Contemporary diagnostic approach to the thyroid nodule.
Thyroid nodules are common, with an estimated incidence of 5%-10% in the United States. The current gold standard for diagnosis is fine needle aspiration biopsy (FNAB). The incidence of indeterminate diagnoses varies from 10% to 25%. Surgical resection is usually indicated to exclude the diagnosis of cancer in these patients. However, only a minority (about 20%) of indeterminate thyroid nodules actually harbor a malignancy, resulting in surgery for diagnostic purposes alone in many patients. The increased detection of benign nodules and microcarcinomas reinforces the need for improved non-operative methods to differentiate benign from malignant disease and discriminate low-risk from high-risk cancers. In this article we present a current, rational diagnostic approach to the patient with a thyroid nodule, evaluate new advances including thyroid genomic and predictor models, and propose the development of prospective trials to incorporate these new additions into clinical decision making. Given how many questions still exist for patients with thyroid nodules, partnership and collaboration, or the "bench to bedside" concept should find its way into most every thyroid surgeon and endocrinologist's lexicon.
Rosen
Jennifer E
JE
Department of Surgery, Section of Surgical Oncology, Boston University School of Medicine, 88 East Newton Street D605, Boston, MA 02118, USA. Jennifer.Rosen@bmc.org
Stone
Michael D
MD
D000465:Algorithms; D044963:Biopsy, Fine-Needle / Q000379:methods; D001707:Biopsy, Needle; D003937:Diagnosis, Differential; D023281:Genomics / Q000379:methods; D006044:Goiter, Nodular / Q000473:pathology; D006801:Humans; D007457:Iodine Radioisotopes; D008487:Medical History Taking; D051096:Proto-Oncogene Proteins c-ret / Q000235:genetics; D013670:Sodium Pertechnetate Tc 99m; D013961:Thyroid Gland / Q000473:pathology* / Q000503:physiopathology; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000473:pathology; D016606:Thyroid Nodule / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D013972:Thyrotropin / Q000097:blood; D014463:Ultrasonography
D007457:Iodine Radioisotopes; D013972:Thyrotropin; D013670:Sodium Pertechnetate Tc 99m; D051096:Proto-Oncogene Proteins c-ret; C099282:RET protein, human