Diagnostic potential of ancillary molecular testing in differentiation of benign and malignant thyroid nodules.
Fine needle aspiration (FNA) cytology, being the mainstay to diagnose thyroid nodules, does not provide definitive results in a subset of patients. The use of molecular markers testing has been described as a useful aid in differentiation of thyroid nodules that present with an indeterminate cytodiagnosis. Molecular tests, such as the Afirma gene classifier, mutational assay and immunohistochemical markers have been increasingly used to further increase the accuracy and defer unnecessary surgeries for benign thyroid nodules. However, in light of the current literature, their emerging roles in clinical practice are limited due to financial and technical limitations. Nevertheless, their synergistic implementation can predict the risk of malignancy and yield an accurate diagnosis. This review discusses the clinical utility of various molecular tests done on FNA indeterminate nodules to avoid diagnostic thyroidectomies and warrant the need of future multi-Institutional studies.
Department of Surgery, Tulane University School of Medicine, New Orleans, LA, U.S.A.
Parisha
P
Bhatia
Department of Surgery, Tulane University School of Medicine, New Orleans, LA, U.S.A.
Ahmed
A
Deniwar
Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA, U.S.A.
Paul
P
Friedlander
Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA, U.S.A.
Rizwan
R
Aslam
Department of Surgery, Tulane University School of Medicine, New Orleans, LA, U.S.A. Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA, U.S.A. ekandil@tulane.edu.
Emad
E
Kandil
D000818:Animals; D044963:Biopsy, Fine-Needle; D003937:Diagnosis, Differential; D011905:Genes, ras; D006801:Humans; D007150:Immunohistochemistry; D009154:Mutation; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics; D016606:Thyroid Nodule / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology
C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf
Thyroid nodules; biological markers; cytodiagnosis; mutations; thyroid neoplasms