New Test May Reduce Unnecessary Thyroid Cancer SurgeriesSep 10, 2012
A new test for thyroid cancer may help doctors make more accurate diagnoses, cutting down on unnecessary surgeries.
The thyroid is a gland in the neck that helps regulate metabolism. Many people develop bumps or nodules on their thyroid gland, and in most cases they are harmless. To check whether thyroid nodules need to be treated, doctors perform a biopsy. Some cells from the nodules are removed with a needle and looked at under a microscope to determine whether they are cancerous. However, in some cases, the results are inconclusive, meaning that it isn’t clear whether the cells are malignant (cancer) or benign (not cancer). When that happens, patients are usually treated as if the cells are malignant, and have the nodules and all or part of the thyroid gland surgically removed.
In a large trial of 3,789 patients conducted at several medical centers in the US, researchers used a new gene expression test to identify which thyroid nodules with inconclusive biopsies had high risk for being cancer. They tested 265 nodules with unclear biopsy results. Eighty-five of them turned out to be malignant, confirmed after surgery. The new test correctly detected 78 of them as suspicious.
Results of the study were published in the New England Journal of Medicine. In an accompanying editorial, J. Larry Jameson, MD, PhD, Dean of the Perelman School of Medicine at the University of Pennsylvania wrote that the new test could eliminate 25,000 thyroid surgeries each year.
An estimated 56,460 new cases of thyroid cancer will be diagnosed in 2012. The chance of being diagnosed with thyroid cancer has risen in recent years and is now more than twice what it was in 1990. Some of this is the result of the increased use of thyroid ultrasound, which can detect small thyroid nodules that might not otherwise have been found in the past. The death rate from thyroid cancer has been fairly stable for many years, and remains very low compared with most other cancers.
Signs and symptoms of thyroid cancer include:
- a nodule, lump, or swelling in the neck, sometimes growing rapidly
- pain in the front of the neck, sometimes going up to the ears
- hoarseness or other voice changes that do not go away
- trouble swallowing
- breathing problems (feeling as if you are "breathing through a straw")
- a constant cough that is not due to a cold
Many benign conditions cause some of these same signs and symptoms, but if you have any of them, it’s important to see your doctor right away.
Preoperative Diagnosis of Benign Thyroid Nodules with Indeterminate Cytology. Published online June 25, 2012 in the New England Journal of Medicine. First author: Erik K. Alexander, MD, Brigham and Women’s Hospital and Harvard Medical School, Boston.