Cytopathology

Biography

Biography: Marino E. Leon

Abstract

The rapid translation into the clinical field of new discoveries in the molecular basis of thyroid cancer has led to the development of several molecular tests that address the deficiencies of thyroid cytopathology. Despite lack of adequate, validated, independently performed clinical studies, several molecular tests are commercially available on the market and are being used on indeterminate thyroid nodules to guide patient-care decisions. This presentation will discuss and summarize the current evidence on the role and limitations of molecular tests used in combination with thyroid cytopathology to refine the pre-surgical diagnosis of thyroid nodules. The presentation will address the fact that the clinical performance of molecular tests depends on the pretest risk of malignancy within the specific cytological group being assessed. This risk is variable and should be assessed at each institution to optimize the selection of the molecular test and the interpretation of its results. The use of Next-generation sequencing (NGS) will be discussed; NGS has increased the sensitivity of oncogene panels while maintaining high specificity. Tests assessing the gene expression pattern have shown promising results, with high sensitivity but low specificity. The impact of the molecular markers on clinical practice remains in flux and their effect on health care costs remains poorly understood. Further large, independent, confirmatory, clinical validation studies and real-world, cost-effec¬tiveness studies are necessary before the widespread adoption of these tests can be endorsed as standard of care.