Skip to main content

Preoperative Molecular Testing for Indeterminate Thyroid Nodules

  • Chapter
  • First Online:
Controversies in Thyroid Nodules and Differentiated Thyroid Cancer

Abstract

Molecular testing has emerged as a valuable tool in the preoperative evaluation of cytologically indeterminate thyroid nodules. The addition of molecular testing to Bethesda III and IV thyroid FNAs has resulted in an overall decrease in diagnostic lobectomies/thyroidectomies. However, molecular testing is not indicated in all patients. This chapter highlights the clinical considerations when determining the appropriate usage of molecular testing in cytologically indeterminate thyroid nodules and currently available tests.

C Davis, N Addasi are co-first authors

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1–133.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology. 2011;260(3):892–9.

    Article  PubMed  Google Scholar 

  3. San Martin VT, Lawrence L, Bena J, Madhun NZ, Berber E, Elsheikh TM, et al. Real-world comparison of Afirma GEC and GSC for the assessment of cytologically indeterminate thyroid nodules. J Clin Endocrinol Metabol. 2020;105(3):e428–e35.

    Article  Google Scholar 

  4. Khan TM, Zeiger MA. Thyroid nodule molecular testing: is it ready for prime time? Front Endocrinol. 2020;11:590128.

    Article  Google Scholar 

  5. Livhits MJ, Zhu CY, Kuo EJ, Nguyen DT, Kim J, Tseng CH, et al. Effectiveness of molecular testing techniques for diagnosis of indeterminate thyroid nodules: A randomized clinical trial. JAMA Oncol. 2021;7(1):70–7. https://doi.org/10.1001/jamaoncol.2020.5935. PMID: 33300952; PMCID: PMC7729582.

  6. Hao Y, Choi Y, Babiarz JE, Kloos RT, Kennedy GC, Huang J, et al. Analytical verification performance of afirma genomic sequencing classifier in the diagnosis of cytologically indeterminate thyroid nodules. Front Endocrinol. 2019;10:438.

    Article  Google Scholar 

  7. Patel KN, Angell TE, Babiarz J, Barth NM, Blevins T, Duh Q-Y, et al. Performance of a genomic sequencing classifier for the preoperative diagnosis of cytologically indeterminate thyroid nodules. JAMA Surg. 2018;153(9):817–24.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Krasner JR, Alyouha N, Pusztaszeri M, Forest V-I, Hier MP, Avior G, et al. Molecular mutations as a possible factor for determining extent of thyroid surgery. J Otolaryngol Head Neck Surg. 2019;48(1):51.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Endo M, Nabhan F, Porter K, Roll K, Shirley LA, Azaryan I, et al. Afirma gene sequencing classifier compared with gene expression classifier in indeterminate thyroid nodules. Thyroid. 2019;29(8):1115–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Haddad RI. NCCN clinical practice guidelines in oncology (NCCN guidelines): thyroid carcinoma. NCCN. 2020.

    Google Scholar 

  11. Ahmadi S, Herbst R, Oyekunle T, Jiang XS, Strickland K, Roman S, et al. Using the ATA and ACR TI-RADS sonographic classifications as adjunctive predictors of malignancy for indeterminate thyroid nodules. Endocr Pract. 2019;25(9):908–17.

    Article  PubMed  Google Scholar 

  12. Ohori NP, Landau MS, Manroa P, Schoedel KE, Seethala RR. Molecular-derived estimation of risk of malignancy for indeterminate thyroid cytology diagnoses. J Am Soc Cytopathol. 2020;9(4):213–20.

    Article  PubMed  Google Scholar 

  13. Angell TE, Heller HT, Cibas ES, Barletta JA, Kim MI, Krane JF, et al. Independent comparison of the Afirma genomic sequencing classifier and gene expression classifier for cytologically indeterminate thyroid nodules. Thyroid. 2019;29(5):650–6.

    Article  CAS  PubMed  Google Scholar 

  14. Nikiforova MN, Mercurio S, Wald AI, Barbi de Moura M, Callenberg K, Santana-Santos L, et al. Analytical performance of the ThyroSeq v3 genomic classifier for cancer diagnosis in thyroid nodules. Cancer. 2018;124(8):1682–90.

