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Development of a Nomogram to Integrate Molecular Testing and Clinical Variables to Improve Malignancy Risk Assessment
Jiahui Wu1, Paul Stewardson1, Markus Eszlinger1,2
1Cumming School of Medicine, and Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Canada.
Summary
Integrating molecular testing (MT) with clinical data significantly improves malignancy risk prediction for indeterminate thyroid nodules (ITNs). This combined approach aids in personalized treatment decisions, optimizing surgical intervention for thyroid nodules.
Area of Science:
- Endocrinology
- Oncology
- Pathology
Background:
- Molecular testing (MT) of indeterminate thyroid nodules (ITNs) alone has not reduced thyroidectomy rates.
- Clinical variables are crucial for improving malignancy risk prediction in ITNs.
Purpose of the Study:
- To evaluate the incremental diagnostic value of clinical variables combined with MT results for predicting malignancy risk in ITNs.
- To develop a nomogram for integrated risk assessment of ITNs.
Main Methods:
- Prospective observational study of 1024 ITNs undergoing ThyroSPEC MT.
- Multivariable logistic regression analysis incorporating nodule palpation, ultrasound risk, size, Bethesda category, atypia, and MT results.
- Development of a nomogram based on the regression model using 332 surgically confirmed cases.
Main Results:
- The integrated model achieved a cross-validated AUC of 0.831.
- High-risk mutations/markers, nodule size >5 cm, nuclear atypia, high ultrasound risk category, and palpation discovery significantly increased malignancy odds.
- Integrated risk of malignancy (ROM) correlated with surgical approach: lobectomy for low/intermediate ROM, total thyroidectomy for high ROM.
Conclusions:
- Integrating MT results with clinical variables enhances malignancy risk prediction for ITNs beyond MT alone.
- This integrated approach is vital for informed decision-making regarding surveillance versus surgery.
- Contextualizing MT within an interdisciplinary diagnostic pathway optimizes thyroid nodule management.
