{"entity":{"id":"thyroid-fna-molecular","kind":"technology","name":"Thyroid nodule FNA, Bethesda cytology & molecular classifiers","aka":[],"tldr":"Thyroid fine-needle aspiration takes a needle sample from a thyroid lump and grades it on a six-level scale; when the result is uncertain, a gene test on the same sample can often rule cancer out and avoid surgery.","summary":"Ultrasound-guided fine-needle aspiration reported by the Bethesda System (I-VI). Indeterminate categories (III-IV, ~20% of nodules) historically went to diagnostic lobectomy; molecular classifiers such as Afirma GSC (RNA expression, Veracyte) and ThyroSeq v3 (DNA/RNA NGS) have negative predictive values around 95-97%, halving unnecessary surgery. TI-RADS ultrasound scoring decides which nodules to biopsy at all.","status":"standard-of-care","asOf":"2026-09-07","links":[{"label":"Ali et al., The 2023 Bethesda System for Reporting Thyroid Cytopathology (Thyroid 2023)","url":"https://doi.org/10.1089/thy.2023.0141"},{"label":"Haugen et al., 2015 American Thyroid Association management guidelines for thyroid nodules and differentiated thyroid cancer (Thyroid 2016)","url":"https://doi.org/10.1089/thy.2015.0020"}],"tags":[],"related":[],"cancers":["thyroid"],"sections":["diagnostics"],"technologies":["ultrasound","cgp","rna-seq"],"targets":[],"drugs":[],"companies":["veracyte"],"institutions":[],"pathways":[],"terms":["bethesda-category","tert-promoter"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":["paper-ali-thyroid"],"journals":[],"dependsOn":[],"notes":[],"principle":"Cytology is combined with gene-expression or mutation/fusion panels calibrated on surgical outcomes.","strengths":["Avoids surgery for most benign indeterminate nodules","Detects BRAF, RET, RAS, TERT for risk and therapy planning"],"limitations":["Cost; positive predictive value is moderate","Overdiagnosis of indolent microcarcinoma remains the systemic problem"]},"route":"/technologies/thyroid-fna-molecular/","neighbours":{"cancer":[{"id":"thyroid","kind":"cancer","name":"Thyroid cancer","route":"/cancers/thyroid/"}],"section":[{"id":"diagnostics","kind":"section","name":"Diagnostics & Biomarkers","route":"/fronts/diagnostics/"}],"technology":[{"id":"cgp","kind":"technology","name":"Comprehensive genomic profiling","route":"/technologies/cgp/"},{"id":"rna-seq","kind":"technology","name":"RNA sequencing & expression profiling","route":"/technologies/rna-seq/"},{"id":"thyroid-cancer-markers","kind":"technology","name":"Thyroglobulin, calcitonin and CEA in thyroid cancer follow-up","route":"/technologies/thyroid-cancer-markers/"},{"id":"ultrasound","kind":"technology","name":"Ultrasound","route":"/technologies/ultrasound/"}],"company":[{"id":"veracyte","kind":"company","name":"Veracyte (Decipher)","route":"/companies/veracyte/"}],"term":[{"id":"bethesda-category","kind":"term","name":"Bethesda category (thyroid cytology)","route":"/terms/bethesda-category/"},{"id":"tert-promoter","kind":"term","name":"TERT promoter mutation","route":"/terms/tert-promoter/"}],"paper":[{"id":"paper-ali-thyroid","kind":"paper","name":"The 2023 Bethesda System for Reporting Thyroid Cytopathology","route":"/key-papers/paper-ali-thyroid/"}],"idea":[{"id":"idea-thyroid-overdiagnosis-reversal","kind":"idea","name":"Ultrasound restraint and surveillance to reverse thyroid cancer overdiagnosis","route":"/ideas/idea-thyroid-overdiagnosis-reversal/"}],"bottleneck":[{"id":"b-overdiagnosis","kind":"bottleneck","name":"Overdiagnosis and false alarms","route":"/bottlenecks/b-overdiagnosis/"}],"drug":[{"id":"afirma","kind":"drug","name":"Afirma Genomic Sequencing Classifier","route":"/drugs/afirma/"}]}}