Molecular Testing Helps Diagnose Low-Risk Thyroid Cancer

Yuri E. Nikiforov, MD, PhD, professor of pathology and director of the Division of Molecular Anatomic Pathology at the University of Pittsburgh School of Medicine, discusses improvements in diagnosis of thyroid cancer including the classification of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP).

According to Nikiforov, identifying NIFTP and other low-risk tumors can help reduce overtreatment. He says molecular testing has shown the ability to diagnose the risk level of disease through certain biomarkers, since currently NIFTP can only be diagnosed after surgical removal of part of the thyroid gland. Identifying patients with NIFTP with high confidence through genetic testing is an important way to get an earlier diagnosis.

More reliable diagnosis before surgery is important, because even if the physician suspects a thyroid nodule is cancerous or precancerous, they may be able to determine if it is low-risk or high-risk to know if surgical approaches can be minimized. If surgery is required, it may be possible to preserve 1 lobe of the thyroid, which continues the natural function of the thyroid without the need for replacement thyroid hormone, leading to better quality of life for these patients.

TRANSCRIPTION:

0:08 | Right now, also, a big revolution in medicine, patient care, and in thyroidology is molecular testing. We are understanding molecular markers that can help us predict, even before surgery, if this is cancer or maybe NIFTP, non-cancerous, or low-risk or high-risk disease. Now, although NIFTP can be diagnosed only after removal of the part of the thyroid gland, we now have molecular markers that can predict with a high degree of confidence when we are dealing with low-risk tumors, NIFTP or other low-risk, and this may help us not overtreat patients [with] lobectomy. If a diagnosis of NIFTP is rendered, no additional treatments are needed.

1:04 | We still need to diagnose better before we take patients for surgery. Even if you suspect that the nodule is cancerous or precancerous, we still need to diagnose better if this is a low-risk disease or if this is more likely to be a high-risk disease because we can minimize surgical approaches, and even at the stage of surgery, not remove the entire thyroid gland. We can do a lobectomy to preserve the second lobe of the thyroid for the patient, and to preserve the natural function of the thyroid, no need for hormonal supplementation, and a higher quality of life.