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The Risk of Thyroid Malignancy in a Predominately Older Male Population Based on Sonographic Pattern and Fine Needle Aspiration Cytology

Ahmad Abu-Limon

Background: Thyroid cancer is a common malignancy and has an increasing incidence. Thyroid ultrasound is widely used to stratify the risk of malignancy of thyroid nodules and aid decision-making about whether fine needle aspiration biopsy is indicated using the Thyroid Imaging Reporting and Data System (TIRADS). We undertook this study to determine incidence of thyroid cancer in an older, most male population referred for evaluation of a thyroid nodule at a US veterans medical center.

Methods: We performed a retrospective study of all patients undergoing evaluation of a thyroid nodule at the Oklahoma City US Department of Veterans Affairs Medical Center. We recorded sonographic findings, TIRADS score, cytopathology and surgical pathology.

Results: Among 162 subjects undergoing evaluation of a thyroid nodule, 80% were men and average age was >60 years. Only 8 of the 164 had a malignancy diagnosed. Neither age, sex, nor nodule size was associated with malignancy. All with malignancy had a TIRADS score or either 4 or 5, but only a minority of TIRADS 4 (2.4%) or TIRADS 5 (8.8%) had thyroid cancer. Punctate calcifications were found in 6 of the 8 nodules with thyroid cancer and was the only finding statistically associated with malignancy. No malignancy was found in nodules categorized as Bethesda III category.