Diagnostic Yield of Thyroid Incidentaloma Evaluation and the Impact of Guideline Variability: Insights from a Retrospective Cohort Study
Authors' conclusion
Conventional imaging-detected incidentalomas carry a low malignancy risk, resulting in a high diagnostic workload to detect few malignancies. More restrictive evaluation criteria can substantially reduce diagnostic burden but may miss a small number of low-risk malignancies.
Study context
- Population
- Patients referred to Zuyd Thyroid Center (2018–2023) for thyroid nodule evaluation with one or more thyroid incidentalomas; median age 66 years (IQR 54–74); 70.6% femaleof 1825 referred
- Participants
- 630 patients
- Exposure
- Nuclear vs conventional imaging-detected incidentalomas; European Thyroid Association (ETA) vs American Thyroid Association (ATA) vs Dutch guideline evaluation criteria
- Outcome
- Diagnostic yield of thyroid incidentaloma evaluation and impact of guideline variability on malignancy detection and diagnostic workload
Methodological detailsguideline-based simulation analysis, single-centre
- Guideline-based simulation analysis
- Single-centre
Main finding
As reported in the abstract
Malignancy rate by imaging modality
P < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | ETA | ATA | Dutch guideline |
|---|---|---|---|
| Guideline-based simulation: patients recommended for evaluation and malignancies detectedSimulation analysis | |||
| Evaluated | all cases | — not stated in the abstract | — not stated in the abstract |
| Evaluated (without clinical warning signs) | — not stated in the abstract | 85.3% | — not stated in the abstract |
| Evaluation avoided | — not stated in the abstract | — not stated in the abstract | 96.9% |
| Missed malignancies among 528 unevaluated cases | — not stated in the abstract | — not stated in the abstract | 7 (1.3%) |
— not stated in the abstract
Guideline-based simulation: patients recommended for evaluation and malignancies detected
- ETA and ATA both identified all malignancies
- Malignancies missed by Dutch guideline were all subtypes with good prognosis even if left undetected
Original publication
Diagnostic Yield of Thyroid Incidentaloma Evaluation and the Impact of Guideline Variability: Insights from a Retrospective Cohort Study. Thyroid. Published 14 April 2026. doi:10.
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