Diagnostic utility of molecular and imaging biomarkers in cytological indeterminate thyroid nodules

Elizabeth J. de Koster*, Lioe Fee de Geus-Oei, Olaf M. Dekkers, Ilse van Engen-van Grunsven, Jaap Hamming, Eleonora P.M. Corssmit, Hans Morreau, Abbey Schepers, Jan Smit, Wim J.G. Oyen, Dennis Vriens

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

21 Citations (Scopus)
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Abstract

Indeterminate thyroid cytology (Bethesda III and IV) corresponds to follicular-patterned benign and malignant lesions, which are particularly difficult to differentiate on cytology alone. As ~25% of these nodules harbor malignancy, diagnostic hemithyroidectomy is still custom. However, advanced preoperative diagnostics are rapidly evolving. This review provides an overview of additional molecular and imaging diagnostics for indeterminate thyroid nodules in a preoperative clinical setting, including considerations regarding cost-effectiveness, availability, and feasibility of combining techniques. Addressed diagnostics include gene mutation analysis, microRNA, immunocytochemistry, ultrasonography, elastosonography, computed tomography, sestamibi scintigraphy, [18F]-2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET), and diffusion-weighted magnetic resonance imaging. The best rule-out tests for malignancy were the Afirma® gene expression classifier and FDG-PET. The most accurate rule-in test was sole BRAF mutation analysis. No diagnostic had both near-perfect sensitivity and specificity, and estimated cost-effectiveness. Molecular techniques are rapidly advancing. However, given the currently available techniques, a multimodality stepwise approach likely offers the most accurate diagnosis, sequentially applying one sensitive rule-out test and one specific rule-in test. Geographical variations in cytology (e.g., Hürthle cell neoplasms) and tumor genetics strongly influence local test performance and clinical utility. Multidisciplinary collaboration and implementation studies can aid the local decision for one or more eligible diagnostics.

Original languageEnglish
Pages (from-to)154-191
Number of pages38
JournalEndocrine Reviews
Volume39
Issue number2
DOIs
Publication statusPublished - 1 Apr 2018
Externally publishedYes

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