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Molecular Testing for Bethesda III Thyroid Nodules: Trends in Implementation, Cytopathology Call Rates, Surgery
Mason D Stillman1, Eric J Kuo1, Rachel Liou1
1Division of GI/Endocrine Surgery, Columbia University Irving Medical Center, New York, New York, USA.
Summary
Molecular testing (MT) for indeterminate thyroid lesions (Bethesda III) is widely adopted. While MT use increased, it led to more surgeries for benign nodules and a decreased positive predictive value.
Area of Science:
- Endocrinology
- Oncology
- Cytopathology
Background:
- Molecular testing (MT) is standard for indeterminate thyroid lesions (Bethesda III) to rule out malignancy.
- Assessing MT adoption and its impact on clinical outcomes is crucial for thyroid nodule management.
Purpose of the Study:
- To evaluate the adoption of molecular testing in thyroid fine-needle aspirations (FNAs).
- To assess the impact of MT on Bethesda III call rates, malignancy yield, and surgery rates.
- To compare outcomes between community and academic sites before and after MT availability.
Main Methods:
- Retrospective cross-sectional study of 8960 FNAs from 2017-2021.
- Analysis of MT utilization trends by platform and site.
- Comparison of BIII rates, MT use, surgery rates, and malignancy yield using chi-square and regression analysis.
Main Results:
- Broad adoption of MT across community and academic sites was observed.
- Significant increases in Bethesda III rates and MT utilization occurred post-MT availability (p<0.001).
- Malignancy yield remained unchanged (57.1% vs. 50.0%), but MT's positive predictive value decreased from 85% to 50% (p=0.008).
Conclusions:
- Increased MT availability, particularly with dedicated passes, correlated with higher BIII rates and MT utilization.
- Potential unintended consequences include increased surgeries for benign nodules.
- Clinicians must be aware of MT's limitations and counsel patients appropriately regarding its use and outcomes.
