When managing thyroid nodules, physicians need to distinguish potentially malignant nodules from those with benign disease to limit unnecessary surgery. Fine-needle aspiration (FNA) can identify 80% of malignant nodules and 70% of benign nodules without having to perform diagnostic surgery, thus decreasing the need for surgery in patients with a low probability of cancer. However, the relatively low diagnostic yield of cytology results in up to 20% of nodule aspirates of indeterminate malignant risk.
Because the clinician and surgeon may be unable to determine malignancy preoperatively or intra-operatively, patients with indeterminate thyroid lesions on FNA cannot be optimally managed. Molecular markers help inform the malignant potential of thyroid nodules and thus serve as an important adjunct to FNA cytology. In this CME-certified activity, Dr. Nicole A. Massoll, Professor of Pathology and Director of Cytopathology at the University of Arkansas for Medical Sciences in Little Rock, discusses the role of microRNAs as biomarkers, illustrates how molecular testing can guide clinicians to make the most appropriate treatment recommendations for their patients, and reviews the sensitivity and specificity of commercially available molecular tests for indeterminate thyroid nodules.