Preoperative Diagnosis of Benign Thyroid Nodules with Indeterminate Cytology

• Published in: The New England journal of medicine Vol. 367; no. 8; pp. 705 - 715
• Main Authors: Alexander, Erik K, Kennedy, Giulia C, Baloch, Zubair W, Cibas, Edmund S, Chudova, Darya, Diggans, James, Friedman, Lyssa, Kloos, Richard T, LiVolsi, Virginia A, Mandel, Susan J, Raab, Stephen S, Rosai, Juan, Steward, David L, Walsh, P. Sean, Wilde, Jonathan I, Zeiger, Martha A, Lanman, Richard B, Haugen, Bryan R
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 23.08.2012
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Algorithms; Benign; Biological and medical sciences; Biomarkers, Tumor - genetics; Biopsy, Fine-Needle; Cytology; Diagnosis, Differential; Double-Blind Method; Endocrinopathies; Female; Gene Expression; Gene Expression Profiling - methods; General aspects; Humans; Investigations; Male; Medical diagnosis; Medical sciences; Middle Aged; Mutation; Nodules; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Oligonucleotide Array Sequence Analysis; Prospective Studies; Risk assessment; RNA, Messenger - analysis; Sensitivity and Specificity; Surgery; Surgical outcomes; Thyroid; Thyroid gland; Thyroid Gland - pathology; Thyroid Nodule - diagnosis; Thyroid Nodule - genetics; Thyroid Nodule - pathology; Thyroid. Thyroid axis (diseases); Young Adult; Endocrinopathy; Medicine; Thyroid diseases; Cytology; Thyroid nodule; Diagnosis; Preoperative
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa1203208

A significant fraction of fine-needle aspirates obtained from thyroid nodules are read as indeterminate. A new molecular test accurately predicts whether a cytologically indeterminate nodule is benign 93% of the time, permitting a conservative approach to management. Thyroid nodules are common and are usually benign. 1 However, 5 to 15% prove to be malignant; accordingly, identification of a nodule 1 cm or larger in diameter often prompts a diagnostic evaluation. 2 , 3 The cornerstone of thyroid-nodule evaluation is fine-needle aspiration, 4 which enables the assessment of cellular morphologic features that could not be identified by means of clinical assessment or imaging. Preoperative, ultrasonographically guided fine-needle aspiration has been shown to accurately classify 62 to 85% of thyroid nodules as benign, thereby avoiding diagnostic surgery. 5 However, 15 to 30% of aspirations yield indeterminate cytologic findings, 4 which include three subtypes: “atypia (or . . .