The Diagnostic Mirage: Incidental Thyroid Nodules and Over-Investigation in Low-Risk Patients
Olivier Roux ¹,Bianca Bisson ²,Julie Lambert³, Jourdan Mckinnis⁴,
Keywords:
thyroid nodules, overdiagnosis, incidental findings, TI-RADS, low-value careAbstract
Abstract:
Background: The widespread use of imaging has led to incidental thyroid nodule detection, prompting excessive workup. This study investigates patterns of over-investigation and cost implications in low-risk individuals.
Methods: A review of 412 incidental thyroid nodules (ITNs) found on CT/MRI in asymptomatic adults in France. Ultrasound features, FNA rates, cost analysis, and malignancy outcomes were assessed.
Results: 76.2% of ITNs were <1.5 cm with benign features, yet 61.4% underwent FNA. Only 3.4% were malignant. The average cost per malignancy detected was €8,920. Use of ACR TI-RADS reduced unnecessary FNA by 42%.
Conclusion: Over-investigation of ITNs remains widespread despite guidelines. Adherence to risk-based protocols can reduce patient burden and resource waste.
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