Nodular Thyroid Disease in the Era of Precision Medicine

Dario Tumino, Giorgio Grani, Marta Di Stefano, Maria Di Mauro, Maria Scutari, Teresa Rago, Laura Fugazzola, Maria Grazia Castagna, Fabio Maino

Research output: Contribution to journalReview articlepeer-review

Abstract

Management of thyroid nodules in the era of precision medicine is continuously changing. Neck ultrasound plays a pivotal role in the diagnosis and several ultrasound stratification systems have been proposed in order to predict malignancy and help clinicians in therapeutic and follow-up decision. Ultrasound elastosonography is another powerful diagnostic technique and can be an added value to stratify the risk of malignancy of thyroid nodules. Moreover, the development of new techniques in the era of “Deep Learning,” has led to a creation of machine-learning algorithms based on ultrasound examinations that showed similar accuracy to that obtained by expert radiologists. Despite new technologies in thyroid imaging, diagnostic surgery in 50–70% of patients with indeterminate cytology is still performed. Molecular tests can increase accuracy in diagnosis when performed on “indeterminate” nodules. However, the more updated tools that can be used to this purpose in order to “rule out” (Afirma GSC) or “rule in” (Thyroseq v3) malignancy, have a main limitation: the high costs. In the last years various image-guided procedures have been proposed as alternative and less invasive approaches to surgery for symptomatic thyroid nodules. These minimally invasive techniques (laser and radio-frequency ablation, high intensity focused ultrasound and percutaneous microwave ablation) results in nodule shrinkage and improvement of local symptoms, with a lower risk of complications and minor costs compared to surgery. Finally, ultrasound-guided ablation therapy was introduced with promising results as a feasible treatment for low-risk papillary thyroid microcarcinoma or cervical lymph node metastases.

Original languageEnglish
Article number907
JournalFrontiers in Endocrinology
Volume10
DOIs
Publication statusPublished - Jan 23 2020

Keywords

  • microcarcinoma
  • mini invasive treatment
  • molecular testing
  • thyroid nodule
  • ultrasound

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

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