A 38-year-old woman presents with a 2.5 cm solid thyroid nodule. FNAC reveals Bethesda category III (AUS/FLUS). Molecular testing is negative for BRAF, RAS, and RET/PTC mutations, and shows a low-risk gene expression profile. According to current management guidelines, what is the recommended next step?
- A Repeat FNA in 3-6 months with ultrasound guidance ✓
- B Diagnostic lobectomy
- C Total thyroidectomy given the nodule is over 2 cm
- D Core needle biopsy for histopathological confirmation
Correct answer: A. Repeat FNA in 3-6 months with ultrasound guidance
Explanation
Bethesda category III (AUS/FLUS) carries a 10-30% risk of malignancy. With negative molecular markers and a low-risk gene expression profile, the nodule is effectively reclassified as low-risk, and surveillance with repeat FNA in 3-6 months is appropriate. Diagnostic lobectomy is indicated for high-risk molecular profiles or suspicious sonographic features. Total thyroidectomy is premature without confirmed malignancy. Core needle biopsy is not routinely recommended for thyroid nodules and does not replace FNA or molecular testing in decision-making.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.