Objective: Assess the impact of molecular test results on the quality of life of patients with thyroid nodules.
Purpose: Thyroid cancer is known to have a disproportionately negative effect on quality of life compared to malignancies with a worse prognosis. The quality of life of patients with thyroid nodules has not been previously evaluated.
Methods: A short version of the Thyroid-Related Patient-Reported Outcome assessed the quality of life of all patients who underwent thyroid biopsy throughout the UCLA Health System from May 2016 to June 2017. The survey was administered to patients after they were informed of their biopsy results, but prior to any surgical treatment. Scale scores for quality of life associated with goiter, anxiety, depression, and daily life were analyzed. Biopsy results were categorized into benign, indeterminate (risk of malignancy 10-30%), and malignant. All patients with an indeterminate biopsy result underwent molecular testing with either Afirma Gene Expression Classifier (GEC) or ThyroSeq v2 to further assess the risk of malignancy, which decreases to 5% with a benign molecular test result and increases to 50% which a suspicious result. As no significant differences were found between the two molecular tests, the quality of life scale scores were combined for analysis.
Results: Of 825 patients who underwent thyroid biopsy, 366 patients completed the assessment (44.4% response rate). Thirty-four patients completed the survey after surgery and were excluded, leaving 332 patients for analysis. The mean age of responders was 54.9 years and 82% were female. The percentage of patients with a nodule size of 0-1 cm, 1-2 cm, 2-4 cm, and > 4 cm were 11%, 41%, 40% and 8%, respectively. The biopsy results were as follows: 76% benign (n = 251), 7% malignant (n = 23), and 17% indeterminate (n = 58, including 37 patients with a benign molecular test result and 21 patients with a suspicious test result). There were no significant differences found between patients who received a benign biopsy result and patients who received an indeterminate result with benign molecular testing. There were also no significant differences found between patients who received a malignant biopsy result and patients who received an indeterminate result with suspicious molecular testing, with the exception of daily life (worse in patients with a malignant biopsy result compared to patients with an indeterminate result and suspicious molecular testing, p = 0.003). In patients with an indeterminate biopsy result, quality of life scores were better for those with a suspicious molecular test result as compared with a benign test result, significant for goiter (p = 0.033) and depression (p = 0.026).
Conclusions: A benign molecular test result may provide reassurance for patients with indeterminate thyroid nodules that the risk of malignancy is low and correlate with better quality of life. Follow-up is necessary to determine if benign molecular test results would maintain improved quality of life during long-term surveillance.