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• W2020429178 abstract "In Brief Objective: To test whether a clinical algorithm using routine cytological molecular testing (MT) promotes initial total thyroidectomy (TT) for clinically significant thyroid cancer (sTC) and/or correctly limits surgery to lobectomy when appropriate. Background: Either TT or lobectomy is often needed to diagnose differentiated thyroid cancer. Determining the correct extent of initial thyroidectomy is challenging. Methods: After implementing an algorithm for prospective MT of in-house fine-needle aspiration biopsy specimens, we conducted a single-institution cohort study of all patients (N = 671) with nonmalignant cytology who had thyroidectomy between October 2010 and March 2012, cytological diagnosis using 2008 Bethesda criteria, and 1 or more indications for thyroidectomy by 2009 American Thyroid Association guidelines. sTC was defined by histological differentiated thyroid cancer of 1 cm or more and/or lymph node metastasis. Cohort 2 patients did not have MT or had unevaluable results. In cohort 1, MT for a multigene mutation panel was performed for nonbenign cytology, and positive MT results indicated initial TT. Results: MT guidance was associated with a higher incidence of sTC after TT (P = 0.006) and a lower rate of sTC after lobectomy (P = 0.03). Without MT results, patients with indeterminate (follicular lesion of undetermined significance/follicular or oncocytic neoplasm) cytology who received initial lobectomy were 2.5 times more likely to require 2-stage surgery for histological sTC (P < 0.001). In the 501 patients with non-sTC for whom lobectomy was the appropriate extent of surgery, lobectomy was correctly performed more often with routine preoperative MT (P = 0.001). Conclusions: Fine-needle aspiration biopsy MT for BRAF, RAS, PAX8-PPARγ, and RET-PTC expedites optimal initial surgery for differentiated thyroid cancer, facilitating succinct definitive management for patients with thyroid nodules. Single-institution cohort study to determine whether prospective routine cytological molecular testing (MT) correctly guides the extent of initial thyroidectomy. MT guidance was associated with a higher incidence of initial total thyroidectomy for clinically significant thyroid cancer and limited surgery to lobectomy when indicated. Thus, MT optimizes surgery for patients with thyroid nodule." @default.
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• W2020429178 date "2014-07-01" @default.
• W2020429178 modified "2023-10-01" @default.
• W2020429178 title "A Clinical Algorithm for Fine-Needle Aspiration Molecular Testing Effectively Guides the Appropriate Extent of Initial Thyroidectomy" @default.
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• W2020429178 doi "https://doi.org/10.1097/sla.0000000000000215" @default.
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