T. Patel1, A. Shukla2, A. Salma3, D. Patel4, J.D. John5, R. Kantamneni6, P. Kalyandrug1, H. Nookala7, S. Khan8, N. Anand9, B.S. Gadad9 1Trinity Medical Sciences University school of medicine, Ratho Mill Kingstown, ST VINCENT, Saint Vincent and the Grenadines 2St Martinus University, Curacao, ANTILLES, Netherlands Antilles 3Shadan institute of medical sciences, Hyderabad, TELANGANA, India 4Lokmanya Tilak Municipal medical College, Mumbai, MAHARASHTRA, India 5Malla Reddy Institute of medical science, Hyderabad, TELANGANA, India 6Rangaraya medical College, dr.YSR university of health sciences, Kakinada, ANDHRA PRADESH, India 7Mamata Academy of Medical Sciences, Hyderabad, TELANGANA, India 8California Institute of Behavioral Neurosciences & Psychology, Fairfield, CALIFORNIA, India 9University of Texas Rio Grande Valley School of Medicine, Department Of Medical Education, Edinburg, TEXAS, USA
Introduction: Diagnosing whether an indeterminate thyroid nodule is malignant or benign is a significant and challenging task. In this study, we explore the individual predictors of malignancy. Recent research has focused on studying individual predictors in isolation. However, it is important to conduct a comprehensive assessment of these predictors of malignancy to improve diagnostic accuracy and patient outcomes for patients diagnosed with indeterminate thyroid nodules.
Methods: For the current comprehensive systematic review, rigorous screening of PubMed, PubMed Central, and Medline databases was conducted, Ten articles were selected to provide a holistic understanding of the research question. The study analysed 1419 patients with indeterminate thyroid nodules, using different determinants, such as Genetic, Biochemical, Clinical, Radiological, and Cytological, for a comprehensive and robust analysis.
Results: The study unveils numerous independent indicators: a history of Hashimoto's thyroiditis and multinodular goitre and past malignant history, which are strong clinical predictors for malignancy. Neck lymphadenopathy, Heterogeneity of internal echogenicity, Long axis size greater than or equal to 1.93 cm, and Small to long axis ratio greater than or equal to 0.64 all showcase increased risk of malignancy and strong ultrasound predictors. Integrating cytology with increased serum thyroglobulin levels also emerges as a strong cytological and biochemical indicator of malignancy. The study also identifies other predictors like Molecular testing, Dual-spectral CT, and the combination of US TI-RADS and new US scoring systems.
Conclusion: The findings of this study strongly advocate for a multimodal diagnostic approach, which has the potential to significantly improve diagnostic accuracy and, consequently, patient outcomes. While ultrasound and cytology remain the cornerstone of diagnosis, the addition of serum markers, molecular markers, and advanced imaging techniques such as dual-spectral CT can further enhance diagnostic accuracy. These independent characters provide a strong case for the development of a risk stratification system, which could greatly improve diagnostic accuracy and patient outcomes.