Solitary and multiple thyroid nodules as predictors of malignancy: a systematic review and meta-analysis

Aqeeb Ur Rehman; Muhammad Ehsan; Haseeba Javed; Muhammad Zain Ameer; Aleenah Mohsin; Muhammad Aemaz Ur Rehman; Ahmad Nawaz; Zunaira Amjad; Fatima Ameer

doi:10.1186/s13044-022-00140-6

Solitary and multiple thyroid nodules as predictors of malignancy: a systematic review and meta-analysis

Thyroid Res. 2022 Dec 5;15(1):22. doi: 10.1186/s13044-022-00140-6.

Authors

Aqeeb Ur Rehman¹, Muhammad Ehsan¹, Haseeba Javed², Muhammad Zain Ameer¹, Aleenah Mohsin¹, Muhammad Aemaz Ur Rehman³, Ahmad Nawaz¹, Zunaira Amjad⁴, Fatima Ameer⁵

Affiliations

¹ Department of Medicine, King Edward Medical University, Lahore, Pakistan.
² Department of Medicine, King Edward Medical University, Lahore, Pakistan. haseebajaved1998@gmail.com.
³ Clinical Research Fellow, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
⁴ Department of Medicine, Services Institute of Medical Sciences, Lahore, Pakistan.
⁵ Department of Medicine, Mayo Hospital, Lahore, Pakistan.

Abstract

Background: The debate on whether or not there is a difference in the incidence of thyroid cancer between the patients with Solitary thyroid Nodule (STN) and Multinodular Goiter (MNG) has been constantly present for the last few decades. With newer studies yielding mixed results, it was imperative to systematically compile all available literature on the topic.

Methods: PubMed/MEDLINE, Cochrane Central, ScienceDirect, GoogleScholar, International Clinical Trials registry, and reference lists of the included articles were systematically searched for article retrieval. No filter was applied in terms of time, study design, language or country of publication. Rigorous screening as per PRISMA guidelines was undertaken by 2 independent reviewers in order to identify the articles that were most relevant to the topic.

Results: Twenty-two studies spanning from 1992 to 2018 were included in this analysis and encompassed 50,321 patients, 44.2% of which belonged to the STN subgroup and 55.37% to the MNG subgroup. MNG was found to be associated with a significantly lower risk of thyroid cancer (OR = 0.76; 95% CI 0.61-0.96) when compared with STN. Papillary carcinoma was the most frequently occurring carcinoma across both groups, followed by follicular and medullary carcinomas. A subgroup analysis was performed to assess the efficacy of the two most commonly employed diagnostic tools i.e. surgery and fine needle aspiration cytology (FNAC), however it yielded nonsignificant results, indicating a comparable usefulness of the two. Another subgroup analysis run on the basis of the presumed iodine status of the participants also yielded nonsignificant results.

Conclusion: There is a higher incidence of thyroid cancer among patients of STN, however, given the low quality of existing evidence on the topic, it is crucial to conduct larger studies that can establish association with a greater precision.

Keywords: Multinodular goiter; Nodular goiter; Single nodule; Single thyroid nodule; Thyroid cancer; Thyroid carcinoma; Thyroid nodule.

Publication types

Review