Background
Thyroid fine-needle aspiration cytology (FNAC) is a high-performance diagnostic procedure used to assess the risk of malignancy and to determine the best management of thyroid nodules. Nevertheless, up to 30% of FNACs are still classified as “indeterminate.” Several studies have shown that molecular testing can improve the interpretation of indeterminate FNACs and can allow a more accurate cancer risk stratification of thyroid nodules, thereby reducing unnecessary surgery.
Methods
This is a retrospective study that assesses the utilization, diagnostic performance, and clinical impact of molecular testing on indeterminate FNACs in the management of patients at CHUV between July 1st, 2014 and December 31st, 2017. 142 patients were included in the study, 35 of whom (24.6%) had a molecular test.
Results
Surgery was performed in 12/35 (34.3%) patients of the molecular test group and in 73/107 (68.2%) patients of the non-molecular test group (p=0.0006). In the molecular test group, surgery was performed for 7/8 (87.5%) lesions with molecular alterations and for 5/27 (18.5%) lesions without molecular alterations (p= 0.0008).
Conclusion
The main conclusions of this study are that: (i) among patients with indeterminate FNAC results, molecular testing should only be used in selected cases; and (ii) when molecular testing is used, its results significantly influence the subsequent management of patients.