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Which Nodules Can Be Monitored Without Biopsy?
The ATA guidelines do not recommend biopsy for thyroid nodules smaller than 5 mm in diameter, even if suspicious features are present. Solid nodules smaller than 1 cm escape biopsy if no clinical risks or microcalcifications are present. Pure cysts do not require biopsy, nor do spongiform nodules smaller than 2 cm. Biopsy is not recommended for complex cysts smaller than 1.5 to 2 cm (even if suspicious features are present).
The AACE guidelines do not recommend biopsy of solid nodules smaller than 1 cm in diameter if the patient has no clinical risks and there are no suspicious features on ultrasonography. Nodules hyperfunctioning on scintigraphy do not require biopsy.
Similarly, the KSTR guidelines do not recommend biopsy of nodules smaller than 1 cm without suspicious features. In addition, biopsy is considered unnecessary for spongiform nodules and simple cysts smaller than 2 cm in diameter.
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