Hungary, a pioneer in the introduction of a test that avoids surgery for the study of thyroid nodules

The University Hospital of Navarra (HUN) has launched a new molecular test that avoids surgery in the investigation of thyroid nodules when the initial test carried out to determine whether they are benign or malignant gives an uncertain or inconclusive result. This happens in 15% of cases. In a large number of such cases, surgery is performed to establish a definite diagnosis. Surgery, which can be avoided with the new test and may be unnecessary in 70-75% of cases where an indeterminate nodule turns out to be benign.

The primary examination of thyroid nodules is carried out in consultation with an endocrinologist with an assessment of the patient’s clinical risk factors and an ultrasound scan. Depending on the size and characteristics of the node visible on ultrasound, the specialist determines the need to analyze its cells (cytological examination) after removing a tissue sample by inserting a thin needle (fine needle aspiration or FNAP). ) to detect possible cancer cells.

As noted, in 15% of cases after FNA, cytology gives an indeterminate result, i.e., it is not possible to confidently determine the benignity or malignancy of the sample. However, up to 25-30% of these indeterminate nodules may become malignant.

Until now, the recommended action in these cases was repeated cytological examination or surgical intervention for diagnostic purposes, or observation of the patient, depending on his characteristics.

Using this molecular test, recently marketed in Spain, the Hungarian Pathological Anatomy Service examines ten genes in the extracted tissue after a new FNA. In this way, the likelihood of node malignancy can be stratified much more accurately in order to make better therapeutic decisions and thereby avoid diagnostic surgery. If the test classifies the nodule as benign, clinical observation will be performed; and if a suspicion of malignancy is detected, treatment will be surgical.

This test is a complementary method to clinical, ultrasound and cytological examinations, and its implementation was made possible through the work of the multidisciplinary thyroid pathology committee and the Hungarian pathology service.

Different incidence in men and women

The presence of thyroid nodules in the population is very common, reaching 50-60% when detected by ultrasound. The frequency is higher in women and in old age.

Most nodules occur in people with normal thyroid function, they do not cause compression symptoms or aesthetic problems, and the main purpose of their investigation is to exclude malignancy, which occurs in 5-15% of cases.

According to the Institute of Public and Labor Health of Navarra (ISPLN), 113 new cases of thyroid cancer were detected in Navarre in 2023. Three out of four of these, 86 cases, were in women, in whom thyroid cancer was the fifth most common type of cancer, with 5% of total new cases diagnosed in the past year for that gender. There were 27 cases diagnosed in men, representing 1.1% of the total number diagnosed in men, among whom it is the eighteenth most common type of cancer.

It is a cancer with relatively low mortality rates in Navarre: during the five-year period 2018-2022, it ranked twentieth in cancer mortality among men and twenty-second among women, with an adjusted rate of 0.4. and 0.6 per 100,000 inhabitants, respectively.