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Valderrabano P, McIver B. Evaluation and Management of Indeterminate Thyroid Nodules: The Revolution of Risk Stratification Beyond Cytological Diagnosis. Cancer Control 2018; 24:1073274817729231. [PMID: 28975825 PMCID: PMC5937245 DOI: 10.1177/1073274817729231] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
In accordance with National Guidelines, we currently follow a linear approach to the diagnosis of thyroid nodules, with management decision based primarily on a cytological diagnosis following fine-needle aspiration biopsy. However, 25% of these biopsies render an indeterminate cytology, leaving uncertainty regarding appropriate management. Individualizing the risk of malignancy of these nodules could improve their management significantly. We summarize the current evidence on the relevance of clinical information, radiological features, cytological features, and molecular markers tests results and describe how these can be integrated to personalize the management of thyroid nodules with indeterminate cytology. Several factors can be used to stratify the risk of malignancy in thyroid nodules with indeterminate cytology. Male gender, large tumors (>4 cm), suspicious sonographic patterns, and the presence of nuclear atypia on the cytology are all associated with an increased cancer prevalence. The added value of current molecular markers in the risk stratification process needs further study because their performance seems compromised in some clinical settings and remains to be validated in others. Risk stratification is possible in thyroid nodules with indeterminate cytology using data that are often underused by current guidelines. Future guidelines should integrate these factors and personalize the recommended diagnostic and therapeutic approaches accordingly.
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Affiliation(s)
- Pablo Valderrabano
- 1 Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Bryan McIver
- 1 Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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52
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Valderrabano P, Khazai L, Thompson ZJ, Leon ME, Otto KJ, Hallanger-Johnson JE, Wadsworth JT, Chung CH, Centeno BA, McIver B. Impact of oncogene panel results on surgical management of cytologically indeterminate thyroid nodules. Head Neck 2018; 40:1812-1823. [PMID: 29624786 DOI: 10.1002/hed.25165] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/15/2017] [Accepted: 02/14/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The impact of oncogene panel results on the surgical management of indeterminate thyroid nodules (ITNs) is currently unknown. METHODS Surgical management of 649 patients consecutively evaluated from October 2008 to April 2016 with a single nodule biopsied and indeterminate cytology (193 evaluated with and 456 without oncogene panels) was assessed and compared. Histological features of 629 consecutively resected ITNs (164 evaluated with and 465 without oncogene panels) were also characterized and compared. RESULTS Oncogene panel evaluation was associated with higher rates of total thyroidectomy (45% vs 28%; P = .006), and central lymph node dissection (19% vs 12%; P = .03) without increasing the yield of malignancy or decreasing the rate of completion thyroidectomy. Most malignancies (64%), including 83% of those with driver mutation identified, were low-risk cancers for which a lobectomy could have been sufficient initial treatment. CONCLUSION Current oncogene panel results seem insufficient to guide the surgical extent of solitary ITNs.
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Affiliation(s)
- Pablo Valderrabano
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Laila Khazai
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Zachary J Thompson
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Marino E Leon
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kristen J Otto
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Julie E Hallanger-Johnson
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - J Trad Wadsworth
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Christine H Chung
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Barbara A Centeno
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Bryan McIver
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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de Koster EJ, de Geus-Oei LF, Dekkers OM, van Engen-van Grunsven I, Hamming J, Corssmit EPM, Morreau H, Schepers A, Smit J, Oyen WJG, Vriens D. Diagnostic Utility of Molecular and Imaging Biomarkers in Cytological Indeterminate Thyroid Nodules. Endocr Rev 2018; 39:154-191. [PMID: 29300866 DOI: 10.1210/er.2017-00133] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 12/27/2017] [Indexed: 12/21/2022]
Abstract
Indeterminate thyroid cytology (Bethesda III and IV) corresponds to follicular-patterned benign and malignant lesions, which are particularly difficult to differentiate on cytology alone. As ~25% of these nodules harbor malignancy, diagnostic hemithyroidectomy is still custom. However, advanced preoperative diagnostics are rapidly evolving.This review provides an overview of additional molecular and imaging diagnostics for indeterminate thyroid nodules in a preoperative clinical setting, including considerations regarding cost-effectiveness, availability, and feasibility of combining techniques. Addressed diagnostics include gene mutation analysis, microRNA, immunocytochemistry, ultrasonography, elastosonography, computed tomography, sestamibi scintigraphy, [18F]-2-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET), and diffusion-weighted magnetic resonance imaging.The best rule-out tests for malignancy were the Afirma® gene expression classifier and FDG-PET. The most accurate rule-in test was sole BRAF mutation analysis. No diagnostic had both near-perfect sensitivity and specificity, and estimated cost-effectiveness. Molecular techniques are rapidly advancing. However, given the currently available techniques, a multimodality stepwise approach likely offers the most accurate diagnosis, sequentially applying one sensitive rule-out test and one specific rule-in test. Geographical variations in cytology (e.g., Hürthle cell neoplasms) and tumor genetics strongly influence local test performance and clinical utility. Multidisciplinary collaboration and implementation studies can aid the local decision for one or more eligible diagnostics.
