Accuracy of Fine-Needle Aspiration Biopsy for Predicting Neoplasm or Carcinoma in Thyroid Nodules 4 cm or Larger

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Abstract
Clinically apparent thyroid nodules are extremely common, affecting 4% to 10% of the adult population in the United States.1,2 These figures likely underestimate the true frequency of thyroid nodular disease, as demonstrated by several autopsy surveys reporting rates of 37% to 57%.3,4 Likewise, in radiographic surveys of random patients undergoing ultrasonography, 20% to 76% of adult women were found to have at least 1 thyroid nodule.5,6 Despite this relative frequency, large retrospective case series have shown that only 4% to 5% of thyroid nodules demonstrate histopathologically proven malignant disease.7,8 Several risk factors for the presence of carcinoma within thyroid nodules have been identified, including age, sex, and prior neck irradiation. Similarly, although controversial, the prevalence of thyroid carcinoma appears to be associated with larger thyroid nodule size.9,10