Guest post by Marita Teng, MD, Associate Professor, Otolaryngology-Head and Neck Surgery and member of the Head and Neck Institute and Center for Thyroid and Parathyroid Diseases at The Mount Sinai Hospital.
Thyroid nodules are exceedingly common, especially in women. By age 50, up to 70 percent of women have one or more thyroid nodules, but the vast majority of these are noncancerous. In fact, of all thyroid nodules, up to 95 percent are ultimately characterized as benign.
However, largely because of the increased use of radiologic imaging, the incidence of thyroid nodules – and the incidence of thyroid cancer – is increasing. Though this statistic may seem alarming, thyroid cancer is by far one of the most curable cancers.
One of the most important factors for achieving cure in thyroid cancer is being aware of a thyroid nodule and having an accurate assessment of it. Ultrasound, which is a noninvasive, basic imaging method, is highly accurate for the thyroid gland. Ultrasound can not only measure the size of a nodule, but also screen it for characteristics which might suggest malignancy. If a nodule is deemed large enough or suspicious enough to warrant testing, this can be done through a fine needle aspiration (FNA), which samples some of the cells in the nodule to be characterized under a microscope.
Genetic Testing of Thyroid Nodule Specimens Helps Determine Treatment
Recent advances in the molecular testing of FNA specimens allows detection of cancer-specific mutations in 14 thyroid cancer-related genes, and 42 types of other known gene abnormalities in thyroid cancer. This technology has greatly impacted physicians’ ability to counsel patients on the true likelihood of malignancy in their thyroid nodules, and thus allow for a much more informed decision about potentially undergoing thyroid surgery.
For example, a traditional FNA may frequently suggest that a thyroid nodule has a 15-30 percent possibility of containing cancer. Patients receiving this information may feel conflicted about going for surgery for what may ultimately turn out to be benign disease. The newer testing is much more specific and can indicate, for instance, only a 2-4 percent risk of malignancy, assuring the patient that observation is a safe choice. On the contrary, the molecular testing might indicate a very high (~95 percent) likelihood of thyroid cancer, thus making the decision to have surgery a very straightforward one.
Remember, thyroid nodules are usually not cancerous, but if you have a family history of thyroid cancer, or personal history of exposure to radiation, your risk of malignancy is greater. If you feel a lump on the front of your neck that is persistent or enlarging, see your doctor for an examination.
To make an appointment with Dr. Teng, call 212-241-9410.