The thyroid incidentaloma - Ignore or investigate?

Objective. The purpose of this study was to evaluate the potential importance and need for further investigation of thyroid lesions detected during imaging investigations unrelated to the thyroid gland (thyroid incidentalomas). The management of these lesions is controversial because most malignancies detected will be papillary microcarcinomas, which will not manifest as overt disease. Methods. A systematic literature search was performed, including the MEDLINE (11951 to date) and EMBASE (11974 to date) databases, using the Dialog DataStar and PubMed search engines and the Cochrane database. Results. Relevant studies were reviewed, together with consensus documents, looking at the prevalence of thyroid incidentalomas and associated malignancy and the use of ultrasound and fine-needle aspiration cytologic examination in further investigation of incidentalomas. Conclusions. The management and importance of the thyroid incidentaloma remain controversial, although problems relating to these issues are likely to become increasingly common in radiologic practice. Once an incidentaloma has been observed, formal clinical and sonographic assessment should be considered, with fine-needle aspiration cytologic examination as appropriate, after an informed discussion with patient.