Endocrinology ·
Predictors of malignancy and recurrence in 585 RAS-positive thyroid nodules
A single-center retrospective series assessed 585 RAS-positive thyroid nodules with surgical pathology and 55 non-resected nodules. Isolated KRAS mutations were associated with a lower cancer or NIFTP rate than isolated NRAS or HRAS, while concurrent high-risk mutations were associated with more persistent or recurrent disease.
- Isolated KRAS had lower cancer or NIFTP prevalence than NRAS or HRAS.
- Copy number alterations and higher Bethesda class were associated with cancer or NIFTP.
- Recurrence was uncommon in isolated RAS cancers during follow-up.
- Six of 55 non-resected nodules showed significant growth.
Researchers retrospectively analyzed consecutive RAS-positive thyroid nodules tested with ThyroSeq v3 at one institution from 2018 to 2024. The series included 585 nodules with surgical pathology and 55 non-resected nodules with at least one year of ultrasound follow-up. The primary assessment was malignancy or non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), alongside clinical and molecular predictors and follow-up outcomes.
Of the resected nodules, 140 (24%) were benign, 149 (25%) were NIFTP and 296 (51%) were cancers. Cancer or NIFTP occurred in 34% of nodules with isolated KRAS, compared with 74% with isolated NRAS and 81% with isolated HRAS. Copy number alterations, larger ultrasound nodule size and higher Bethesda classification were associated with cancer or NIFTP. Among patients with cancer, persistent or recurrent disease occurred in 19 of 272 (7%); it was reported in 14 of 28 patients with concurrent high-risk mutations versus 5 of 244 without them. The rate among isolated RAS cancers was 1 of 133 (0.8%). Six of 55 non-resected nodules had significant growth over a median 2.3 years.
The retrospective, single-center findings suggest risk varies by mutation and other features, but do not establish which nodules can safely avoid surgery. Follow-up was limited, and the abstract does not provide further details on patient selection or management outcomes.
In practice
For patients with RAS-positive thyroid nodules, mutation subtype and additional findings may help distinguish risk: cancer or NIFTP was less frequent with isolated KRAS than with isolated NRAS or HRAS, and copy number alterations and higher Bethesda classification were associated with cancer or NIFTP. Persistent or recurrent disease was uncommon in isolated RAS cancers in this series. These retrospective single-center results, with limited follow-up and only 55 non-resected nodules, do not establish that surgery can safely be omitted or define management criteria.
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The Journal of Clinical Endocrinology & Metabolism: Clinical and Molecular Predictors of Malignancy in a Series of 585 RAS-positive Thyroid Nodules with Surgical Outcome ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.