive, and making you hypothyroid. Only a small percentage of nodules in the isthmus are found to be cancerous. The distribution of FNA cytology is shown in Table 2. Elsevier; 2020. https://www.clinicalkey.com. https://www.uptodate.com/contents/search. TABLE 5 Comparison of area under curve of malignant tumors according to ATA guideline high suspicion and ACR TIRADS TR5. Although the significance of this remains uncertain, this implies the current histologic parameters used to distinguish follicular adenomas and carcinomas may be an incomplete assessment of malignant potential. In about 5% of cases, the nodule is malignant. For the purposes of this investigation, thyroid nodules 1.0 to 1.9 cm in diameter provided baseline cancer risk for comparison (10.5% risk of cancer). The American Cancer Society medical and editorial content team. Can cytology and the Thyroid Imaging, Reporting, and Data System (TI-RADS) identify noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) before surgery? In most surgeries, the entire thyroid is removed (total thyroidectomy). You will probably go to a medical clinic to have the procedure performed. Obviously if the nodule is malignant, then this would be the best and most justifiable reason to have it removed. Often, your doctor will use ultrasound to help guide the placement of the needle. Know the reason for your visit and what you want to happen. You might need the test to see whether your nodule is cancerous. In contrast, the increasing proportion of follicular and Hurthle cell carcinoma in larger nodules confers a different meaning. The thyroid is located at the front of the lower part of the neck. A rare primordial odontogenic tumor in a pediatric patient. Similar findings were found for indeterminate classifications (atypical cells of an undetermined significance, suggestive of a follicular or Hurthle cell neoplasm, and suspicious for malignancy) as well as those positive for malignancy. Most times, the nodules are not dangerous. Webmalignancy among TR5 nodules were found to be highest (83.3%). The location where nodules are found is significant in determining cancer risk. Nikiforov YE , Ohori NP , Hodak SP, et al. If the lesion is benign, the patient is monitored via ultrasound for the growth of the nodule or development of new nodules. Furthermore, only 79% of nodules were completely evaluated. It is estimated that 56 000 new cases of thyroid cancer will be diagnosed in the United States annually, and over 2000 patients will die from this disease. But if you have any of these symptoms, you should speak with your healthcare provider. If a thyroid nodule is producing thyroid hormones, overloading your thyroid gland's normal hormone production levels, your doctor may recommend treating you for hyperthyroidism. At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Some of theselike weightare modifiable risk factors, while otherslike agecannot be changed. Of these nodules, 79 of 7348 (1.1%) proved to be malignant on final histology as follows: for nodules 1.0 to 1.9 cm, 41 of 3621 (1.1%) were false-negative aspirates; for those 2.0 to 2.9 cm, 13 of 1956 (0.7%) were false-negative aspirates; for those 3.0 to 3.9, 15 of 998 (1.5%) were false-negative aspirates; and for those 4 cm, 10 of 773 (1.3%) were false-negative aspirates (P = .15 for difference between group). After cleaning the area, your provider will insert the thin, fine needle into your thyroid gland. With many thyroid nodules being incidentally detected, it is important to identify as many malignant nodules as possible while excluding those that are highly likely to be benign from fine needle aspiration (FNA) biopsies or surgeries. The needle attaches to a syringe that can apply suction and remove some cells from the nodule. Because cystic fluid can significantly influence nodule size even though it is felt to be a benign characteristic, we also considered whether the proportion of cystic content in nodules influenced the above findings of size and malignancy. Although all nodules evaluated were 1 cm sonographically, in rare circumstances, the histopathology measurement was <1 cm. Less than 20% will recur. We have also detected no evidence of selection or referral bias within our sample cohort, because >95% of all patients with thyroid nodules in our healthcare system are evaluated in our multidisciplinary center and are accounted for in this analysis. All Rights Reserved. To get the most from your appointment, try these suggestions: Mayo Clinic does not endorse companies or products. Patients are