Most thyroid nodules identified as benign do not get bigger. And these nodules rarely progress to cancer, according to a study which calls for a revision of the recommendations for their follow-up.
We are discovering more and more nodules in the thyroid. Especially very small, accidentally, thanks to advances in imagery. And even though more than 90% of the nodules detected are benign, these findings can be stressful for patients, who fear they will one day develop thyroid cancer.
Reassuring study
But Italian researchers published a reassuring study on Tuesday in the Journal of the American Medical Association (JAMA). It shows that most benign nodules do not grow significantly over the five-year horizon. The development of thyroid cancer is also rare. The researchers therefore plead for an evolution of the recommendations for monitoring benign thyroid nodules.
Sebastiano Filetti, of the University of Rome and his colleagues, followed 992 patients for five years in which had been detected one to four nodules and without showing any symptoms. Their nodules were considered benign after ultrasound examination and analysis of cells taken with a fine needle (fine needle aspiration). It was not just small nodules.
0.3% of cancers
After five years, only 11% of the nodules have grown. This growth, which concerned 15% of patients, was associated with the presence of multiple nodules. In 18% of patients, the nodules also shrunk spontaneously during follow-up. Thus, in the rest of the cases, which constitute the majority, the nodules did not change in size. Furthermore, the development of thyroid cancer has been rare. Only five nodules detected at the start of the study evolved in this way (or 0.3%), and among them, only two had grown.
In light of these observations, the researchers believe that the American Thyroid Association’s recommendations for monitoring benign nodules should be revised. Currently, a repeated examination by ultrasound and a fine needle aspiration are recommended in the event of suspicious appearance and / or in the event of important growth.
Evolution of recommendations
In a editorial accompanying the article, Anne Cappola and Susan Mandel, of the University of Pennsylvania in Philadelphia, also say they are in favor of changing the recommendations. For these specialists, there should be no more fine-needle aspiration after ultrasound when the nodules grow a lot, but only if they appear suspicious.
In France, the overdiagnosis of thyroid nodules leads to unnecessary treatments. Thus, one out of five thyroid nodules would be useless because they are benign nodules requiring only monitoring, according to a Health Insurance report made public at the end of 2013. These operations can cause rare complications. For example, they can affect the vocal cords and disturb the voice. It is therefore inappropriate to run this risk to patients who do not need it. At the end of 2013, the UFC-Que Choisir had asked the Health Insurance to sensitize patients to this problem of overtreatment via a campaign and the High Authority of Health (HAS) to develop supported and updated recommendations for doctors. .
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