Beyond the suspicious thyroid fine needle aspirate. A review.
Fine needle aspiration (FNA) is currently the best diagnostic tool for thyroid nodules. However, the cytologic category of indeterminate or suspicious lesion, which is found in 10-15% of cases, remains a challenge. Since neither clinical presentation nor intraoperative frozen section is often helpful in differentiating these lesions and since surgical procedures for benign and malignant lesions differ, there is a clear need to develop ancillary tests. In this review we identify 12 potential markers of thyroid malignancy that have been examined in thyroid cytologic samples. Although many of these markers hold promise as adjuncts to FNA cytology, multicenter studies have often shown limitations in the predictive value of these assays due to lack of specificity, sensitivity or both. The recent development, however, of tissue microarray techniques to validate promising new markers suggests that improvements in the approach to indeterminate thyroid FNA samples may soon be at hand. This review presents a summary of the issues facing the development of a clinically useful diagnostic test in the differential diagnosis of thyroid nodules.
Segev
Dorry L
DL
Departments of Surgery, Pathology and Oncology, Johns Hopkins Medical Institutions, 720 Rutland Avenue, Ross 756, Baltimore, Maryland 21205, USA.
Clark
Douglas P
DP
Zeiger
Martha A
MA
Umbricht
Christopher
C
D014408:Biomarkers, Tumor / Q000032:analysis* / Q000235:genetics; D001707:Biopsy, Needle; D020869:Gene Expression Profiling; D006801:Humans; D009363:Neoplasm Proteins / Q000032:analysis* / Q000235:genetics; D020411:Oligonucleotide Array Sequence Analysis; D013964:Thyroid Neoplasms / Q000737:chemistry / Q000175:diagnosis* / Q000473:pathology
D014408:Biomarkers, Tumor; D009363:Neoplasm Proteins