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Molecular markers for the classification of cytologically indeterminate thyroid nodules

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Abstract

Background

The diagnosis of indeterminate lesions of the thyroid is a challenge in cytopathology practice. Indeed, up to 30% of cases lack the morphological features needed to provide definitive classification. Molecular tests have been developed to assist in the diagnosis of these indeterminate cases. The first studies dealing with the preoperative molecular evaluation of FNA samples focused on the analysis of BRAFV600E or on the combined evaluation of two or three genetic alterations. The sensitivity of molecular testing was then improved through the introduction of gene panels, which became available for clinical use in the late 2000s.

Two different categories of molecular tests have been developed, the ‘rule-out’ methods, which aim to reduce the avoidable treatment of benign nodules, and the ‘rule-in’ tests that have the purpose to optimize surgical management. The genetic evaluation of indeterminate thyroid nodules is predicted to improve patient care, particularly if molecular tests are used appropriately and with the awareness of their advantages and weaknesses. The main disadvantage of these tests is the cost, which makes them rarely used in Europe. To overcome this limitation, customized panels have been set up, which are able to detect the most frequent genetic alterations of thyroid cancer.

Conclusions

In the present review, the most recent available versions of commercial molecular tests and of custom, non-commercial panels are described. Their characteristics and accuracy in the differential diagnosis of indeterminate nodules, namely Bethesda classes III (Atypical follicular lesion of undetermined significance, AUS/FLUS) and IV (Suspicious for follicular neoplasm, FN/SFN) are fully analyzed and discussed.

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Funding

This work was partially supported by the Ricerca Finalizzata program of Italian Ministry of Health, Rome (code: RF 2013-02354985) and by the Ministero dell’Istruzione, dell’Università e della Ricerca (MIUR, Investigator Grant 2015, PRIN 2017YTWKWH).

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  1. Division of Endocrine and Metabolic Diseases, IRCCS IstitutoAuxologicoItaliano, 20149, Milan, Italy

    M. Muzza, C. Colombo, G. Pogliaghi & L. Fugazzola

  2. Department of Pathophysiology and Transplantation, University of Milan, P.le Brescia 20, 20149, Milano, Italy

    M. Muzza, C. Colombo, G. Pogliaghi & L. Fugazzola

  3. Department of Endocrinology, 401 Military Hospital, 11525, Athens, Greece

    O. Karapanou

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  2. C. Colombo
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Muzza, M., Colombo, C., Pogliaghi, G. et al. Molecular markers for the classification of cytologically indeterminate thyroid nodules. J Endocrinol Invest 43, 703–716 (2020). https://doi.org/10.1007/s40618-019-01164-w

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  • DOI: https://doi.org/10.1007/s40618-019-01164-w

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