referred upon clinical suspicion (or known detection) of a thyroid nodule. That suggests an increased risk for malignancy, which may require surgery or monitoring. The hormones produced by the thyroid help the body produce energy, stay warm, and keep vital organslike the heart and brainworking properly. When a nodule is discovered in the thyroid, healthcare providers must consider the possibility of cancer (malignancy). This suggests the prognosis for men is worse than the prognosis for women. Because the needle is so small, this is often not necessary. If this happens, you might need a repeat biopsy. Sophia C. Kamran, Ellen Marqusee, Mathew I. Kim, Mary C. Frates, Julie Ritner, Hope Peters, Carol B. Benson, Peter M. Doubilet, Edmund S. Cibas, Justine Barletta, Nancy Cho, Atul Gawande, Daniel Ruan, Francis D. Moore, Jr, Karla Pou, P. Reed Larsen, Erik K. Alexander, Thyroid Nodule Size and Prediction of Cancer, The Journal of Clinical Endocrinology & Metabolism, Volume 98, Issue 2, 1 February 2013, Pages 564570, https://doi.org/10.1210/jc.2012-2968. The therapies following surgery will be dependent on what is discovered during the surgical procedure. A 25-gauge needle was used to obtain typically 3 needle samples per nodule. However, the low but consistent rate of false-negative aspirates among all size categories argues against an intrinsic error otherwise unaccounted for, and it is also not feasible to expect removal of all such nodules given their benign cytology results. Lung cancer is one of the most frequently diagnosed cancers and the leading cause of cancer-related deaths worldwide in 2020 with an estimated 2.20 million diagnosed cases and 1.79 million deaths per year [] The majority (about 82%) of lung cancer cases are attributable to smoking [] and approximately 81% of lung cancer If the proportions of patients in the different TR groups in the ACR TIRADs data set is similar to the real-world population, then the prevalence of thyroid cancer in the TR3 and TR4 groups is lower than in the overall population of patients with thyroid nodules. Using these therapies will cure or control the majority of cancers. . Visit the American Cancer Societys Cancer Statistics Center for more key statistics. Also know what the side effects are. Accessed at https://seer.cancer.gov/statfacts/html/thyro.html on January 18, 2023. A Single-Center Retrospective Validation Study of the American College of Radiology Thyroid Imaging Reporting and Data System. This analysis of nearly 5000 patients with over 7000 clinically relevant thyroid nodules provides the largest unbiased assessment of thyroid nodule size and risk of cancer. Of 7348 evaluated nodules, 927 (13%) were cancerous. Based on surgical pathology, 927 of 7348 nodules (13%) were cancers. All nodules that are found to be malignant (cancerous) or are highly suspicious of being cancerous require surgical removal. American Thyroid Association. The majority of thyroid nodules are benign, with 5-15% being malignant. Both clinical and sonographic variables have been investigated with regard to their ability to modify preoperative risk. http://www.thyroid.org/thyroid-nodules/. This was largely due to increased detection during imaging tests such as CT or MRI scans that were done for other medical problems. Perhaps there are even people in your environment who have never undergone chemotherapy or other diagnostics for the presence of cancer. FNA cytology slides were evaluated by a Brigham and Women's Hospital cytopathologist. Your risk of developing thyroid nodules or thyroid cancer is increased if members of your family have already had thyroid and certain other cancers. Mayo Clinic. Thyroid cancer occurs more commonly in women than men. Thyroid cancer management: From a suspicious nodule to targeted therapy. First introduced over 50 years ago, thyroid nodule FNA has proven to be of high value because nearly 70% of aspirates return benign. Permission for this review and analysis was granted from the Investigational Review Board at the Brigham and Women's Hospital. Cells are removed through a small, hollow needle. WebWhile most thyroid nodules are non-cancerous (Benign), ~5% are cancerous. However, a thyroid scan can't distinguish between cold nodules that are cancerous and those that aren't cancerous. A common treatment for cancerous nodules is surgical removal. Ultrasound guidance enables physicians to biopsy the nodule to obtain an adequate amount of material for interpretation. Benign nodules include: I Have A Thyroid Nodule: Epub 2020 Feb 20. Ive never had cancer! 