Performance of molecular testing for indeterminate thyroid nodules in Black patients - 07/11/25
Abstract |
Introduction |
Current molecular testing of thyroid nodules assesses malignancy risk without considering racial genetic variations, possibly introducing bias.
Methods |
We conducted a retrospective analysis of 2905 patients who underwent fine needle aspiration (FNA) for thyroid nodules from 2015 to 2023. Indeterminate nodules were classified as Bethesda III and IV. The performance of molecular testing was assessed by comparing Afirma test results with histopathological findings.
Results |
Among 662 patients with indeterminate FNA results, 173 (26.7 %) were Black and 474 (73.3 %) were White. The benign call rate was higher in Black patients (45.7 % vs. 34.7 %, p = 0.035). Malignancy rates based on surgical pathology were 16.7 % for nodules classified as benign by molecular testing in Black patients and 7.7 % in White patients (p = 0.574). There was a trend toward lower sensitivity (88.5 % vs. 96.1 %, p = 0.349) and negative predictive value (84.6 % vs. 90 %, p = 0.492) in molecular testing for Black patients.
Conclusions |
Molecular testing might miss thyroid cancers in Black patients, potentially impacting prognosis. Surgeons should carefully interpret molecular testing results as part of holistic thyroid nodule treatment.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Molecular testing shows varying performance across racial groups for thyroid nodules. |
• | Black patients have higher benign call rates, potentially missing thyroid cancers. |
• | Our study reveals lower sensitivity and higher specificity of testing in Black patients. |
• | Underrepresented follicular cell pathologies may be more prevalent in Black patients. |
• | Our findings emphasize cautious interpretation of molecular results in Black patients. |
Keywords : Thyroid cancer, Genetic testing, Health disparity, Precision medicine, BRAF, RAS
Plan
| This article is part of a special issue entitled: SBAS 2025 published in The American Journal of Surgery. |
Vol 250
Article 116569- décembre 2025 Retour au numéro
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