Hürthle 细胞学检查不确定的甲状腺结节仍然是诊断挑战。第一代分子检测的低良性检出率和阳性预测值阻碍了它们用于排除恶性肿瘤。我们检查了当前测试的诊断性能。我们的前瞻性随机试验的子集分析将 Bethesda III 和 IV 结节中 Afirma 基因测序分类器和 Thyroseq v3 的良性检出率和阳性预测值与 Hürthle 细胞细胞学进行了比较。分子测试样本是在最初的细针抽吸（8/2017-7/2022）时获得的，并反射性地送去处理。对 140 个 Hürthle 细胞结节进行了分子测试。在使用 Afirma 基因测序分类器测试的 79 个结节中，良性检出率为 84% (66/79)。 66 个良性结节中有 9 个被切除，没有恶性肿瘤。 13 个结果可疑的结节中有 12 个被切除，发现 3 例恶性肿瘤：2 例甲状腺乳头状癌和 1 例 Hürthle 细胞癌（阳性预测值 25%）。在使用 Thyroseq v3 测试的 61 个结节中，良性检出率为 56%（34/61；（与 Afirma 基因测序分类器相比，P < .01）。34 个结果为阴性的结节中有 5 个被切除，没有恶性肿瘤。27 个结节中有 19 个被切除。结果呈阳性的患者被切除，发现 3 例恶性肿瘤 - 2 例甲状腺乳头状癌和 1 例 Hürthle 细胞癌（阳性预测值 16%）。目前 Hürthle 细胞结节分子检测的高良性检出率增强了其使患者避免手术的价值。由爱思唯尔公司出版

Indeterminate thyroid nodules with Hürthle cell cytology remain a diagnostic challenge. The low benign call rate and positive predictive value of first-generation molecular tests precluded their use to rule out malignancy. We examined the diagnostic performance of current tests.This subset analysis of our prospective randomized trial compared the benign call rate and positive predictive value of Afirma Gene Sequencing Classifier and Thyroseq v3 in Bethesda III and IV nodules with Hürthle cell cytology. Molecular test samples were obtained at initial fine-needle aspiration (8/2017-7/2022) and reflexively sent for processing.Molecular testing was performed on 140 Hürthle cell nodules. Of 79 nodules tested with the Afirma Gene Sequencing Classifier, the benign call rate was 84% (66/79). Nine of 66 nodules with benign results were resected, with no malignancies. Twelve of 13 nodules with suspicious results were resected, revealing 3 malignancies-2 papillary thyroid carcinomas and one Hürthle cell carcinoma (positive predictive value 25%). Of 61 nodules tested with Thyroseq v3, the benign call rate was 56% (34/61; (P < .01 versus Afirma Gene Sequencing Classifier). Five of 34 nodules with negative results were resected, with no malignancies. Nineteen of 27 nodules with positive results were resected, revealing 3 malignancies-2 papillary thyroid carcinomas and 1 Hürthle cell carcinoma (positive predictive value 16%).The high benign call rate of current molecular tests in Hürthle cell nodules strengthens their value in enabling patients to avoid surgery.Published by Elsevier Inc.