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This study evaluates if thyroid nodule size correlates with malignancy risk, using FNAc findings for diagnosis.

June 6, 2026Open Access

Thyroid Nodule Size is Not a Predictor of Malignancy: A Focus on Fine-needle Aspiration Cytology Findings

Key Points

This study evaluates if thyroid nodule size correlates with malignancy risk, using FNAc findings for diagnosis.
Conducted a retrospective analysis on 760 patients with 850 thyroid nodules between June 2023 to July 2024.
Used ultrasound and US-guided FNAc for assessment, following ACR-TIRADS and Bethesda classification.
Applied logistic regression to analyze the association between nodule features and malignancy risk.
Malignant nodules were predominantly found in TIRADS category 5 (72.7%).
Each unit increase in TIRADS score correlated with a 5.86-fold increase in odds of malignancy (P=0.0001).
Malignancy risk decreased by 2% per additional year of patient age (P=0.028), while nodule size was not an independent predictor of malignancy.

Abstract

Abstract Background: This study aimed to evaluate the relationship between thyroid nodule size and various factors and malignancy risk, using fine-needle aspiration cytology (FNAc) as the diagnostic standard. Methods: A retrospective analysis was conducted on 760 patients with 850 thyroid nodules who underwent ultrasound (US) and US-guided FNAc from June 2023 to July 2024. Nodules were assessed using the ACR-Thyroid Imaging Reporting and Data Systems (TIRADS) classification and classified cytologically according to the 2017 Bethesda System. Statistical analyses included logistic regression to evaluate the association between variables and malignancy risk. Results: Malignant nodules were predominantly observed in TIRADS category 5 (72.7%), while benign nodules were more frequent in categories 3 and 4. Higher TIRADS scores were significantly associated with malignancy, each unit increase in score was associated with a 5.86 – fold increase in odds ( P = 0.0001). Malignancies were more common in younger patients, with risk decreasing by 2% per additional year of age ( P = 0.028). Nodule size was not an independent predictor of malignancy. Conclusion: TIRADS is an effective tool for predicting thyroid malignancy and stratifying risk, aiding clinical decision-making. Younger age is a significant risk factor, while nodule size alone should not be used as a predictor of malignancy.

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