Salvatore Sciacchitano
University Nicholas of Cusa for Research Medical and Scientific, Italy
Title: Which is the best test-method to increase accuracy in thyroid nodules classified as indeterminate at FNA cytology? A comparative analysis of diagnostic performance, feasibility and cost of several different test-methods
Biography
Biography: Salvatore Sciacchitano
Abstract
Since it is not possible to recognize malignancy at FNA cytology in thyroid indeterminate nodules, surgery is recommended for all of them, but cancer rate at the final histology is <30%. Many test-methods have been proposed for increasing the diagnostic accuracy in these lesions and new emerging molecular-based test-methods have been developed and commercialized. To allow a more cost-conscious clinical management of patients bearing such nodules, we compared technical features, feasibility, diagnostic performance and cost of the following test-methods: Galectin-3-ICC, FDG-PET/CT, GEC alone and GEC + BRAF, thyroid cancer mutation/fusion panel, alone and plus miRNA GEC, thyroid cancer mutation/fusion panel by NGS and TSHR mRNA blood assay. FDG-PET/CT was the best rule-out (sensitivity 95%) and TSH mRNA blood assay the best rule-in (specificity 96%) test-method, with some bias for the latter. Mutation/fusion panel by NGS showed the highest accuracy (92%) and diagnostic odds ratio (DOR=121). Mutation/fusion panel alone and plus miRNA GEC as well as TSHR mRNA blood assay showed very high DOR. Galectin-3-ICC approached the best performances both as a rule-out (sensitivity 83%) and rule-in (specificity 88%) test-method, with a good accuracy (87%) and DOR (38). Galectin-3-ICC is by far the cheapest one and it is the easiest one to be performed in different clinical settings. In conclusion, at this moment, the more accurate molecular-based test-methods are still very expensive and are restricted to few, highly specialized Centers. Galectin-3-ICC represents the most suitable screening test-method for indeterminate thyroid nodules and deserves a central place in the diagnostic algorithm of indeterminate thyroid lesions.