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Michael Yeh, MD COVER STORY Molecular Profiling Can Help Inform Surgical Decisions for Patients with Thyroid Nodules STORY HIGHLIGHTS Molecular-profiling techniques bring a new level of surgical certainty to a significant percentage of cases involving indeterminate thyroid nodules. While roughly one-fourth of indeterminate results are eventually diagnosed as thyroid cancer, surgery has been required to make a clear determination. (continued from cover) Although data suggests that part of this increase is due to more frequent detection, the number of life-threatening thyroid cancers is also on the rise. “Given that so many people have thyroid nodules, 96 percent of whom don’t have cancer, the issue we have to be concerned with is how we avoid providing invasive treatment to people who don’t need it,” says Michael Yeh, MD, chief of endocrine surgery at UCLA. “As surgeons, we need to be advocates for appropriate care. Molecular profiling is contributing to our ability to better do that.” The challenge for endocrine surgeons has been the large number of patients — about one in four — for whom ultrasound-guided biopsy, performed via fine-needle aspiration, is inconclusive. “When UCLAHEALTH.ORG 1-800-UCLA-888 (1-800-825-2888) a biopsy reveals a benign result, which occurs in the majority of patients, we follow up with serial imaging and biopsy again later if sonographic changes are detected within the nodule,” explains UCLA endocrine surgeon Avital Harari, MD. “On the other end of the spectrum, when the biopsy gives a diagnosis of cancer, patients are treated with one definitive surgery, a total thyroidectomy. We also remove any lymph nodes associated with the cancer at the initial operation. However, in about 25 percent of patients, the initial biopsy results are inconclusive and are classified as indeterminate.” Roughly one-fourth of indeterminate results are eventually diagnosed as thyroid cancer. The problem is that determining whether