2020 Jul;128(7):470-481. doi: 10.1002/cncy.22254. American Cancer Society medical information is copyrightedmaterial. Treating benign nodules. Elizabeth Pratt is a medical journalist based in Australia. Near-total thyroidectomy may be used depending on the extent of the disease. In such circumstances, the nodule was still included for study analysis so long as the referential integrity of the nodule could be confirmed from ultrasound to histopathology. Those who are overweight or obese have a higher risk of developing thyroid cancer than those who are not. What you see might not be what you get: Analysis of 15 prospective cases of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Such findings would likely be apparent in thyroid nodules regardless of their size. 2021 Mar;216(3):570-578. doi: 10.2214/AJR.20.24608. Epub 2019 Aug 16. Ask if your condition can be treated in other ways. A small bandage will be placed over the needle insertion site. Thyroid nodule. Rarely, they may cause neck swelling, pain, swallowing problems, shortness The nodules in 5% of each size group were classified as malignant. Those who had radiation treatments involving the neck or head as children are at higher risk for thyroid cancer. 4. Hoang JK, et al. Doctors use radioactive iodine to treat hyperthyroidism. Overview of thyroid nodule formation. In summary, these data provide strong evidence that thyroid nodule size >2 cm is associated with an increased risk of well-differentiated thyroid cancer. Previous analyses confirm that 95% of thyroid nodules evaluated within our hospital system are referred to this clinic (5, 10), strongly suggesting no referral or selection bias. Any time a lump is discovered in thyroid tissue, the possibility of cancer must be considered. Accessed Oct. 31, 2019. Rarely, they may cause neck swelling, pain, swallowing problems, shortness of breath, or changes in the sound of your voice as they grow. This concern is amplified in centers where thyroid surgery is performed infrequently (26). Unable to load your collection due to an error, Unable to load your delegates due to an error. What happens if you have a cancerous thyroid nodule? The prognosis for cancer that spreads beyond the thyroid is less favorable than cancer that remains in the thyroid. Thyroid nodules are detected in about 6 percent of women and 1-2 percent of men; they occur 10 times as often in older individuals, but are usually not diagnosed. In thyroid ultrasoundography, high-frequency sound waves pass through the skin and are reflected back to the machine to create detailed images of the thyroid. Our data are from a single institution and retrospective in nature. Ross DS. For benign modules that continue to grow, or develop concerning features discovered during a follow-up ultrasound, surgery may be recommended, even in the absence of cancer. Results are presented according to nodule or according to patient and compared using 2 or t test as appropriate. However, given the slight risk, such tests should be avoided in children unless absolutely necessary. Nodules detected this way are usually smaller than those found during a physical exam. Nodules are often biopsied to make sure no cancer is present. Rumack CM, et al., eds. This content does not have an English version. Cancer risk can differ based on whether nodules are found in the isthmus or the lobar (winged) areas of the thyroid. Epub 2021 Jan 21. Unauthorized use of these marks is strictly prohibited. A 10- to 17-mHz transducer was used for the procedure. This was seen in children and adults who lived near the 1986 Chernobyl nuclear power plant disaster in the Soviet Union, which exposed millions to radioactivity. The sample is sent to the lab for analysis. Often, your doctor may discover thyroid nodules during a routine medical exam. Accessed Nov. 4, 2019. Sometimes, this provides enough information to know that the nodule isnt due to cancer. This procedure is called a total thyroidectomy. If concern arises about the possibility of cancer, the doctor may simply recommend monitoring the nodule over time to see if it grows. Blood tests of thyroid levels also may provide helpful information. WebFortunately, about 95% of thyroid nodules are benign. