Thyroid Nodules with Indeterminate Cytology-Minimizing Unnecessary Surgery

Thyroid Nodules with Indeterminate Cytology-Minimizing Unnecessary Surgery

The following articles were published online at NEJM.org to coincide with a presentation at the annual meeting of The Endocrine Society. One is an Original Article (Funded by Veracyte) along with an Editorial. I have previously blogged about the evaluation of thyroid nodules and discussions regarding quality tools for use. In addition, these previous blog articles touched on some of the new molecular techniques used in concert with thyroid cytology in the evaluation of indeterminate cytology. The following article, published in the NEJM, describes results from a prospective, multicenter validation study which included “…49 clinical sites, 3789 patients, and 4812 fine-needle aspirates from thyroid nodules 1 cm or larger that required evaluation.” Out of 577  cytologically indeterminate aspirates, 413 with corresponding histopathological excisional material, 265 indeterminate samples which met inclusion criteria were evaluated with a gene-expression classifier  and its performance was assessed.  The final summation describes that “…this study shows that a gene-expression classifier can be used to identify a subpopulation of patients with a low likelihood of cancer in a population of patients for whom diagnostic surgery is otherwise recommended. Though each clinical decision must be individualized, these data suggest consideration of a more conservative clinical approach for patients who have nodules with indeterminate cytologic features on fine-needle aspiration and a benign result on gene-expression classifier testing.”

Original Article

Preoperative Diagnosis of Benign Thyroid Nodules with Indeterminate Cytology

E.K. Alexander and Others

Editorial

Minimizing Unnecessary Surgery for Thyroid Nodules

J.L. Jameson

Original article is supported by research grants to the individual study institutions from Veracyte.