Growth of Benign Thyroid Nodules Is Associated With a High Reintervention Rate Without Clear Benefit
In brief
After benign thyroid biopsy, 0.5% had cancer, none in the biopsied nodule
In this single-center review of 411 patients, 17.1% had a repeat biopsy and 3.9% underwent surgery; just two patients were later diagnosed with thyroid cancer, and neither cancer was in the biopsied nodule. Nodules meeting guideline growth criteria were more likely to be rebiopsied, while repeated ultrasounds were common. Longer-term follow-up is needed to clarify the value of this surveillance.
- Journal
- The Journal of surgical research (Q1)
- Published
- 29 October 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 4, Very Low (CEBM 4)
- Authors
- Akash Koul, Dereck Wang, Mihir Tandon, Joshua C Chao, Jessica W Thiesmeyer, Nada A Farhat, et al.
- PMID
- 42956661
- DOI
- 10.1016/j.jss.2026.09.040
Why clinicians should know about it
- Picked for Breast and Endocrine Surgery (paper of the day, 1 November 2026): Benign thyroid nodule surveillance and surgery reintervention
Abstract
INTRODUCTION: The American Thyroid Association (ATA) guidelines recommend routine follow-up ultrasounds following benign thyroid biopsies and repeat fine needle aspiration (FNA) biopsy for nodules that grow. We hypothesized that this may be associated with frequent reintervention without detecting additional cancers. METHODS: A single-center retrospective study of patients with an initial benign thyroid FNA from 2017 to 2021 was performed, 12 mo of data were randomly selected for review. The primary outcome of interest was the rate of repeat FNA or surgery (reintervention), and the secondary outcome of interest was the number of subsequent surveillance ultrasounds. Multivariable regression was used to identify preditors of reintervention. RESULTS: A total of 411 patients with 562 biopsy-proven benign nodules were included. In total, 70 patients (17.1%) underwent at least one repeat biopsy, and 15 patients (3.9%) underwent thyroid surgery. Two patients (0.5%) were ultimately diagnosed with thyroid cancer, neither in the biopsied nodule. During a median follow-up period of 26.4 mo, 282 (68.6%) had at least one follow-up ultrasound, while 64 (15.6%) underwent five or more follow-up ultrasounds. At 5 y, nearly one-third of patients still under surveillance had undergone either repeat FNA or surgery. Patients with nodules meeting ATA growth criteria for repeat FNA were more likely to undergo repeat biopsy than those whose nodules did not (48.5% versus 23.5%, P = 0.02). CONCLUSIONS: Malignancy after an initial benign thyroid FNA biopsy is rare, and subsequent surveillance is resource-intensive without clear benefit. The growth criteria for repeat FNA in the 2015 ATA guidelines were associated with reintervention without detection of malignancies.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.