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Fewer than 1 in 10 Common types of the benign thyroid nodules are adenomas (overgrowths of normal thyroid tissue), thyroid cysts, and Cancer risk from thyroid nodules is low. Chronic thyroiditis is most common in women and people with a family history of thyroid disease. FNA results are tabulated here in the analogous Bethesda System for Reporting Thyroid Cytopathology categories. Therefore, a total of 7348 nodules (79% of total detected) from 4955 patients formed the basis for this evaluation. Sometimes the lump will be all or mainly fluid. Ultrasound and ultrasound-guided fine-needle aspiration of nodules >1 cm was done. Bring someone with you to help you ask questions and remember what your provider tells you. Accessed Oct. 31, 2019. Sometimes, your doctor detects a thyroid nodule when you have an imaging test, such as an ultrasound, CT or MRI scan, to evaluate another condition in your head or neck. We also acknowledge that cytologically benign nodules were classified as benign although in most cases did not undergo repeat FNA or surgical resection to confirm the accuracy of this cytologic diagnosis. Does a higher American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) score forecast an increased risk of malignancy? If your thyroid nodule is not cancer, you might not need any further treatment. Traditionally, the largest (or so-called dominant) nodule is recommended for aspiration. WebMost thyroid nodules are benign, but about 2 or 3 in 20 are cancerous. CancerFacts & Figures 2023. Update on ACR TI-RADS: Successes, Challenges, and Future Directions, From the. The reason for this genetic link is currently unknown. A similar phenotype correlation applies to benign thyroid nodules. Furthermore, we documented false-negative aspirates in only 1.3% of nodules >4 cm. 1. At the American Cancer Society, we have a vision to end cancer as we know it, for everyone. Thyroid cancer risk factors. Of these patients, 3842 (78%) underwent complete evaluation of all nodules >1 cm. A thyroid fine needle aspiration biopsy is a procedure that removes a small sample of tissue from your thyroid gland. In rare cases, there may also be pain in the neck, ears, or jaw. These data confirm the need for improved preoperative assessment. The analysis of differential diagnosis of benign and malignant thyroid nodules based on ultrasound reports. Cancer diagnosis what is it and how to live with it? Specifically, 72% of nodules 1.0 to 1.9 cm were classified benign; 67% of nodules 2.0 to 2.9 cm were classified benign; 65% of nodules 3.0 to 3.9 cm were classified benign; and 64% of nodules 4 cm were classified benign. People who have had radiation treatments to their neck are also more likely to develop nodules. This was not influenced by the cystic content. For each nodule, maximal size, corresponding FNA cytology, and ultimate benign vs malignant categorization were determined. . A total of 1502 nodules were surgically removed despite benign FNA. Diagnostic approach to and treatment of thyroid nodules. Roughly two-thirds of thyroid cancers are diagnosed at the localized stage. Your healthcare provider might repeat this procedure a few times to obtain different samples from different parts of the nodule. For the purposes of this investigation, thyroid nodules 1.0 to 1.9 cm in diameter provided baseline cancer risk for comparison (10.5% Just 2 to 9% of thyroid cancers are found in the isthmus, but cancers in this area are more likely to spread outside of the thyroid than cancers found in other parts of the thyroid. Thyroid cancer is common in those who have been exposed to radioactive fallout from power plant accidents. Most patients who appear to have benign nodules require no specific treatment. Available Every Minute of Every Day. 95% of solitary thyroid nodules are benign, and therefore, only 5% of thyroid nodules are malignant. Kearns AE (expert opinion). Miller B , Burkey S , Lindberg G , Snyder WH , Nwariaku FE. Because cancer is rarely found in hot nodules, a scan showing a hot nodule eliminates the need for fine needle biopsy. A thyroid nodule is a lump in or on the thyroid gland. Sosa JA , Bowman HM , Tielsch JM , Powe NR , Gordon TA , Udelsman R. Oxford University Press is a department of the University of Oxford. Kellerman RD, et al. P values < .05 were considered significant. The presence and histological subtype of cancer was evaluated. 