    Article  CAS  PubMed  Google Scholar 

  15. Cibas ES, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid. 2017;27(11):1341–6.

    Article  PubMed  Google Scholar 

  16. Steward DL, Carty SE, Sippel RS, Yang SP, Sosa JA, Sipos JA, et al. Performance of a multigene genomic classifier in thyroid nodules with indeterminate cytology: a prospective blinded multicenter study. JAMA Oncol. 2019;5(2):204–12.

    Article  PubMed  Google Scholar 

  17. Nikiforova MN, Lepe M, Tolino LA, Miller ME, Ohori NP, Wald AI, et al. Thyroid cytology smear slides: an untapped resource for ThyroSeq testing. Cancer Cytopathol. 2021;129(1):33–42.

    Article  CAS  PubMed  Google Scholar 

  18. Addasi N, Fingeret A, Goldner W. Hemithyroidectomy for thyroid cancer: a review. Medicina. 2020;56(11):586.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Chen Y, Sadow PM, Suh H, Lee KE, Choi JY, Suh YJ, et al. BRAFV600E is correlated with recurrence of papillary thyroid microcarcinoma: a systematic review, multi-institutional primary data analysis, and meta-analysis. Thyroid. 2016;26(2):248–55.

    Article  CAS  PubMed  Google Scholar 

  20. Trybek T, Walczyk A, Gąsior-Perczak D, Pałyga I, Mikina E, Kowalik A, et al. Impact of BRAF V600E and TERT promoter mutations on response to therapy in papillary thyroid cancer. Endocrinology. 2019;160(10):2328–38.

    Article  CAS  PubMed  Google Scholar 

  21. Moon S, Song YS, Kim YA, Lim JA, Cho SW, Moon JH, et al. Effects of coexistent BRAFV600E and TERT promoter mutations on poor clinical outcomes in papillary thyroid cancer: a meta-analysis. Thyroid. 2017;27(5):651–60.

    Article  CAS  PubMed  Google Scholar 

  22. Chin PD, Zhu CY, Sajed DP, Fishbein GA, Yeh MW, Leung AM, et al. Correlation of ThyroSeq results with surgical histopathology in cytologically indeterminate thyroid nodules. Endocr Pathol. 2020;31(4):377–84.

    Article  CAS  PubMed  Google Scholar 

  23. Angell TE, Wirth LJ, Cabanillas ME, Shindo ML, Cibas ES, Babiarz JE, et al. Analytical and clinical validation of expressed variants and fusions from the whole transcriptome of thyroid FNA samples. Front Endocrinol. 2019;10:612.

    Article  Google Scholar 

  24. Krane JF, Cibas ES, Endo M, Marqusee E, Hu MI, Nasr CE, et al. The Afirma Xpression atlas for thyroid nodules and thyroid cancer metastases: insights to inform clinical decision-making from a fine-needle aspiration sample. Cancer Cytopathol. 2020;128(7):452–9.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Nicholson KJ, Roberts MS, McCoy KL, Carty SE, Yip L. Molecular testing versus diagnostic lobectomy in Bethesda III/IV thyroid nodules: a cost-effectiveness analysis. Thyroid. 2019;29(9):1237–43.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Lin JF, Jonker PK, Cunich M, Sidhu SB, Delbridge LW, Glover AR, et al. Surgery alone for papillary thyroid microcarcinoma is less costly and more effective than long term active surveillance. Surgery. 2020;167(1):110–6.

    Article  PubMed  Google Scholar 

  27. Zhu CY, Donangelo I, Gupta D, Nguyen DT, Ochoa JE, Yeh MW, et al. Outcomes of indeterminate thyroid nodules managed nonoperatively after molecular testing. J Clin Endocrinol Metabol. 2021;106(3):e1240–e7.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Whitney S. Goldner .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Davis, C., Addasi, N., Goldner, W.S. (2023). Preoperative Molecular Testing for Indeterminate Thyroid Nodules. In: Roman, S.A., Shen, W.T., Sosa, J.A. (eds) Controversies in Thyroid Nodules and Differentiated Thyroid Cancer. Springer, Cham. https://doi.org/10.1007/978-3-031-37135-6_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-37135-6_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-37134-9

  • Online ISBN: 978-3-031-37135-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics