Decision Making in Indeterminate Thyroid Nodules and the Role of Molecular Testing

Mitchell, Joshua R.; Yip, Linwah

doi:10.1016/j.suc.2019.04.002

Cited by 11 publications

(5 citation statements)

References 68 publications

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“…A recent meta-analysis comparing various molecular tests estimated that up to 85% of surgeries for indeterminate nodules could be avoided with negative molecular testing results. 8 , 9 For example, a multicenter cross-sectional cohort survey found a decline in surgical resection rates from 74% to 7.6% for indeterminate nodules after implementing molecular testing for 6 months. 10 Despite these possible advantages, molecular testing is costly and not covered by universal health care insurance in many jurisdictions.…”

Section: Discussionmentioning

confidence: 99%

“…How molecular testing can be best integrated into routine clinical practice is an active area of interest. A recent meta‐analysis comparing various molecular tests estimated that up to 85% of surgeries for indeterminate nodules could be avoided with negative molecular testing results 8,9 . For example, a multicenter cross‐sectional cohort survey found a decline in surgical resection rates from 74% to 7.6% for indeterminate nodules after implementing molecular testing for 6 months 10 .…”

Section: Discussionmentioning

confidence: 99%

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Treatment Choices in Managing Bethesda III and IV Thyroid Nodules: A Canadian Multi‐institutional Study

et al. 2021

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Objective Patient-centered decision making is increasingly identified as a desirable component of medical care. To manage indeterminate thyroid nodules, patients are offered the options of surveillance, diagnostic hemithyroidectomy, or molecular testing. Our objective was to identify factors associated with decision making in this population. Study Design This is a retrospective cross-sectional study of patients with Bethesda III and IV thyroid nodules. Setting Multi-institutional. Methods Factors of interest included age, sex, socioeconomic status (SES), nodule size, institution, attending surgeon, surgeon payment model, and hospital type. Our outcome of interest was the initial management decision made by patients. Results A total of 956 patients were included. The majority of patients had Bethesda III nodules (n = 738, 77%). A total of 538 (56%) patients chose surgery, 413 (43%) chose surveillance, and 5 (1%) chose molecular testing. There was a significant variation in management decision based on attending surgeon (proportion of patients choosing surgery: 15%-83%; P≤.0001). Fee-for-service surgeon payment models (odds ratio [OR], 1.657; 95% CI, 1.263-2.175; P < .001) and community hospital settings (OR, 1.529; 95% CI, 1.145-2.042; P < .001) were associated with the decision for surgery. Larger nodule size, younger patients, and Bethesda IV nodules were also associated with surgery. Conclusion While it seems appropriate that larger nodules, younger age, and higher Bethesda class were associated with decision for surgery, we also identified attending surgeon, surgeon payment model, and hospital type as important factors. Given this, standardizing management discussions may improve patient-centered shared decision making.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Treatment Choices in Managing Bethesda III and IV Thyroid Nodules: A Canadian Multi‐institutional Study

et al. 2021

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“…Advancements in molecular testing of fine-needle aspiration biopsies have improved preoperative diagnostic accuracy and prognostication. For indeterminate nodules, such testing ideally will reduce the need for surgery for benign nodules and potentially guide appropriate extent of initial surgery for malignancy [21].…”

Section: Thyroid Imaging Reporting and Data System (Tirads) Classificationmentioning

confidence: 99%

Діагностика, Клінічне Значення Та Лікування Вузлів Щитоподібної Залози

Korsak¹,

Nykytiuk²

2021

Mìžnarodnij endokrinologìčnij žurnal

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A thyroid nodule is a discrete lesion within the thyroid gland that is radiologically distinct from the surrounding thyroid parenchyma. Thyroid nodules are prevalent in up to 68 % of randomly selected individuals in whom high resolution ultrasound is performed. The majority of nodules are benign. Thyroid nodules are the clinical manifestation of a myriad of pathologic processes. The use of ultrasound has dramatically reduced the number of patients who undergo surgery for nodules. Several risk scoring systems have been developed which aim to reduce interobserver variability and allow clinicians to make decisions regarding further workup and follow-up. The most useful of these is the Thyroid Imaging Reporting and Data System (TIRADS) classification. The six tier Bethesda scoring system has reduced variability and increased the ability to clinicians to guide patients with thyroid nodules. There is good correlation between cytology and histopathologic outcomes. A significant proportion of patients will however fall into an indeterminate category. The American Thyroid Association uses a different system based on an estimated risk of malignancy from centers that deal with a high volume of patients with thyroid nodules and malignancy. The availability of molecular markers enhanced with next generation sequencing technology and the expression classifier are added diagnostic aids that can help in management. However, these are not available in many countries and in resource limited settings. A pragmatic approach to the diagnosis of indeterminate nodules includes utilizing pre- and posttest probability, clinical acumen, correlation of ultrasound findings and expert opinion in some settings. Using this approach high risk patients can be appropriately chosen for surgery while relegating patients with lower risk to watchful follow-up.

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“…Hipoekoik ve düzensiz sınırları olan nodüller, hipoekoik ve derinliği genişliğinden fazla olan nodüller, mikrokalsifikasyon içeren hipoekoik ve düzensiz sınırlı nodüller, düzensiz sınırlarla beraber şüpheli lateral servikal lenf nodu varlığı ve hipoekoik, düzensiz sınırlı, tiroid dışı yayılım gösteren nodüller yüksek şüpheli grupta yer alır (1). (35).…”

Section: Bi̇yopsi̇ Ve Tedavi̇ Yaklaşimiunclassified

Tiroid Nodülü

Kara¹,

Yıldız²

2020

Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Dergisi

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Thyroid nodule refers to lesions originating from follicular cells and radiologically differentiated from thyroid parenchyma. It is more common in women and its frequency increases with age. In Ultrasonography (USG) scans, nodules are detected in 20-67% in thyroid. Carcinoma develops from 7-15% of thyroid nodules. TSH should be seen from patients with thyroid nodules and thyroid USG should be requested. FNA should be requested from patients according to thyroid USG features. Thyroid FNA results are evaluated according to the Bethesda classification. Treatment for nodule is planned according to Fine needle Aspiration biopsy (FNAB) results, clinical features of the patient, USG findings and molecular tests. In this article, the approach to thyroid nodule is discussed with current literature.

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Decision Making in Indeterminate Thyroid Nodules and the Role of Molecular Testing

Cited by 11 publications

References 68 publications

Treatment Choices in Managing Bethesda III and IV Thyroid Nodules: A Canadian Multi‐institutional Study

Treatment Choices in Managing Bethesda III and IV Thyroid Nodules: A Canadian Multi‐institutional Study

Діагностика, Клінічне Значення Та Лікування Вузлів Щитоподібної Залози

Tiroid Nodülü

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