Malignancy Risk Stratification for Thyroid Nodules with Indeterminate Cytology

What is it about?

In this review article we summarize the current evidence on the use of clinical, radiological, cytological and molecular information to stratify the risk of malignancy of thyroid nodules with indeterminate cytology.

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Why is it important?

Thyroid nodules are very prevalent in the general population and can be detected in >50% of women over age 50 years. Most thyroid nodules are benign, but most thyroid cancers present as a thyroid nodule. We currently follow a linear diagnostic algorithm in which management relies mostly on the cytological diagnosis. Unfortunately, cytology is indeterminate (unable to tell whether the nodule is benign or cancer) 25% of the time. Most indeterminate thyroid nodules end up going to the operating room for diagnostic purposes which proofs necessary (due to cancer diagnosis upon resection) in 30% of the cases. Diagnostic surgery, however, was "unnecessary" for the other 70% of the nodules that turn out to be benign upon resection; and yet those patients are exposed to surgical risks and complications and often face the need for lifelong treatment with thyroid hormone. This review shows that we can refine the presurgical diagnosis of these nodules by integrating clinical information, sonographic features, cytological details, and molecular analysis with the potential to save thousands of "unnecessary" diagnostic surgeries each year around the world.

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