Assessment of the risk of malignancy in Bethesda III thyroid nodules: a comprehensive review

Karthik Nagaraja Rao; Gregory W Randolph; Fernando Lopez; Mark Zafereo; Andrés Coca-Pelaz; Cesare Piazza; Prajwal Dange; Juan Pablo Rodrigo; Göran Stenman; Bart de Keizer; Iain Nixon; Shriyash Sinha; Sophie Leboulleux; Antti A Mäkitie; Abbas Agaimy; Lester Thompson; Alfio Ferlito; This paper was written by members and invitees of the International Head and Neck Scientific Group

doi:10.1007/s12020-024-03737-z

Assessment of the risk of malignancy in Bethesda III thyroid nodules: a comprehensive review

Endocrine. 2024 Feb 28. doi: 10.1007/s12020-024-03737-z. Online ahead of print.

Authors

Karthik Nagaraja Rao¹, Gregory W Randolph², Fernando Lopez³, Mark Zafereo⁴, Andrés Coca-Pelaz³, Cesare Piazza⁵, Prajwal Dange⁶, Juan Pablo Rodrigo³, Göran Stenman⁷, Bart de Keizer⁸, Iain Nixon⁹, Shriyash Sinha⁶, Sophie Leboulleux¹⁰, Antti A Mäkitie^{11

12}, Abbas Agaimy^{13

14}, Lester Thompson¹⁵, Alfio Ferlito¹⁶; This paper was written by members and invitees of the International Head and Neck Scientific Group

Affiliations

¹ Department of Head and Neck Oncology, Sri Shankara Cancer Hospital and Research Center, Bangalore, 560004, India. karthik.nag.rao@gmail.com.
² Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.
³ Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, 33011, Oviedo, Spain.
⁴ Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
⁵ Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy.
⁶ Department of Head and Neck Oncology, Sri Shankara Cancer Hospital and Research Center, Bangalore, 560004, India.
⁷ Sahlgrenska Center for Cancer Research Department of Pathology, University of Gothenburg, Gothenburg, Sweden.
⁸ Department of Nuclear Medicine and Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
⁹ Department of Surgery and Otolaryngology, Head and Neck Surgery, Edinburgh University, Edinburgh, EH3 9YL, UK.
¹⁰ Department of Endocrinology, Diabetology, Nutrition and Therapeutic Education, Geneva University Hospitals, Rue Gabrielle Perret Gentil, Geneva University, Geneva, Switzerland.
¹¹ Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
¹² Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland.
¹³ Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany.
¹⁴ Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054, Erlangen, Germany.
¹⁵ Head and Neck Pathology Consultations, Woodland Hills, CA, 91364, USA.
¹⁶ Coordinator of the International Head and Neck Scientific Group, Padua, Italy.

PMID: 38416380
DOI: 10.1007/s12020-024-03737-z

Abstract

The increasing prevalence of thyroid cancer emphasizes the need for a thorough assessment of risk of malignancy in Bethesda III nodules. Various methods ranging commercial platforms of molecular genetic testing (including Afirma® GEC, Afirma® GSC, ThyroSeq® V3, RosettaGX®, ThyGeNEXT®/ThyraMIR®, ThyroidPRINT®) to radionuclide scans and ultrasonography have been investigated to provide a more nuanced comprehension of risk estimation. The integration of molecular studies and imaging techniques into clinical practice may provide clinicians with improved and personalized risk assessment. This integrated approach we feel may enable clinicians to carefully tailor interventions, thereby minimizing the likelihood of unnecessary thyroid surgeries and overall crafting the optimal treatment. By aligning with the evolving landscape of personalized healthcare, this comprehensive strategy ensures a patient-centric approach to thyroid nodule and thyroid cancer management.

Keywords: Artificial intelligence; Bethesda system; Molecular testing; Risk assessment; Thyroid neoplasms.

Publication types

Review