Short- versus Long-Term Follow-Up Ultrasound Examinations of Biopsy-Proven Benign Thyroid Nodules

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Background Current guidelines suggest indefinite follow-up ultrasound examinations and repeat fine-needle aspiration biopsies (FNABs) be conducted on biopsy-proven benign thyroid nodules depending on their sonographic appearance. The current guidelines are due to the false-negative rate associated with FNABs. The purpose of this review is to determine whether short- versus long-term follow-up ultrasound examinations increase the detection rate of malignancy for individuals with biopsy-proven benign thyroid nodules. Methods A systematic review was conducted of retrospective studies in which the follow-up of biopsy-proven benign thyroid nodules was assessed and it was identified whether malignancy in the form of papillary thyroid carcinoma (PTC) was detected. Results Searches in 3 databases (using the key terms follow-up studies, ultrasonography, thyroid nodule, and biopsy), as well as 3 additional sources, resulted in 53 unduplicated articles. Six full-text articles were assessed for eligibility upon meeting the initial inclusion criteria. Ultimately, 2 studies were included in the systematic review which examined the number of, and reasons for, patients undergoing thyroidectomy or lobectomy after having repeat ultrasound examinations and repeat FNABs in short- (<3 years) or long-term (>3 years) intervals. Results showed that short-term follow-up detected 7 additional malignancies due to a variety of factors including repeat FNAB findings and suspicious ultrasound features. Long-term follow-up detected 3 additional malignancies, however, the reason for resection was largely due to symptomatology. Conclusion Indefinite follow-up of biopsy-proven benign thyroid nodules is costly and may be unnecessary. Short-term follow-up using ultrasound has been shown to increase the detection rate of malignancy. However, the use of ultrasound for long-term follow-up has not proven to increase the detection rate of malignancy. It may prove beneficial to review the current best practice guidelines and implement a change in practice.