World Journal of Surgery

, Volume 38, Issue 6, pp 1312–1317 | Cite as

Trends in Incidentally Identified Thyroid Cancers Over a Decade: A Retrospective Analysis of 2,090 Surgical Patients

  • Manisha Bahl
  • Julie A. Sosa
  • Rendon C. Nelson
  • Ramon M. Esclamado
  • Kingshuk Roy Choudhury
  • Jenny K. HoangEmail author



The aim of this study was to describe trends in the incidence of incidental thyroid cancers and compare their characteristics with clinically presenting cancers.


We performed a retrospective review of patients with thyroid cancer who underwent thyroid surgery from 2003 to 2012. Patients’ initial presentation was categorized as incidental (on imaging or final surgical pathology) or clinical (palpable or symptomatic) cancer. Characteristics of incidental and clinical cancers were compared.


Of the 2,090 patients who underwent thyroid surgery, 680 (33 %) were diagnosed with cancer. One hundred ninety (28 %) were incidental cancer, of which 101 were detected on imaging studies and 89 were detected on analysis of the surgical pathology specimens. The incidence of thyroid cancer increased by 7.6-fold from 2003 to 2012. The proportion of incidental cancers on imaging did not increase, but incidental cancers found on pathology steadily increased from 6 % in 2003 to 20 % in 2012. 84 % of the cancers were papillary cancer, and the proportion of papillary cancer was similar for both clinical and incidental cancers. Clinical cancers were larger than incidental cancers on imaging (2.2 vs. 1.8 cm, p = 0.02). Incidental cancers on imaging were less likely to have lateral compartment nodal metastases (7 vs. 13 %, p < 0.001).


Thyroid cancer diagnoses have increased at our institution, but the proportion of incidental cancers identified on imaging relative to clinical cancers has been stable over a decade and is not the sole explanation for the observed increase in thyroid cancer diagnoses. Incidental cancers on imaging are smaller in size and less likely to have lateral compartment nodal metastases than clinical cancers.


Thyroid Cancer Incidental Cancer Thyroid Nodule Papillary Thyroid Cancer Thyroid Malignancy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

The authors have no conflicts of interest or financial ties to disclose.


  1. 1.
    Davies L, Welch HG (2005) Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA 295:2164–2167CrossRefGoogle Scholar
  2. 2.
    Hoang JK, Roy Choudhury K, Lyman GH et al (2013) An exponential growth in incidence of thyroid cancer: trends and impact of CT imaging. AJNR. doi: 10.3174/ajnr.A3743 Google Scholar
  3. 3.
    Frates MC, Benson CB, Charboneau JW et al (2006) Management of thyroid nodules detected at US: society of radiologists in ultrasound consensus conference statement. Ultrasound Q 22:231–238 discussion 239–240PubMedCrossRefGoogle Scholar
  4. 4.
    American Thyroid Association Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214CrossRefGoogle Scholar
  5. 5.
    Malone MK, Zagzag J, Ogilvie JB et al (2013) Thyroid cancers detected by imaging are not necessarily small or early stage. Thyroid. doi: 10.1089/thy.2012.0651 PubMedCentralGoogle Scholar
  6. 6.
    Mevawalla N, McMullen T, Sidhu S et al (2011) Presentation of clinically solitary thyroid nodules in surgical patients. Thyroid 21:55–59PubMedCrossRefGoogle Scholar
  7. 7.
    Yousem DM, Huang T, Loevner LA, Langlotz CP (1997) Clinical and economic impact of incidental thyroid lesions found with CT and MR. AJNR 18:1423–1428Google Scholar
  8. 8.
    Nguyen XV, Roy Choudhury K, Eastwood JD et al (2013) Incidental thyroid nodules on CT: evaluation of 2 risk-categorization methods for work-up of nodules. AJNR 34(9):1812–1817PubMedCrossRefGoogle Scholar
  9. 9.
    Hobbs H, Bahl M, Nelson RC et al (2014) Incidental thyroid nodules detected on imaging: Can workup be reduced by using the SRU recommendations and the 3-tier system? AJR (in press)Google Scholar
  10. 10.
    Hoang JK, Raduazo P, Yousem DM, Eastwood JD (2012) What to do with incidental thyroid nodules on imaging? An approach for the radiologist. Semin Ultrasound CT MR 33:150–157PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Manisha Bahl
    • 1
  • Julie A. Sosa
    • 2
  • Rendon C. Nelson
    • 3
  • Ramon M. Esclamado
    • 4
  • Kingshuk Roy Choudhury
    • 5
  • Jenny K. Hoang
    • 6
    Email author
  1. 1.Department of RadiologyDuke University Medical CenterDurhamUSA
  2. 2.Division of Surgical Oncology, Department of SurgeryDuke University School of MedicineDurhamUSA
  3. 3.Division of Abdominal Imaging, Department of RadiologyDuke University Medical CenterDurhamUSA
  4. 4.Division of Otolaryngology, Head and Neck Surgery, Department of SurgeryDuke University Medical CenterDurhamUSA
  5. 5.Department of RadiologyDuke University Medical CenterDurhamUSA
  6. 6.Division of Neuroradiology, Department of Radiology and Radiation OncologyDuke University Medical CenterDurhamUSA

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