5
16. A) Diagnostic surgical excision is the long-established standard
of care for the management of follicular neoplasm/suspicious for
follicular neoplasm (FN/SFN) cytology nodules. However, after
consideration of clinical and sonographic features, molecular testing
may be used to supplement malignancy risk assessment data, in lieu
of proceeding directly with surgery. Informed patient preference and
feasibility should be considered in clinical decision-making. (WR-M)
B) If molecular testing is either not performed or inconclusive,
surgical excision may be considered for removal and definitive
diagnosis of an FN/SFN thyroid nodule. (SR-L)
17. A) If the cytology is reported as suspicious for papillary carcinoma
(SUSP), surgical management should be similar to that of malignant
cytology, depending on clinical risk factors, sonographic features,
patient preference, and possibly results of mutational testing (if
performed). (SR-L)
B) After consideration of clinical and sonographic features,
mutational testing for BRAF or the 7-gene mutation marker panel
(BRAF, RAS, RET/PTC, PAX8/PPARĪ³) may be considered in nodules
with SUSP cytology if such data would be expected to alter surgical
decision-making. (WR-M)
18.
18
FDG-PET imaging is not routinely recommended for the evaluation
of thyroid nodules with indeterminate cytology. (WR-M)
