In this article we highlight the importance of using cost-effective diagnostic methods for thyroid cancer diagnosis, particularly through Galectin-3 based immunohistochemistry. This approach is especially crucial for low- and middle-income countries, where financial constraints can limit access to advanced diagnostic solutions.

Global Pandemic of Thyroid Nodules

Thyroid nodules (TNs) are highly prevalent, affecting approximately one in four people globally, and their management poses a significant financial burden on healthcare systems, especially in low- and middle-income countries (LMICs).

Diagnostic Challenges

The primary challenge is identifying the rare malignant nodules among the multitude of benign ones to avoid unnecessary surgery. Cytologically indeterminate thyroid nodules (Bethesda categories III and IV) are particularly problematic.

Advanced Molecular Tests

Advanced molecular tests, such as Gene Expression Classifier (GEC), BRAF mutation analysis, and mutation/fusion (M/F) panels, are accurate but expensive (costing up to $3,000 to $5,000 per test). These tests are often covered by insurance in high-income countries but are not feasible for many LMICs due to their high cost.

Galectin-3 Immunohistochemistry

Galectin-3 based immunohistochemistry (IHC) is a cost-effective and reliable method for diagnosing thyroid cancer. This test is particularly effective for indeterminate thyroid nodules and has been validated in several multicentric clinical trials. With a cost of approximately $100, it is significantly cheaper than advanced molecular tests.

Diagnostic Performance

Galectin-3 ThyroTest has a sensitivity of 83%, specificity of 85%, and an accuracy of 84%. This is comparable to, though not as high as, some advanced molecular tests. However, its low cost and ease of performance make it a viable option, especially in resource-limited settings.

Cost-Effective Thyroid Cancer Diagnosis

LMICs need cost-effective analyses and priority-setting in thyroid cancer diagnosis. Galectin-3 ThyroTest, a laboratory-developed test (LDT), is not commercially distributed but can be integrated into patient care without the need for extensive regulatory approval. This makes it more accessible and cost-effective compared to commercially marketed advanced molecular tests.

Future Perspectives

Galectin-3 ThyroTest could serve as an initial diagnostic step, with advanced molecular methods used as an adjunctive option for nodules with inconclusive results. This approach could significantly reduce the socioeconomic burden of managing suspicious thyroid nodules, particularly in LMICs.

Conclusion

Galectin-3 based immunohistochemistry is a valuable and cost-effective method for diagnosing thyroid cancer, especially in settings where advanced molecular tests are financially unfeasible. There’s a need to recognize and utilize such “good enough” methods to improve healthcare outcomes and reduce the economic burden associated with thyroid cancer management. The integration of Galectin-3 testing can pave the way for better accessibility to diagnostic resources in low-resource environments.