Abstract
Abstract Molecular testing of fine-needle aspirates of indeterminate thyroid nodules is now standard and consists mainly of mutational analysis of the most frequent point mutations and chromosomal rearrangements occurring in advanced thyroid tumors with the goal of determining these genetic alterations early in the neoplastic process. However, mutation panels, even extended ones, face challenges; namely, genetic alterations in cytologically indeterminate categories are represented at relatively low percentage, and with the exception of strong driver mutations, the mere presence of a mutation does not reliably predict malignancy. Currently, dynamic markers such as microRNAs (miRNAs) are being explored to overcome the limitations of mutational panels. Various stages of neoplasia are associated with characteristic patterns of deregulated miRNAs, making them attractive candidates as predictive markers. In this review, we summarize current knowledge from the literature about the potential role of miRNAs in risk stratification of indeterminate thyroid nodules, including our findings based on a large molecular database of fine-needle thyroid aspirates. We believe miRNA classifiers and mutational analysis in combination are powerful tools in the risk stratification of indeterminate thyroid nodules.
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