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Beyond the suspicious thyroid fine needle aspirate. A review
Dorry L Segev1, Douglas P Clark, Martha A Zeiger
1Departments of Surgery, Pathology and Oncology, Johns Hopkins Medical Institutions, 720 Rutland Avenue, Ross 756, Baltimore, Maryland 21205, USA.
Acta Cytologica
|October 7, 2003
Summary
Diagnosing indeterminate thyroid nodules with fine needle aspiration (FNA) is challenging. New molecular markers and tissue microarray techniques show promise for improving diagnostic accuracy in thyroid cancer evaluation.
Area of Science:
- Endocrinology
- Oncology
- Cytopathology
Background:
- Fine needle aspiration (FNA) is the primary diagnostic method for thyroid nodules.
- A significant challenge arises from indeterminate or suspicious cytologic categories (10-15% of cases).
- Clinical presentation and intraoperative frozen sections often fail to differentiate benign from malignant lesions, necessitating improved diagnostic tools.
Purpose of the Study:
- To review potential molecular markers for thyroid malignancy in FNA samples.
- To summarize challenges in developing clinically useful diagnostic tests for indeterminate thyroid nodules.
- To explore advancements like tissue microarray techniques for marker validation.
Main Methods:
- Literature review identifying 12 potential markers for thyroid malignancy.
- Analysis of multicenter studies evaluating the predictive value of these markers.
- Discussion of emerging techniques, including tissue microarrays, for marker validation.
Main Results:
- Numerous potential markers show promise as adjuncts to FNA cytology.
- Multicenter studies reveal limitations in marker specificity and sensitivity, impacting predictive value.
- Tissue microarray techniques offer a promising approach for validating new diagnostic markers.
Conclusions:
- Accurate diagnosis of indeterminate thyroid nodules remains a clinical challenge.
- While several markers show potential, limitations in current assays necessitate further research.
- Advancements in validation techniques may soon lead to improved diagnostic strategies for thyroid nodules.