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Thyroid Cancer pp 3–15Cite as

A Patient with a Single Thyroid Nodule Suspicious for Follicular Neoplasm According to the Bethesda System for Reporting Thyroid Cytopathology: Molecular Evaluation

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Abstract

The risk of malignancy for a nodule with a cytologic diagnosis of “suspicious for follicular neoplasm” is approximately 25 %, although there is significant variability among institutions. The standard of care has been diagnostic lobectomy followed by completion thyroidectomy if the nodule is malignant on histopathology, but most patients will undergo surgery for a nodule that is histologically benign. Molecular diagnostic tools, including several mutational panels and the Veracyte Afirma gene expression classifier (GEC), are potentially useful for improved risk stratification of nodules with indeterminate cytology. However, the application of molecular diagnostic tools is predicated upon the baseline risk of malignancy (i.e., the “pretest probability”). As this risk increases, the reported negative predictive value for a given test decreases and the positive predictive value increases. For this reason, the clinician must also consider sonographic features that are predictive of malignancy, as well as his or her institution-specific risk for malignancy after an indeterminate cytologic diagnosis in order to apply published findings.

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Authors and Affiliations

  1. Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, TRC Building 12th Floor, 3400 Civic Center Blvd., Philadelphia, PA, 19104, USA

    Katie B. Guttenberg MD & Susan J. Mandel MD, MPH

Authors
  1. Katie B. Guttenberg MD
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  2. Susan J. Mandel MD, MPH
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Correspondence to Susan J. Mandel MD, MPH .

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Editors and Affiliations

  1. Johns Hopkins University, Baltimore, Maryland, USA

    David S. Cooper

  2. Department of Internal Medicine, University of Rome, Rome, Roma, Italy

    Cosimo Durante

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Guttenberg, K.B., Mandel, S.J. (2016). A Patient with a Single Thyroid Nodule Suspicious for Follicular Neoplasm According to the Bethesda System for Reporting Thyroid Cytopathology: Molecular Evaluation. In: Cooper, D., Durante, C. (eds) Thyroid Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-22401-5_1

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  • DOI: https://doi.org/10.1007/978-3-319-22401-5_1

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-22400-8

  • Online ISBN: 978-3-319-22401-5

  • eBook Packages: MedicineMedicine (R0)

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