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Affiliation(s)
- Elizabeth J de Koster
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Olaf M Dekkers
- Department of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Jaap Hamming
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Eleonora P M Corssmit
- Department of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Abbey Schepers
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan Smit
- Department of Endocrinology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wim J G Oyen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.,Division of Radiotherapy and Imaging, Institute of Cancer Research, and Department of Nuclear Medicine, Royal Marsden Hospital, London, United Kingdom
| | - Dennis Vriens
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
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54
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Smith AL, Williams MD, Stewart J, Wang WL, Krishnamurthy S, Cabanillas ME, Roy-Chowdhuri S. Utility of the BRAF p.V600E immunoperoxidase stain in FNA direct smears and cell block preparations from patients with thyroid carcinoma. Cancer Cytopathol 2018; 126:406-413. [PMID: 29579361 DOI: 10.1002/cncy.21992] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/15/2018] [Accepted: 02/15/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND The identification of BRAF mutations in thyroid cancer has prognostic and therapeutic implications. Although the gold standard for identifying BRAF mutations is molecular testing, the ability to perform BRAF p.V600E immunostaining on fine-needle aspiration (FNA) samples can facilitate the rapid triaging of patients to treatment options. METHODS A total of 50 thyroid carcinoma FNA samples, including papillary (29 samples), poorly differentiated (10 samples), anaplastic (9 samples), and Hurthle cell (2 samples) carcinomas, with a known BRAF p.V600E mutation status were selected for the current study. Immunostaining was performed on smears and cell block sections using an anti-BRAF p.V600E antibody (clone VE1). The results were compared with the known mutation status obtained by molecular testing and/or immunostaining of surgical pathology material from the same patient. RESULTS Of the total of 50 cases, 26 cases had smears available for the evaluation of BRAF p.V600E immunostaining; positive immunostaining was noted in 16 samples and negative immunostaining was noted in 4 samples, whereas 6 cases were equivocal. Of the 34 cases for which cell blocks were available for evaluation, BRAF p.V600E immunostaining was positive in 17 cases, negative in 16 cases, and equivocal in 1 case. The overall sensitivity and specificity of BRAF p.V600E immunostaining on the cell block preparation was 94.4% and 100%, respectively, whereas for the smears it was 80% and 63.6%, respectively. CONCLUSIONS BRAF p.V600E immunostaining can be performed reliably on thyroid FNA cell block preparations. However, false-positive results on direct smears limit their utility and therefore need to be interpreted with caution. Cancer Cytopathol 2018;126:406-13. © 2018 American Cancer Society.
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Affiliation(s)
- Amber L Smith
- Division of Pathology and Laboratory Medicine, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michelle D Williams
- Division of Pathology and Laboratory Medicine, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John Stewart
- Division of Pathology and Laboratory Medicine, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wei-Lien Wang
- Division of Pathology and Laboratory Medicine, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Savitri Krishnamurthy
- Division of Pathology and Laboratory Medicine, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Maria E Cabanillas
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sinchita Roy-Chowdhuri
- Division of Pathology and Laboratory Medicine, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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55
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Han LO, Li XY, Cao MM, Cao Y, Zhou LH. Development and validation of an individualized diagnostic signature in thyroid cancer. Cancer Med 2018. [PMID: 29522282 PMCID: PMC5911625 DOI: 10.1002/cam4.1397] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
New molecular signatures are needed to improve the diagnosis of thyroid cancer (TC) and avoid unnecessary surgeries. In this study, we aimed to develop a robust and individualized diagnostic signature in TC. Gene expression profiles of tumor and nontumor samples were from 13 microarray datasets of Gene Expression Omnibus (GEO) database and one RNA‐sequencing dataset of The Cancer Genome Atlas (TCGA). A total of 1246 samples were divided into a training set (N = 435), a test set (N = 247), and one independent validation set (N = 564). In the training set, 115 most frequent differentially expressed genes (DEGs) among the included datasets were used to construct 6555 gene pairs, and 19 significant pairs were detected to further construct the diagnostic signature by a penalized generalized linear model. The signature showed a good diagnostic ability for TC in the training set (area under receiver operating characteristic curve (AUC) = 0.976), test set (AUC = 0.960), and TCGA dataset (AUC = 0.979). Subgroup analyses showed consistent results when considering the type of nontumor samples and microarray platforms. When compared with two existing molecular signatures in the diagnosis of thyroid nodules, the signature (AUC = 0.933) also showed a higher diagnostic ability (AUC = 0.886 for a 7‐gene signature and AUC = 0.892 for a 10‐gene signature). In conclusion, our study developed and validated an individualized diagnostic signature in TC. Large‐scale prospective studies were needed to further validate its diagnostic ability.
