Molecular Testing for Thyroid Nodules Recommended as Adjunct to Fine Needle Aspiration

Dr. Yip agreed that the Ladenson et. al cost analysis has some flaws. “To not do surgery based on the Veracyte NPV of 95 percent means that you will miss cancer 5 percent of the time, ” she said. “According to their clinical model, if their test is negative, patients are not followed up at all. In their cost model, they do not address the health, emotional, and legal impact of a missed cancer.”

But such debates should not overshadow the fact that when used in the right patients—that is, in the correct clinical-radiologic context, in conjunction with pre-operative cytomorphology—molecular testing for selected mutations “can serve as an effective quality control tool for the cytopathologist, allowing a valid diagnosis to be made on indeterminate morphology, often with scanty [thyroid nodule] material.”

In doing so, Dr. Theoharis added, these molecular tests “help further the growing field of personalized medicine,” in which a patient’s genetic makeup can help clinicians choose optimal therapy.

Disclosures: Dr. Haugen disclosed that he has received research support from Veracyte through his university but no direct salary support from the company. Dr. Ladenson disclosed that he is a consultant to and received past research support from Veracyte. Drs. Theoharis, Nikiforov and Yip had no relevant financial relationships to disclose.