Oral Abstract Presentation

CSEMO2 - CSEM: Endocrinology & Metabolism Oral Abstracts: Optimization of a Thyroid Nodule Diagnostic Pathway Including ThyroSPEC Molecular Testing for Indeterminate Thyroid Nodules Improves Diagnostic Quality and Yield

Friday, November 28, 2025

14:44 - 14:51 Toronto

Location: Room 201 A/B/C/D/E/F

Presenting Author(s)

JENNIFER E. JACQUIER, MD, FRCPC (she/her/hers)

Associate Clinical Professor
University of Alberta
University of Alberta
Edmonton, Alberta, Canada

Disclosure(s): Alberta Health Services: Grant/Research Support (Ongoing); CPD Network: Speaker/Honoraria (Ongoing); Eli Lilly Canada: Speaker/Honoraria (Ongoing)

Disclosure(s):

JENNIFER JACQUIER, MD, FRCPC: Alberta Health Services: Grant/Research Support (Ongoing); CPD Network: Speaker/Honoraria (Ongoing); Eli Lilly Canada: Speaker/Honoraria (Ongoing)

Blinded Abstract:

Objective: We compared the diagnostic performance and clinical outcomes of two patient cohorts with indeterminate thyroid nodules (ITNs) from Calgary, with an optimized thyroid nodule pathway incorporating reflexive ThyroSPEC testing, and from Edmonton without optimization and ThyroSPEC testing.

Method: Consecutive patients from Calgary and Edmonton diagnosed with ITNs between February 17, 2021 and May 1, 2022, were identified from local thyroid nodule databases with 383 and 395 patients in the Calgary and Edmonton cohorts, respectively. Follow-up data was collected until September 30, 2024.

Results: Edmonton had a higher percentage of ultrasound (US) reports without US categories provided or sufficient features allowing classification (25% vs 7%, p < 0.001). More fine-needle aspiration (FNA) reports in Calgary had nuclear or structural atypia reported (74% vs. 63%, p = 0.001). A greater proportion of Edmonton patients underwent surgery (55% vs. 44%, p = 0.002). In Calgary, 70% (117/167) of surgeries were performed by high-volume surgeons (≥10 ITN surgeries in 14 months) versus 55% (120/217) in Edmonton (p = 0.004). Among patients who underwent surgery, the malignancy rate was higher in Calgary (43%) versus Edmonton (29.5%, p = 0.01).

Conclusion: An optimized thyroid nodule diagnostic pathway — including reflexive ThyroSPEC testing of ITNs — was associated with improved US malignancy risk reporting quality, a higher rate of reported atypia, and a greater prevalence of malignancy among resected nodules. These findings highlight the need to optimize key components of the thyroid nodule diagnostic pathway, including ultrasound and cytology, to improve the impact of molecular testing.