title: The biopsy-proven benign thyroid nodule: is long-term follow-up necessary?
abstract: BACKGROUND
  Thyroid nodules are common, and of those biopsied by fine-needle aspiration (FNA), the majority will be benign colloid nodules (BCN). Current guidelines suggest these BCN should be followed by ultrasonographic examination (US) every 3 years, with no endpoint specified. This study evaluated if long-term follow-up of benign thyroid nodules was associated with change in treatment or improvement in diagnosing a missed malignancy compared with short-term follow-up.
  
  
  METHODS
  All patients with FNA-based diagnosis of BCN at our institution from 1998 to 2009 were identified. Patients observed after the diagnosis were divided into short-term follow-up (<3 years) and long-term follow-up (≥3 years). Rates of repeat FNA, thyroidectomy, and malignancy detection were compared.
  
  
  RESULTS
  Of 738 patients with BCN, 92 patients underwent thyroid resection after the initial US. Six hundred forty-six patients were observed, of which 366 returned for 1 or more follow-up US: 226 in the short-term group (median 13 months) and 140 in the long-term group (median 57 months). There were more follow-up US in long-term vs short-term (medians 4 vs 2, p < 0.01), more repeat FNAs in the long-term group (18 of 140 vs 8 of 226, p < 0.01); but no difference in interval thyroidectomies (13 of 140 vs 31 of 226, p = 0.25) or malignant final pathology (0 of 13 vs 2 of 31, p > 0.99). For all patients undergoing surgery, pathology was malignant in 2 of 136 (1.5%).
  
  
  CONCLUSIONS
  Long-term follow-up of patients with BCN is associated with increased repeat FNA and US without improvement in the malignancy detection rate. After 3 years of follow-up, consideration should be given to ceasing long-term routine follow-up of biopsy-proven BCN.
authors: Section of Surgical Endocrinology, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Sukhyung
authors: S
authors: Lee
authors: Thomas S
authors: TS
authors: Skelton
authors: Feibi
authors: F
authors: Zheng
authors: Katherine A
authors: KA
authors: Schwartz
authors: Nancy D
authors: ND
authors: Perrier
authors: Jeffrey E
authors: JE
authors: Lee
authors: Roland L
authors: RL
authors: Bassett
authors: Salmaan
authors: S
authors: Ahmed
authors: Savitri
authors: S
authors: Krishnamurthy
authors: Naifa L
authors: NL
authors: Busaidy
authors: Elizabeth G
authors: EG
authors: Grubbs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D002277:Carcinoma / Q000175:diagnosis* / Q000601:surgery; D002291:Carcinoma, Papillary; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000077273:Thyroid Cancer, Papillary; D013961:Thyroid Gland / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000601:surgery; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy / Q000706:statistics & numerical data; D018608:Ultrasonography, Doppler; D055815:Young Adult