Metabolic biomarkers of neoplastic cells in non-medullary differentiated thyroid carcinoma

Although thyroid nodules are common, only 10-15% are malignant and require surgical treatment. A systematic approach to their evaluation is important to avoid unnecessary surgery. Fine-needle aspiration biopsy (FNAB) has substantially improved the diagnostic accuracy. However, despite FNAB effectiveness, about 10% of all specimens are classified as “indeterminate”. In those cases, clinicians usually recommend surgical excision for a definitive diagnosis. Because only 15% to 20% of these lesions are malignant, up to 85% of the patients in this subgroup may undergo unnecessary surgery. In this paper, we want to develop an HR-MAS NMR based-approach presuming that metabolic variations will pre-empt the development of morphologic modifications associated with malignancy. Analyzing a series of 72 thyroid lesions (28 papillary thyroid carcinomas, 40 “indeterminate” lesions, and 4 benign nodules), we want to show that the HR-MAS technique is suitable not only to highlight metabolic differences between normal and tumoral thyroid tissues, but can also discriminate malignant from benign tumoral tissues. The principal aim is to transfer this technique to FNABs, in order to answer to diagnostic problems encountered by clinicians and improve the clinical management of patients with a “indeterminate” cytological diagnosis.