Determining Patient Preferences for Indeterminate Thyroid Nodules: Observation, Surgery or Molecular Tests

Area of Science:

• Endocrinology
• Oncology
• Genetics

Background:

• Indeterminate thyroid nodules pose diagnostic challenges.
• Gene-expression classifiers (GEC) and genetic mutation panels (GMP) aid preoperative evaluation.
• Patient preferences are crucial for optimal management strategies.

Purpose of the Study:

• To assess patient preferences for managing indeterminate thyroid nodules.
• To evaluate the impact of malignancy risk, cost, and test properties on patient choices.
• To understand how patient factors influence the adoption of molecular tests.

Main Methods:

• Two patient groups (n=50 each) evaluated hypothetical scenarios.
• Preferences for surgery, observation, and molecular tests (GEC, GMP) were assessed.
• Variables included malignancy risk, cost, and diagnostic accuracy.

Main Results:

• The threshold for surgery over observation was a 38.6% malignancy risk.
• 85% of patients chose molecular tests if free, vs. 51.7% at current cost (p < 0.001).
• Indeterminate FNA diagnosis, sex, and income predicted molecular test preference.

Conclusions:

• Patient preferences for thyroid nodule management depend on malignancy risk, prognosis, and cost.
• Molecular tests are preferred for indeterminate thyroid nodules, but cost is a significant barrier.
• Understanding patient preferences is key to integrating molecular testing into thyroid nodule management.