Thyroid nodule FNA, Bethesda cytology & molecular classifiers
Thyroid fine-needle aspiration takes a needle sample from a thyroid lump and grades it on a six-level scale; when the result is uncertain, a gene test on the same sample can often rule cancer out and avoid surgery.
Ultrasound-guided fine-needle aspiration reported by the Bethesda System (I-VI). Indeterminate categories (III-IV, ~20% of nodules) historically went to diagnostic lobectomy; molecular classifiers such as Afirma GSC (RNA expression, Veracyte) and ThyroSeq v3 (DNA/RNA NGS) have negative predictive values around 95-97%, halving unnecessary surgery. TI-RADS ultrasound scoring decides which nodules to biopsy at all.
How it works
Cytology is combined with gene-expression or mutation/fusion panels calibrated on surgical outcomes.
- Avoids surgery for most benign indeterminate nodules
- Detects BRAF, RET, RAS, TERT for risk and therapy planning
- Cost; positive predictive value is moderate
- Overdiagnosis of indolent microcarcinoma remains the systemic problem
Latest papers
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