Changes are stirring in the management of thyroid cancers, from molecular testing to surveillance in select cases, and from nerve monitoring to the choice between total thyroidectomy over hemi-thyroidectomy for certain tumors. An expert panel reviewed the main points in a session at the Triological Society Combined Sections Meeting, held in Coronado, Calif., January 24–26, 2019.
Explore this issue:March 2019
Robert Witt, MD, professor of otolaryngology–head and neck surgery at Thomas Jefferson University in Philadelphia, said molecular tests are becoming increasingly important in the diagnosis and exclusion of thyroid
cancer. “We are, I believe, at the beginning of a renaissance in the management of thyroid disease,” he said. “And I think it’s spearheaded by molecular testing.”
There are four main commercial testing options: the Genetic Sequencing Classifier; ThyroSeqv3; ThyGenX & ThyraMIR; and RosettaGX Reveal. The value of the testing on indeterminate thyroid nodules (Bethesda Grade 3 or 4) stems from their ability either to improve accuracy of ruling in thyroid cancer, with positive predictive values that can cut down on the number of completion thyroidectomies, or to rule out thyroid cancer, with negative predictive values that can reduce unnecessary surgery on indeterminate thyroid nodules that would ultimately be found to be benign if they underwent operation.