MOLECULAR CLASSIFICATION OF CYTOLOGICALLY INDETERMINATE THYROID NODULES AND ITS EFFECT ON SURGICAL CASE VOLUME: A SYSTEMATIC REVIEW

AUTHORS:
K. Griffin (Galway, Ireland) , B. Al-Kendi (Galway, Ireland) , S.M. Abd Elwahab (Galway, Ireland) , A. Lowery (Galway, Ireland) , M.J. Kerin (Galway, Ireland)
Background:
With up to one-third of thyroid nodule aspirates returning a result of indeterminate cytology, molecular classification of these nodules is becoming increasingly popular. This review is the first that examines the literature available on the use of three commercially available molecular panels and their efficacy in reducing surgical case volume with avoidable diagnostic hemithyroidectomies.
Methods:
A computerised search of EMBASE, Pubmed and Cochrane databases was conducted. Original studies published between 2011 and 2023 that utilised Afirma (Veracyte), ThyroSeq (CBL PATH) or ThyGeNEXT/ThyraMIR (Interpace Diagnostics Group) molecular panels and had surgical histology and follow-up data available were reviewed.
Results:
The platforms analysed were successful in aiding differentiation of benign and malignant thyroid nodules after an indeterminate cytological result, aiding risk stratification and preventing unnecessary surgery.
Conclusions:
The relatively high sensitivity and benign call rate of molecular tests for nodules with low or intermediate risk of malignancy can aid in reducing diagnostic surgical resection. Nodules with indeterminate cytology but with suspicious features seen on ultrasound should proceed to surgery and the cost of molecular testing can be avoided. At present, molecular testing is best employed as a 'rule-out' test, used alongside our current practice of radiological investigation and clinical judgement.