Development of a Nomogram to Integrate Molecular Testing and Clinical Variables to Improve Malignancy Risk Assessment Among Cytologically Indeterminate Thyroid Nodules
Authors' conclusion
Although MT alone played an important role in decision-making regarding surveillance versus surgery in our study population, integrating MT results with additional clinical variables improved the malignancy risk prediction for ITNs.
Study context
- Population
- Cytologically indeterminate thyroid nodules (ITNs) undergoing reflexive ThyroSPEC molecular testing, Jul 30, 2020–Oct 30, 2023332 in model
- Participants
- 1,024 participants
- Outcome
- Malignancy on histology predicted by clinical variables plus molecular testing results
Methodological detailsconsecutive nodules, multivariable logistic regression, nomogram development, cross-validated
- Consecutive nodules
- Multivariable logistic regression
- Nomogram development
- Cross-validated
Main finding
As reported in the abstract
Prediction of malignancy (model with molecular testing (MT) and clinical variables)
- Cross-validated AUC
- 0.831 (95% CI 0.787-0.874)
- Odds of malignancy, high-risk mutations or malignant molecular markers vs mutation-negative or benign results
- 152.79 times higher
- Odds of malignancy, maximum nodule size >5 cm vs 0-2 cm
- 4.34 times higher
- Odds of malignancy with nuclear atypia
- 4.26 times higher
- Odds of malignancy, US risk category 5 vs categories 1-3
- 2.89 times higher
- Odds of malignancy with positive palpation discovery
- 1.83 times higher
Observational data: associations, not effects.
Further findings
Surgery type by integrated risk of malignancy (ROM) category
- Integrated ROM associated with surgery type
- P < 0.001
- Lobectomy alone, low ROM (0-30%)
- 61%
- Lobectomy alone, intermediate ROM (31-70%)
- 70%
- Total thyroidectomy, high ROM (>70%)
- 62%
Original publication
Development of a Nomogram to Integrate Molecular Testing and Clinical Variables to Improve Malignancy Risk Assessment Among Cytologically Indeterminate Thyroid Nodules. Thyroid. Published 5 March 2025. doi:10.
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