TY - JOUR
T1 - Nodular Thyroid Disease in the Era of Precision Medicine
AU - Tumino, Dario
AU - Grani, Giorgio
AU - Di Stefano, Marta
AU - Di Mauro, Maria
AU - Scutari, Maria
AU - Rago, Teresa
AU - Fugazzola, Laura
AU - Castagna, Maria Grazia
AU - Maino, Fabio
N1 - Publisher Copyright:
© Copyright © 2020 Tumino, Grani, Di Stefano, Di Mauro, Scutari, Rago, Fugazzola, Castagna and Maino.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/1/23
Y1 - 2020/1/23
N2 - 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.
AB - 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.
KW - microcarcinoma
KW - mini invasive treatment
KW - molecular testing
KW - thyroid nodule
KW - ultrasound
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U2 - 10.3389/fendo.2019.00907
DO - 10.3389/fendo.2019.00907
M3 - Review article
AN - SCOPUS:85079124307
VL - 10
JO - Frontiers in Endocrinology
JF - Frontiers in Endocrinology
SN - 1664-2392
M1 - 907
ER -