524 chapter 13 Final remarks The accurate diagnosis of cytologically indeterminate thyroid nodules remains challenging. The results of this thesis have shown that [18F]FDG-PET/CT can be a valuable addition to the routine diagnostic workup, as it cost-effectively reduces the number of futile diagnostic surgeries for benign nodules in an oncologically safe manner while sustaining HRQoL. The rule-out capabilities of [18F] FDG-PET/CT are competitive with MD, even though the latter may have already taken a firmer global position in the diagnostic routine. The local decision favouring or opposing a certain diagnostic may vary globally, depending on local expertise, accessibility to the different techniques, case-mix, and cost-effectiveness considerations. Regardless of which diagnostic or combination of diagnostics is preferred, the decision should be a deliberate, multidisciplinary one and consider more general challenges regarding capacity and costs in health care, too. Besides what the EfFECTS trial has taught us about the diagnosis of indeterminate thyroid nodules, it also demonstrated the strength of multidisciplinary research projects for rare conditions and emphasized the added value as well as the ethical and methodological challenges of randomized studies for diagnostic tests.
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