Impact of oncogene panel results on surgical management of cytologically indeterminate thyroid nodules

• Published in: Head & neck 2018-08, Vol.40 (8), p.1812-1823
• Main Authors: Valderrabano, Pablo, Khazai, Laila, Thompson, Zachary J., Leon, Marino E., Otto, Kristen J., Hallanger‐Johnson, Julie E., Wadsworth, J. Trad, Chung, Christine H., Centeno, Barbara A., McIver, Bryan
• Format: Article
• Language: English
• Subjects: Adenoma - diagnosis; Adenoma - surgery; Biomarkers, Tumor - genetics; Biopsy; Biopsy, Fine-Needle; Carcinoma - diagnosis; Carcinoma - surgery; Cytology; Disease management; Female; Gene Expression Regulation, Neoplastic; Head and neck; Humans; Lymph nodes; Male; Malignancy; Middle Aged; molecular marker tests; Neck Dissection - statistics & numerical data; Nodules; noninvasive follicular thyroid neoplasm with papillary‐like nuclear features (NIFTP); Oncogenes; Oncogenes - genetics; Retrospective Studies; Sensory evaluation; Thyroid; Thyroid cancer; Thyroid gland; Thyroid Neoplasms - diagnosis; Thyroid Neoplasms - surgery; thyroid nodule; Thyroid Nodule - pathology; Thyroid Nodule - surgery; thyroid surgery; Thyroidectomy; Thyroidectomy - statistics & numerical data
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/hed.25165

Background The impact of oncogene panel results on the surgical management of indeterminate thyroid nodules (ITNs) is currently unknown. Methods Surgical management of 649 patients consecutively evaluated from October 2008 to April 2016 with a single nodule biopsied and indeterminate cytology (193 evaluated with and 456 without oncogene panels) was assessed and compared. Histological features of 629 consecutively resected ITNs (164 evaluated with and 465 without oncogene panels) were also characterized and compared. Results Oncogene panel evaluation was associated with higher rates of total thyroidectomy (45% vs 28%; P = .006), and central lymph node dissection (19% vs 12%; P = .03) without increasing the yield of malignancy or decreasing the rate of completion thyroidectomy. Most malignancies (64%), including 83% of those with driver mutation identified, were low‐risk cancers for which a lobectomy could have been sufficient initial treatment. Conclusion Current oncogene panel results seem insufficient to guide the surgical extent of solitary ITNs.