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Outcomes of Indeterminate Thyroid Nodules Managed Nonoperatively after Molecular Testing
Catherine Y Zhu1, Ines Donangelo2, Deepashree Gupta2
1Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
The Journal of Clinical Endocrinology and Metabolism
|January 4, 2021
Summary
Molecular testing for indeterminate thyroid nodules is useful, but a 6% false-negative rate necessitates ongoing ultrasound surveillance to detect delayed cancers. Long-term follow-up is crucial for managing these nodules.
Area of Science:
- Endocrinology
- Oncology
- Molecular Diagnostics
Background:
- Molecular testing is increasingly used for cytologically indeterminate thyroid nodules.
- Limited data exist on the long-term reliability of these tests and the rate of delayed surgeries.
Purpose of the Study:
- To determine the rate of delayed surgical resection in indeterminate thyroid nodules with benign/negative molecular test results.
- To assess the risk of false-negative molecular test results in this patient group.
Main Methods:
- Prospective follow-up of a randomized controlled trial comparing Afirma Gene Expression Classifier and ThyroSeq v2.
- Ultrasound surveillance was used for patients with indeterminate nodules (Bethesda III/IV) and negative molecular tests.
Main Results:
- Of 95 nodules with negative molecular tests, 87.4% pursued nonoperative management.
- During a median follow-up of 26.7 months, 10 nodules were resected, revealing malignancy in 4 (overall false-negative rate of 5.8%).
- Delayed surgeries were prompted by sonographic changes in malignant nodules.
Conclusions:
- Most indeterminate nodules with negative molecular tests show stability over 3 years.
- A 6% false-negative rate underscores the importance of continued sonographic surveillance.
- Further long-term studies are needed to establish optimal follow-up duration.
