Paspala Anna, Bompetsi Georgia, Paschou Stavroula A, Charalambopoulos Anestis, Pikoulis Emmanuil, Peppa Melpomeni, Nastos Constantinos
Department of Surgery, Evgenideio Hospital, Papadiamantopoulou 20, Athens, 115 28, Greece.
3rd Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
Hormones (Athens). 2025 Mar;24(1):217-229. doi: 10.1007/s42000-024-00597-0. Epub 2024 Sep 3.
The incidence of thyroid cancer has increased over recent years due to the fact that several diagnostic tools, such as neck ultrasound and fine-needle aspiration, are being ever more widely adopted. Lately, another modality which might provide significant information preoperatively on the aggressiveness of a thyroid tumor, its prognosis, and its recurrence rate is molecular testing. We reviewed the literature with regard to the role of preoperative molecular testing in patients with Bethesda V and Bethesda VI thyroid nodules and its impact on choice of the optimal treatment strategy. Several molecular mutations and alterations are associated with thyroid cancer and its biological behavior, such as BRAF-V600E, RET, and TERT promoter. Although the value of preoperative molecular testing for indeterminate nodules (Bethesda III and Bethesda IV) have been analyzed in numerous studies, the impact of preoperative molecular testing on Bethesda V and Bethesda VI thyroid nodules is not adequately described in the current literature. The preoperative recognition of specific molecular mutations, such as BRAFV600E and TERT promoter mutation, might provide more individualized management for thyroid cancer patients by altering the surgical approach and the extent of surgery for patients diagnosed with a more aggressive or iodine-resistant subtype of thyroid cancer.Thyroid cancer is characterized by multiple genetic mutations and alterations and, as a result, preoperative molecular testing of malignant nodules could be a very useful tool for surgeons, enabling them to decide on the most appropriate surgical approach for each patient.
近年来，由于颈部超声和细针穿刺等多种诊断工具的应用越来越广泛，甲状腺癌的发病率有所上升。最近，另一种可能在术前提供有关甲状腺肿瘤侵袭性、预后及其复发率的重要信息的方法是分子检测。我们回顾了有关术前分子检测在贝塞斯达V级和贝塞斯达VI级甲状腺结节患者中的作用及其对最佳治疗策略选择的影响的文献。几种分子突变和改变与甲状腺癌及其生物学行为有关，如BRAF-V600E、RET和TERT启动子。尽管众多研究分析了术前分子检测对不确定结节（贝塞斯达III级和贝塞斯达IV级）的价值，但目前文献中对术前分子检测对贝塞斯达V级和贝塞斯达VI级甲状腺结节的影响描述不足。术前识别特定的分子突变，如BRAFV600E和TERT启动子突变，可能通过改变手术方式和手术范围，为诊断为侵袭性更强或碘抵抗亚型甲状腺癌的患者提供更个体化的管理。甲状腺癌具有多种基因突变和改变，因此，对恶性结节进行术前分子检测可能是外科医生非常有用的工具，使他们能够为每位患者决定最合适的手术方式。
