Outcomes of Patients with RAS -Positive Bethesda III and IV Cytology Thyroid Nodules
Authors' conclusion
Isolated RAS mutation alone may not uniformly mandate surgery. Active surveillance represents a viable and safe alternative to surgery in appropriately selected patients with RAS-positive nodules, though further long-term data are needed.
Study context
- Population
- Patients with isolated RAS-positive Bethesda III and IV thyroid nodules on reflexive ThyroSPEC molecular testing, July 2020–September 2024175 Bethesda III, 28 Bethesda IV
- Participants
- 203 patients
- Exposure
- Surgery vs surveillance
- Surgeryn = 126
- Surveillancen = 77reference
- Outcome
- Final pathology in surgery
Methodological detailssingle health care region, institutional prospective thyroid nodule database
- Single health care region
- Institutional prospective thyroid nodule database
Main finding
As reported in the abstract
Malignancy
43
34%
Of malignancies, 2025 American Thyroid Association (ATA) intermediate-high or high risk
8
19%
Benign lesions
57
45%
Neoplasms of uncertain or very low malignant potential
26
21%
Observational data: associations, not effects.
Further findings
Bethesda III nodules
P = 0.010
| Outcome | P value |
|---|---|
| Nuclear atypia in resected nodulesMalignant vs Benign | P = 0.007 |
- Age · younger with Surgery
- P = 0.001
- Nodule size (maximum diameter, volume) · larger nodules with Surgery
- P < 0.05 for both
- Nuclear atypia in resected nodules: Malignant 70%
- Nuclear atypia in resected nodules: Benign 40%
Age
- Surgical patients were younger
Nodule size (maximum diameter, volume)
- Surgical patients had larger nodules
Crossover from surveillance to surgery
- Crossed over to surgery (patient preference, nodule growth or symptoms)
- 7
- Malignant pathology among crossovers (both ATA low-intermediate risk)
- 2
Nodule growth (threshold 50%) in surveillance patients with ≥1 post-MT ultrasound (US) and ≥1-year follow-up
- Exhibited growth
- 3/48 (6%)
- Cumulative incidence of growth at 2 years
- 2%
Original publication
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