ENT 2026

Thyroid tumours of uncertain malignant potential (TT-UMP) represent a diagnostically challenging group of low-risk thyroid neoplasms (LRTN) that exhibit overlapping features between benign adenomas and malignant carcinomas. Despite being formally recognised in the World Health Organization (WHO) classification of thyroid tumours, standardised clinical management and follow-up strategies remain poorly defined due to the paucity of data upon which to provide guidance. This study evaluates the current evidence surrounding the incidence, pathological characteristics, management and prognostic outcomes of TT-UMP, aiming to provide an evidence based clinical approach.A systematic review and meta-analysis of the literature was performed finding 221 articles matching search criteria. These were screened finding 23 relevant articles, of which 17 were accessed and reviewed. Data from the review was compared with that of benign thyroid nodules (TN) and papillary microcarcinomas, TT-UMP accounts for 1.49% of TN. The recurrence rate was 1.94%. Disease specific mortality is very low at 0.21% and both recurrence and mortality are associated with telomerase reverse transcriptase (TERT) mutation. There was no significant difference in disease specific mortality between TT-UMP and benign TN or PTMC or disease recurrence between TT-UMP and benign TN. PTMC had significantly greater disease recurrence when compared to TT-UMP, ConclusionThis systematic review recommends management with diagnostic hemithyroidectomy and further therapy if high risk features are present. TT-UMP without other risk factors should be followed up at 6-12 months and discharge following this. TT-UMP displays a low malignant potential and excellent long-term prognosis when managed conservatively.

Mykola Korolchuk is an ENT Clinical Fellow and Anatomy Demonstrator at Cambridge University Hospitals and the University of Cambridge. He completed his medical degree at Imperial College London before undertaking Core Surgical Training in the Kent, Surrey and Sussex Deanery, with dedicated ENT experience at Royal Surrey County Hospital, East Surrey Hospital and Guy’s and St Thomas’ NHS Foundation Trust. He holds MRCS (ENT) and has a developing clinical and academic interest in head and neck surgery, particularly thyroid and head and neck oncology. His research interests include thyroid pathology, surgical outcomes and evidence-based management. He is also actively involved in postgraduate surgical education and anatomy teaching at Cambridge.