Preoperative diagnosis of benign thyroid nodules with intermediate cytology

Muhammad Ghanem, Yair Levy, Haggi Mazeh


Thyroid nodules are very common and are diagnosed in over 7% of the adult population. However, most thyroid nodules are benign and only 5% harbor malignancy. Therefore it is of utter importance to develop safe and accurate tools that distinguish between benign nodules and malignant ones. At present, fine needle aspiration biopsy (FNAB) is considered the gold standard diagnostic tool for thyroid nodules. Despite a specificity of over 95%, indeterminate FNAB results are obtained in 15-30% of the cases. Indeterminate FNAB results include follicular lesions of unknown significance (FLUS), follicular lesions or neoplasms (FL or FN), and suspicious for malignancy. These specific FNAB results carry a malignancy risk of 5-15%, 15-30%, and 60-75% respectively (1). Such indeterminate FNAB results face both the patient and the surgeon with a treatment dilemma and in most cases patients undergo diagnostic surgery even though the majority of the cases turn out to be benign. The development of new and more accurate preoperative diagnostic techniques in such cases can eliminate the need of unnecessary diagnostic surgery. This article is a research highlight of the new and developing diagnostic techniques for such lesions.