{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:28:48Z","timestamp":1787236128403,"version":"build-2736575974"},"reference-count":30,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T00:00:00Z","timestamp":1765238400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"National Institute of Health T32","award":["CA229102"],"award-info":[{"award-number":["CA229102"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The incidence of thyroid nodules measuring \u22654\u00a0centimeters (cm) has increased over the last decade and is particularly concerning for malignancy. However, the malignancy risk and diagnostic accuracy of fine-needle aspiration biopsy (FNAB) in nodules \u22654\u00a0cm remain debated. This study aims to determine the malignancy rate in nodules \u22654\u00a0cm and evaluate the diagnostic accuracy of FNAB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed patients who underwent partial or total thyroidectomy from January 2015 to December 2024 at a large tertiary care center. Data collected included patient demographics, thyroid nodule size, and final surgical pathology to determine the malignancy rate. Patients with nodules \u22654\u00a0cm were identified, and those who underwent FNAB were analyzed for diagnostic concordance between cytology and surgical pathology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 1049 patients who underwent thyroidectomy, 167 (16%) had nodules \u22654\u00a0cm. Of these, 95 (57%) underwent preoperative FNAB and formed the analytic cohort. In this group, 14 patients (14.7%) had malignant final pathology, and 5 of these malignancies (35.7%) were incidentally discovered. Three of the incidental malignancies were papillary thyroid microcarcinomas (&lt;1\u00a0cm) and were excluded from diagnostic performance analysis. Fine-needle aspiration biopsy demonstrated a sensitivity of 54.1%, specificity of 91.4%, false-negative rate of 20.99%, and positive predictive value of 81.3%. Concordance between FNAB and final pathology was observed in 79% of benign and 86% of malignant cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Fine-needle aspiration biopsy demonstrates limited sensitivity in nodules \u22654\u00a0cm, with a 21% false-negative rate and potential for missed incidental malignancies. Based on this, surgical resection should be considered for thyroid nodules \u22654\u00a0cm.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348251407348","type":"journal-article","created":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T10:37:53Z","timestamp":1765276673000},"page":"1813-1818","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Malignancy Risk and Diagnostic Accuracy of Fine-Needle Aspiration in Thyroid Nodules \u22654\u00a0cm: A Retrospective Analysis of Incidental Cancer"],"prefix":"10.1177","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1329-6192","authenticated-orcid":false,"given":"Niranjna","family":"Swaminathan","sequence":"first","affiliation":[{"name":"The University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angel J.","family":"Laboy","sequence":"additional","affiliation":[{"name":"The University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9960-2826","authenticated-orcid":false,"given":"Azeem","family":"Izhar","sequence":"additional","affiliation":[{"name":"The University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjana","family":"Balachandra","sequence":"additional","affiliation":[{"name":"The University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chandler","family":"McLeod","sequence":"additional","affiliation":[{"name":"The University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Gillis","sequence":"additional","affiliation":[{"name":"The University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Fazendin","sequence":"additional","affiliation":[{"name":"The University of Oklahoma"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenessa","family":"Lindeman","sequence":"additional","affiliation":[{"name":"The University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herbert","family":"Chen","sequence":"additional","affiliation":[{"name":"The University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,12,9]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2023.1113977"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2021.02.027"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2023.03.023"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21254"},{"issue":"1","key":"e_1_3_5_6_2","first-page":"25","article-title":"The epidemiology of thyroid carcinoma","volume":"4","author":"Franceschi S","year":"1993","unstructured":"Franceschi S, Boyle P, Maisonneuve P, et al. The epidemiology of thyroid carcinoma. Crit Rev Oncog. 1993;4(1):25-52.","journal-title":"Crit Rev Oncog"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2024.116016"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012-2968"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2007.08.012"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ando.2022.08.002"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2023.1252503"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-014-3952-7"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.3803\/EnM.2017.32.1.77"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.5858\/133.5.787"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2015.0300"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.yasu.2006.06.003"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.5858\/2001-125-0484-AOFNAO"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2012.0265"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.5144\/0256-4947.2021.36"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaa322"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.2009.116"},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2022.06.049"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2017.0419"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-013-2261-9"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2011.09.016"},{"key":"e_1_3_5_26_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000040373"},{"key":"e_1_3_5_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2020.05.034"},{"key":"e_1_3_5_28_2","doi-asserted-by":"publisher","DOI":"10.4158\/EP151150.OR"},{"key":"e_1_3_5_29_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2013.0317"},{"key":"e_1_3_5_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2024.115830"},{"key":"e_1_3_5_31_2","doi-asserted-by":"publisher","DOI":"10.1308\/rcsann.2019.0156"}],"container-title":["The American Surgeon\u2122"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348251407348","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00031348251407348","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348251407348","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T12:19:01Z","timestamp":1777465141000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00031348251407348"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,9]]},"references-count":30,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1177\/00031348251407348"],"URL":"https:\/\/doi.org\/10.1177\/00031348251407348","relation":{},"ISSN":["0003-1348","1555-9823"],"issn-type":[{"value":"0003-1348","type":"print"},{"value":"1555-9823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,9]]}}}