Indeterminate Single Thyroid Nodule: Synergistic Impact of Mutational Markers and Sonographic Features in Triaging Patients to Appropriate Surgery

• DOI: 10.1089/thy.2015.0311
• Publication Date: 2015-11-09T01:08:11Z
• Authors: Luigi De Napoli; Sohail Bakkar; Carlo Enrico Ambr...; Gabriele Materazzi; Agnese Proietti; Elisabetta Macerola; Fulvio Basolo; Paolo Miccoli
• Keywords: Indeterminate; Thyroid Nodules; Nodule (geology)

Patients labeled as having indeterminate thyroid nodular disease following fine-needle aspiration cytology are at risk of non-optimal initial surgery: an overly radical total thyroidectomy, or unnecessary two-stage operation. The objective this study was to assess the impact combining mutational markers and ultrasonographic (US) features preoperatively on predicting malignancy in patients with nodules, thereby offering them a tailored surgical intervention.The records 258 who underwent conventional thyroidectomy for single nodules reported suspicious follicular neoplasm (Bethesda category IV) four-year period were reviewed. Main issues addressed included: certain US findings (individually combination), (BRAF NRAS), combinations both. Correlation these assessed, their ability predict malignancy. usefulness absence sonographic also evaluated.Among diagnosis, only 90 lesions found be malignant. that correlated significantly irregular margins, microcalcifications, "taller than wide" shape. presence margins feature highest positive predictive value. Combinations two more always associated predictivity excess 90%, times 100%. NRAS mutation most common gene alteration. Both BRAF mutations mutually exclusive Their high, particularly when combined (100%). major limitation both and/or low occurrence proved extremely useful tailoring strategy, it could have ultimately spared 143/258 (55%) thyroidectomy.The preoperative utility combination has synergistic impact. It can high accuracy, properly triaging appropriate surgery.