title: American Thyroid Association Statement on Surgical Application of Molecular Profiling for Thyroid Nodules: Current Impact on Perioperative Decision Making.
abstract: BACKGROUND
  Recent advances in research on thyroid carcinogenesis have yielded applications of diagnostic molecular biomarkers and profiling panels in the management of thyroid nodules. The specific utility of these novel, clinically available molecular tests is becoming widely appreciated, especially in perioperative decision making by the surgeon regarding the need for surgery and the extent of initial resection.
  
  
  METHODS
  A task force was convened by the Surgical Affairs Committee of the American Thyroid Association and was charged with writing this article.
  
  
  CONCLUSIONS
  This review covers the clinical scenarios by cytologic category for which the thyroid surgeon may find molecular profiling results useful, particularly for cases with indeterminate fine-needle aspiration cytology. Distinct strengths of each ancillary test are highlighted to convey the current status of this evolving field, which has already demonstrated the potential to streamline decision making and reduce unnecessary surgery, with the accompanying benefits. However, the performance of any diagnostic test, that is, its positive predictive value and negative predictive value, are exquisitely influenced by the prevalence of cancer in that cytologic category, which is known to vary widely at different medical centers. Thus, it is crucial for the clinician to know the prevalence of malignancy within each indeterminate cytologic category, at one's own institution. Without this information, the performance of the diagnostic tests discussed below may vary substantially.
authors.affiliation: 1 Division of Head and Neck Surgery, Department of Otolaryngology, University of Pittsburgh Cancer Institute , Pittsburgh, Pennsylvania.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Ferris
authors.affiliation: 2 Department of Pathology, University of Pennsylvania Medical Center , Philadelphia, Pennsylvania.
authors.forename: Zubair
authors.initials: Z
authors.lastname: Baloch
authors.affiliation: 3 Department of Endocrinology, Mayo Clinic , Jacksonville, Florida.
authors.forename: Victor
authors.initials: V
authors.lastname: Bernet
authors.affiliation: 4 Department of Otolaryngology/Head and Neck Surgery, Emory University , Atlanta, Georgia .
authors.forename: Amy
authors.initials: A
authors.lastname: Chen
authors.affiliation: 5 Department of Surgery, New York Presbyterian Hospital , New York, New York.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Fahey
authors.affiliation: 6 Head and Neck Service, Memorial Sloan-Kettering Cancer Center , New York, New York.
authors.forename: Ian
authors.initials: I
authors.lastname: Ganly
authors.affiliation: 7 Division of Endocrinology, New York University Medical Center , New York, New York.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Hodak
authors.affiliation: 8 Endocrine Oncology Branch, Center for Cancer Research, National Cancer Institute , Bethesda, Maryland.
authors.forename: Electron
authors.initials: E
authors.lastname: Kebebew
authors.affiliation: 9 Division of Endocrine Surgery, New York University Medical Center , New York, New York.
authors.forename: Kepal N
authors.initials: KN
authors.lastname: Patel
authors.affiliation: 6 Head and Neck Service, Memorial Sloan-Kettering Cancer Center , New York, New York.
authors.forename: Ashok
authors.initials: A
authors.lastname: Shaha
authors.affiliation: 10 Department of Otolaryngology/Head and Neck Surgery, University of Cincinnati Medical Center , Cincinnati, Ohio.
authors.forename: David L
authors.initials: DL
authors.lastname: Steward
authors.affiliation: 11 Department of Otolaryngology/Head and Neck Surgery, Johns Hopkins University , Baltimore, Maryland.
authors.forename: Ralph P
authors.initials: RP
authors.lastname: Tufano
authors.affiliation: 12 Department of Surgery, Division of General Surgery, St. Paul's Hospital and University of British Columbia , Vancouver, Canada .
authors.forename: Sam M
authors.initials: SM
authors.lastname: Wiseman
authors.affiliation: 13 Division of Endocrine Surgery, Department of Surgery, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania.
authors.forename: Sally E
authors.initials: SE
authors.lastname: Carty
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000235:genetics* / Q000473:pathology / Q000601:surgery; D018249:Adenoma, Oxyphilic; D044963:Biopsy, Fine-Needle; D002277:Carcinoma / Q000235:genetics* / Q000473:pathology / Q000601:surgery; D002291:Carcinoma, Papillary; D000066491:Clinical Decision-Making; D059014:High-Throughput Nucleotide Sequencing; D006801:Humans; D059035:Perioperative Period; D011237:Predictive Value of Tests; D012955:Societies, Medical; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000235:genetics* / Q000473:pathology / Q000601:surgery; D016606:Thyroid Nodule / Q000235:genetics* / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy; D014481:United States