27 Diagnostic utility of molecular and imaging biomarkers 2 Main advantages Main limitations Cost-effectiveness Perfect specificity at low cost Strong geographical variation in occurrence, clinical utility likely limited to gene mutation panels in countries other than South Korea Presumed, though unpublished. €7.50 to $123 per test [91, 101, 110, 126] High prevalence, frequently detected Often found in follicular adenomas (falsepositive); clinical utility limited to gene mutation panels Unpublished Specific for PTC Low prevalence; clinical utility limited to gene mutation panels Unpublished No significant advantages Low prevalence; utility limited to gene mutation panels Unpublished Comparatively inexpensive mutation panel Specificity often insufficient for surgical decision-making USA: likely [158]. Europe: unlikely [53]. $425 to $1,700 per test [158, 159] Highly accurate; rapidly advancing technology Limited availability outside the USA; limited clinical validation studies Unpublished. €230 to $3,200 per test [161, 162] High rule-out capacity [168, 169, 172, 182] Limited availability outside the USA; limited high-quality clinical validation studies Unlikely [53, 159, 175-178]. $3,500 ($1,750 to $7,000) per test [159, 169, 175] Stable expression irrespective of preservation medium [186, 199] Limited clinical validation, research ongoing Unpublished Global availability; inexpensive. Limited current application in cytology; no methodological consensus; limited validation studies for combinations of immunostains. Unpublished. Up to €20 per test. Global availability, low cost Operator dependency; limited prospective clinical validation; diagnostic accuracy of individual US features insufficient for surgical decision-making Presumed, though unpublished. Global availability, low cost, easily performed during standard US work-up Operator dependency; limited clinical utility studies; alternative elasticity cut-off possibly more useful Presumed, though unpublished. Unavailable Not investigated in indeterminate thyroid nodules n.a. More widely available and lower cost than PET Limited test performance; limited clinical validation studies; exposure to limited dose of ionizing radiation Unclear. USA $669-$1,156, Europe: €119-€500 per scan [177, 300, 301] High rule-out capacity; increasing global availability Exposure to limited dose of ionizing radiation. USA: unpublished. Europe: likely [53]. No ionizing radiation Limited evidence; no methodological consensus; research ongoing unpublished
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