2023 Cedars-Sinai. New York. Tests include: Physical exam. For reprint requests, please see our Content Usage Policy. If serum TSH was <0.5 U/mL, patients were referred for thyroid scintigraphy to identify autonomously functioning nodules. Elselvier; 2018. https://www.clinicalkey.com. A threshold is detected at 2.0 cm, beyond which cancer risk is unchanged. These lobes are joined by a bridge of tissue known as the isthmus, which spans across the windpipe. No association was found. For the U.S. population, the lifetime risk of developing thyroid cancer is 1.1 percent. Blood tests may be ordered to determine whether the thyroid is functioning normally. Thyroid nodules are classified as: Solitary (a single nodule). What percentage of TR5 thyroid nodules are cancerous? Patients with nodules that are malignant or suspicious for cancer by FNA usually undergo thyroid surgery. Any of the above symptoms could also be caused by conditions other than thyroid cancer. Your doctor will likely ask you to swallow while he or she examines your thyroid because a nodule in your thyroid gland will usually move up and down during swallowing. Of 4955 patients, 813 (16%) were diagnosed with clinically relevant thyroid cancer >1 cm as follows: 697 of 813 (86%) papillary carcinoma (including follicular variant), 66 of 813 (8%) follicular or Hurthle cell carcinoma, 42 of 813 (5%) other carcinoma (including medullary, anaplastic carcinoma, follicular lymphoma, and metastatic disease), and 8 of 812 (1%) with two types of pathology. Accessed Oct. 31, 2019. Thank you, {{form.email}}, for signing up. Modifiable risk factors for thyroid cancer include: Exposure to radiation is a proven risk factor for cancer in the thyroid. Our above findings confirm that preferentially aspirating solid or partially cystic nodules >2.0 cm may enhance detection of malignancy. They need to be surgically removed if they cause neck pain or difficultly swallowing. Paja M, Zafn C, Iglesias C, Ugalde A, Cameselle-Teijeiro JM, Rodrguez-Carnero G, Fernndez-Seara P, Anda E, Povoa A, Quiceno H, Snchez-Gmez NM, Gonzlez C, Garca-Pascual L, Gmez de la Riva I, Blanco C, Meizoso T, Riesco-Eizaguirre G, Capel I, Ortega MV, Mancha I, Chao M, Alczar V, Rosell E, Maravall J, Lpez-Agull S, Prez-Lzaro A, Meseguer P, Sanz J, Paricio JJ, Echeverra S, Castao , Bella RM. Although thyroid cancer can occur at any age, the risk of thyroid cancer starts earlier in women, often between the ages of 40 and 50 at the time of diagnosis. Most people will not need this, though. Weve invested more than $5 billion in cancer research since 1946, all to find more and better treatments, uncover factors that may cause cancer, and improve cancer patients quality of life. Thethyroid glandis located in the lower front of the neck, below the voicebox (larynx) and above the collarbones. Patient demographics and nodule characteristics are depicted in Table 1. American Thyroid Association. In 95% of cases, thyroid nodules are found to be benign (noncancerous). You might notice a small bump in your gland area. Any time a lump is discovered in thyroid tissue, the possibility of malignancy (cancer) must be considered. Choose a doctor and schedule an appointment. The American Cancer Society offers programs and services to help you during and after cancer treatment. It is butterfly shaped, with 2 lobes connected by a narrow band of tissue. Most thyroid nodules (90% to 95%) are benign. WebMore than 90% of detected nodules in adults are noncancerous (benign), but they may represent thyroid cancer in approximately 4.0% to 6.5% of cases. Clinical thyroidology for the public: Volume 8 issue 2. 2020 May-Jun;9(3):159-165. doi: 10.1016/j.jasc.2020.01.002. 2021 Jul;73(1):131-140. doi: 10.1007/s12020-021-02610-7. Atlanta, Ga: American Cancer Society; 2023. Your provider may want to monitor your nodule, though, and you might need another biopsy in the future. Your healthcare provider may perform the biopsy with the help of an ultrasound machine. Healthcare providers perform these procedures much less often than fine needle aspiration biopsy. 4, 6 Risk factors for thyroid cancer include ionizing radiation (e.g., from cancer treatments, occupational exposure, Hung W , Anderson KD , Chandra RS, et al. According to the Society of Radiologists in Ultrasound, biopsy should be performed on a nodule 1 cm in diameter or larger with microcalcifications, 1.5 cm in diameter or larger that is solid or has coarse calcifications, and 2 cm in diameter or larger that has mixed solid and cystic components, and a nodule that has , Additional issues with the ACR TIRADS data set and guidelines. But what if? Recent advances in ultrasonography helps physicians identify nodules which are more likely to be cancerous. This is primarily because of a heightened concern for malignancy and false-negative aspiration (which in a large nodule would allow undetected, yet later-stage disease to remain untreated) or separately because of mass effect from the nodule itself.