Does a patient with isoechoic thyroid nodules, measuring 3.1 centimeters (cm) on the right and 2.8 cm on the left, require a biopsy?

From the Guidelines

Yes, isoechoic thyroid nodules of 3.1cm on the right and 2.8cm on the left typically require biopsy, as any thyroid nodule larger than 1-1.5cm generally warrants fine needle aspiration (FNA) biopsy to rule out malignancy, regardless of its echogenicity, according to the most recent guidelines 1.

Key Points to Consider

• The size of the nodules is an important independent risk factor for malignancy, and these nodules are well above the threshold for recommended biopsy.
• Fine needle aspiration cytology (FNAC) should be performed in any thyroid nodule >1 cm, as stated in the guidelines 1.
• While isoechoic nodules are less suspicious than hypoechoic ones, the size of the nodules in question necessitates further investigation to rule out malignancy.
• The procedure involves using a thin needle to extract cells from the nodules for microscopic examination and is usually performed under ultrasound guidance as an outpatient procedure with minimal discomfort.

Recommendations for Patients

• Patients should discuss with their physician any medications they're taking that might affect bleeding, as these may need to be temporarily discontinued before the procedure.
• The biopsy results will determine whether further intervention is needed, ranging from simple monitoring to surgical removal.
• It is essential to follow the guidelines and recommendations provided by the most recent and highest quality studies, such as those published in the Annals of Oncology 1, to ensure the best possible outcomes in terms of morbidity, mortality, and quality of life.

From the Research

Thyroid Nodule Biopsy Requirements

• The patient has isoechoic thyroid nodules measuring 3.1 cm on the right and 2.8 cm on the left, which are larger than 1 cm and may require a biopsy 2.
• Fine-needle aspiration (FNA) biopsy is a reasonable approach to thyroid nodules and has decreased costs substantially because it facilitates selection of patients who need to undergo surgical excision 3.
• FNA biopsy is a safe, simple, reliable, and cost-effective means of detecting benign nodules, and it is the preferred initial diagnostic test in all patients with thyroid nodules 3.

Nodule Size and Biopsy

• Lesions larger than 1 cm should be biopsied, regardless of other factors 2.
• The size of the nodules in this patient (3.1 cm and 2.8 cm) exceeds the 1 cm threshold, suggesting that a biopsy may be necessary 2.
• However, the relationship between nodule size and malignancy risk is inverse, and a cutoff point of 12 mm was found for detecting malignant nodules 4.

Molecular Testing and Thyroid Nodule Evaluation

• Molecular testing can be used to refine the diagnosis of thyroid nodules, including the use of commercial assays to detect specific genetic alterations 5.
• The evaluation of thyroid nodules using thyroid imaging reporting and data system (TIRADS) and nodule size can help predict the malignancy risk of thyroid nodules 4.
• TIRADS ≥4 could detect malignant nodules with a sensitivity of 91.67% and specificity of 52.8%, and an inverse relationship was observed between nodule size and malignancy risk 4.