An update on management of cytologically indeterminate thyroid nodules

IF 2.9 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM
Malanie Roy , Cécile Ghander , Claude Bigorgne , Mathilde Brière , Gabrielle Deniziaut , François Ansart , Charlotte Lussey-Lepoutre , Camille Buffet
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Abstract

Thyroid nodules are common, but only 5–15% are cancerous. Fine-needle aspiration cytology is the gold-standard examination for determining the nature of a thyroid nodule, with results reported according to the Bethesda International Classification as updated in 2023. However, 20–30% of nodules are cytologically indeterminate. The challenge here is to avoid unnecessary diagnostic surgery, since 70% of these nodules are benign, although thyroid cancer remains a possibility. Nodule size, growth rate and ultrasonographic or elastographic characteristics can guide management, but have not been shown to have robust diagnostic performance. Thyroid scintigraphy with iodine-123, MIBI and 18F-FDG PET/CT have shown some usefulness, but their efficacy and cost–benefit ratio remain debatable. Artificial intelligence should help clarify the diagnosis of thyroid nodules, but these approaches have yet to be validated in routine clinical practice. Molecular tests performed during aspiration of a thyroid nodule, marketed mainly in the United States, offer robust prospects, as they show good negative predictive values to rule out malignancy when the test is negative, but their high cost limits widespread use in Europe. In France, the development of molecular tests for research purposes is being encouraged. In conclusion, although progress has been made, management of indeterminate thyroid nodules remains complex and relies on a medical decision shared with the patient, pending validation of new diagnostic tools.
细胞学上不确定的甲状腺结节治疗的最新进展。
甲状腺结节是常见的,但只有5-15%是癌性的。细针穿刺细胞学检查是确定甲状腺结节性质的金标准检查,其结果根据2023年更新的Bethesda国际分类报告。然而,20-30%的结节在细胞学上不确定。这里的挑战是避免不必要的诊断性手术,因为70%的结节是良性的,尽管甲状腺癌仍有可能。结节大小、生长速度和超声或弹性图特征可以指导治疗,但尚未显示出强大的诊断性能。碘-123甲状腺显像、MIBI和18F-FDG PET/CT显示出一定的有效性,但其疗效和成本效益比仍有争议。人工智能应该有助于明确甲状腺结节的诊断,但这些方法尚未在常规临床实践中得到验证。主要在美国销售的甲状腺结节抽吸过程中进行的分子检测具有良好的前景,因为当检测结果为阴性时,它们显示出良好的阴性预测值,可以排除恶性肿瘤,但其高昂的成本限制了其在欧洲的广泛应用。在法国,正在鼓励开发用于研究目的的分子测试。总之,尽管取得了进展,但不确定甲状腺结节的管理仍然很复杂,依赖于与患者共同的医疗决定,等待新的诊断工具的验证。
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来源期刊
Annales d'endocrinologie
Annales d'endocrinologie 医学-内分泌学与代谢
CiteScore
4.40
自引率
6.50%
发文量
311
审稿时长
50 days
期刊介绍: The Annales d''Endocrinologie, mouthpiece of the French Society of Endocrinology (SFE), publishes reviews, articles and case reports coming from clinical, therapeutic and fundamental research in endocrinology and metabolic diseases. Every year, it carries a position paper by a work-group of French-language endocrinologists, on an endocrine pathology chosen by the Society''s Scientific Committee. The journal is also the organ of the Society''s annual Congress, publishing a summary of the symposia, presentations and posters. "Les Must de l''Endocrinologie" is a special booklet brought out for the Congress, with summary articles that are always very well received. And finally, we publish the high-level instructional courses delivered during the Henri-Pierre Klotz International Endocrinology Days. The Annales is a window on the world, keeping alert clinicians up to date on what is going on in diagnosis and treatment in all the areas of our specialty.
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