{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:10:30Z","timestamp":1787019030688,"version":"build-2736575974"},"reference-count":25,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Thyroid\u00ae"],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"\n Background:<\/jats:title>\n \n Routine resection of all\n RAS<\/jats:italic>\n -positive nodules may result in overtreatment for up to 50% of patients. We evaluated the management strategy and outcomes of\n RAS<\/jats:italic>\n -positive nodules.\n <\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n Following implementation of reflexive ThyroSPEC\n TM<\/jats:sup>\n molecular testing (MT) for all Bethesda III and IV thyroid nodules in July 2020, we identified patients with isolated\n RAS<\/jats:italic>\n mutations between July 30, 2020, and September 30, 2024, using an institutional prospective thyroid nodule database. Patients were categorized by management strategy: surgery versus surveillance. Exclusion criteria included: absence of ultrasound (US) within 12 months prior to MT, incomplete post-MT management data, comutations with\n RAS<\/jats:italic>\n , initial lobectomy before MT, concomitant fine-needle aspiration-proven papillary thyroid carcinomas or metastatic lymph nodes, and presence of contralateral high-risk nodules. This study represents a retrospective analysis of institutional registry data from a single health care region.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Among 203 patients with\n RAS<\/jats:italic>\n -positive nodules (175 Bethesda III, 28 Bethesda IV), 126 (62%) underwent surgery and 77 (38%) were under surveillance (median follow-up: 24 months, interquartile range 14\u201337). Final pathology in surgery group revealed malignancy in 43 (34%), with 8 (19%) 2025 American Thyroid Association (ATA) intermediate-high or high risk, 57 (45%) benign lesions, and 26 (21%) neoplasms of uncertain or very low malignant potential. Surgical patients were younger (45 vs. 53 years,\n p<\/jats:italic>\n = 0.001) with larger nodules (maximum diameter 2.9 vs. 2.5 cm, volume 6.2 vs. 3.8 cm\n 3<\/jats:sup>\n ,\n p<\/jats:italic>\n < 0.05 for both). Bethesda III nodules were more frequently managed with surveillance than surgery (95% vs. 81%,\n p<\/jats:italic>\n = 0.010). Nuclear atypia was more frequent in malignant versus benign resected nodules (70% vs. 40%,\n p<\/jats:italic>\n = 0.007). Seven patients crossed over to surgery during surveillance due to patient preference, nodule growth, or symptoms; two had malignant pathology (both ATA low-intermediate risk). Nodule stability was evaluated in 48 surveillance patients with at least one post-MT US and minimum 1-year follow-up. Using a threshold of 50%, 3\/48 (6%) exhibited growth, with a 2% cumulative incidence of growth at 2 years.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n \n Isolated\n RAS<\/jats:italic>\n mutation alone may not uniformly mandate surgery. Active surveillance represents a viable and safe alternative to surgery in appropriately selected patients with\n RAS<\/jats:italic>\n -positive nodules, though further long-term data are needed.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/10507256261429119","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T10:17:20Z","timestamp":1773224240000},"page":"363-372","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Outcomes of Patients with\n RAS<\/i>\n -Positive Bethesda III and IV Cytology Thyroid Nodules"],"prefix":"10.1177","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6989-0759","authenticated-orcid":false,"given":"Jiahui","family":"Wu","sequence":"first","affiliation":[{"name":"Cumming School of Medicine, and Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin","family":"Yeo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jackson","family":"Qi","sequence":"additional","affiliation":[{"name":"Cumming School of Medicine, and Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sana","family":"Ghaznavi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of Endocrinology, Cumming School of Medicine, University of Calgary, Calgary, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moosa","family":"Khalil","sequence":"additional","affiliation":[{"name":"Alberta Precision Laboratories, Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Nohr","sequence":"additional","affiliation":[{"name":"Alberta Precision Laboratories, Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Box","sequence":"additional","affiliation":[{"name":"Alberta Precision Laboratories, Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Eszlinger","sequence":"additional","affiliation":[{"name":"Department of Oncology, Cumming School of Medicine, and Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Paschke","sequence":"additional","affiliation":[{"name":"Departments of Medicine, Oncology, Pathology and Laboratory Medicine, Biochemistry and Molecular Biology, and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, 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