, Volume 66, Issue 2, pp 249–253 | Cite as

Thyroid nodules over 4 cm do not have higher malignancy or benign cytology false-negative rates

  • Muhammed Kizilgul
  • Rupendra Shrestha
  • Angela Radulescu
  • Maria R. Evasovich
  • Lynn A. BurmeisterEmail author
Original Article



Whether thyroid nodules 4 cm or larger with benign cytology carry a higher risk of malignancy, and should be managed differently than smaller nodules remains controversial. We aimed to evaluate the malignancy rate and benign cytology false-negative rate in thyroid nodules ≥4 cm compared with those <4 cm.


All thyroidectomies between January 2010 and December 2014 were reviewed. Patient demographics, preoperative sonographic nodule size, fine needle aspiration cytology (FNAC), and final surgical pathology results were compared for index nodules ≥4 vs. <4 cm.


A total of 490 index nodules with preoperative FNAC were identified. A total of 137 nodules were ≥4 cm and 353 nodules were <4 cm. The prevalence of carcinoma was lower (23 vs. 53%) in nodules ≥4 vs. <4 cm (p < 0.0001). The false-negative rate of benign FNAC for ≥4 and <4 cm index nodule was 5.2% and 5.9%, respectively (p = 1.000).


This study shows that thyroid nodules ≥4 cm do not have a higher malignancy rate at surgery nor higher benign cytology false-negative rate than smaller nodules. Thyroid nodules over 4 cm do not require resection, to rule out malignancy, based on size alone.


Thyroid nodule ≥4 cm Thyroid carcinoma False-negative rate Size 



This study was funded by the National Institutes of Health’s National Center for Advancing Translational Sciences, grant UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health’s National Center for Advancing Translational Sciences. Muhammed Kizilgul was supported by a grant from The Scientific and Technical Research Council of Turkey (TUBITAK).

Compliance with ethical standards

Conflict of interest

The authors delare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the University of Minnesota Institutional Review Board.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of MedicineSurgery University of MinnesotaMinneapolisUSA
  2. 2.Department of Endocrinology and MetabolismUHS Diskapi Training and Research HospitalAnkaraTurkey

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