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Affiliation(s)
- Li-Ou Han
- Department of Thyroid Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Xin-Yu Li
- Department of Endocrinology, the First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Ming-Ming Cao
- Department of Endocrinology, the First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Yan Cao
- Department of Endocrinology, the First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Li-Hong Zhou
- Department of Endocrinology, the First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
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Vargas-Salas S, Martínez JR, Urra S, Domínguez JM, Mena N, Uslar T, Lagos M, Henríquez M, González HE. Genetic testing for indeterminate thyroid cytology: review and meta-analysis. Endocr Relat Cancer 2018; 25:R163-R177. [PMID: 29255094 PMCID: PMC5799829 DOI: 10.1530/erc-17-0405] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/18/2017] [Indexed: 12/14/2022]
Abstract
Thyroid cancer is the most frequent endocrine malignancy, and its incidence is increasing. A current limitation of cytological evaluation of thyroid nodules is that 20-25% are reported as indeterminate. Therefore, an important challenge for clinicians is to determine whether an indeterminate nodule is malignant, and should undergo surgery, or benign, and should be recommended to follow-up. The emergence of precision medicine has offered a valuable solution for this problem, with four tests currently available for the molecular diagnosis of indeterminate cytologies. However, efforts to critically analyze the quality of the accumulated evidence are scarce. This systematic review and meta-analysis is aimed to contribute to a better knowledge about the four available molecular tests, their technical characteristics, clinical performance, and ultimately to help clinicians to make better decisions to provide the best care options possible. For this purpose, we address three critical topics: (i) the proper theoretical accuracy, considering the intended clinical use of the test (rule-in vs rule-out) and the impact on clinical decisions; (ii) the quality of the evidence reported for each test (iii) and how accurate and effective have the tests proved to be after their clinical use. Together with the upcoming evidence, this work provides significant and useful information for healthcare system decision-makers to consider the use of molecular testing as a public health need, avoiding unnecessary surgical risks and costs.
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Affiliation(s)
- Sergio Vargas-Salas
- Department of Surgical OncologyFaculty of Medicine, Pontificia Universidad Católica de Chile , Santiago, Chile
| | - José R Martínez
- Department of Surgical OncologyFaculty of Medicine, Pontificia Universidad Católica de Chile , Santiago, Chile
| | - Soledad Urra
- Department of Surgical OncologyFaculty of Medicine, Pontificia Universidad Católica de Chile , Santiago, Chile
| | - José Miguel Domínguez
- Department of EndocrinologyFaculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Thomas Uslar
- Department of Internal MedicinePontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcela Lagos
- Department of Clinical LaboratoriesFaculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcela Henríquez
- Department of Clinical LaboratoriesFaculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Hernán E González
- Department of Surgical OncologyFaculty of Medicine, Pontificia Universidad Católica de Chile , Santiago, Chile
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Díaz Del Arco C, Fernández Aceñero MJ. Molecular diagnostic techniques in cytopathology: From the bench to the patient's bedside. Diagn Cytopathol 2018; 46:620-623. [PMID: 29446247 DOI: 10.1002/dc.23903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 01/17/2018] [Accepted: 01/31/2018] [Indexed: 12/13/2022]
Abstract
Molecular techniques are increasingly used in everyday practice for patient diagnosis and also to guide therapy. Their application in cytological specimens can allow a more cost-effective management with fewer risks. However, standardized protocols are needed to guarantee accurate and reproducible results. We herein report five practical examples of the application of ancillary techniques in cytopathology and review the literature on the issue, highlighting the practical aspects of sample management.
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58
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Partyka KL, Randolph ML, Lawrence KA, Cramer H, Wu HH. Utilization of direct smears of thyroid fine-needle aspirates for ancillary molecular testing: A comparison of two proprietary testing platforms. Diagn Cytopathol 2018; 46:320-325. [PMID: 29446257 DOI: 10.1002/dc.23902] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/25/2018] [Accepted: 01/31/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Ancillary molecular testing has been recommended for thyroid fine-needle aspirates (FNA) with indeterminate cytologic diagnoses. Rosetta Genomics and Interpace Diagnostics have developed assays that can utilize direct smears as the testing substrate. METHODS A retrospective study of indeterminate thyroid FNAs with known histologic follow-up was performed. One Diff-Quik-stained smear and one Papanicolaou-stained smear with similar cellularity (at least 60-100 lesional cells) from each case were sent to Rosetta and Interpace, respectively, for analysis. The results were directly compared and correlated with the final histopathology. Neither company was aware of the follow-up histologic findings in these cases. RESULTS A total of 10 thyroid FNAs were identified from our 2015 files. The cytologic diagnoses included follicular lesion of undetermined significance (FLUS, n = 5), follicular neoplasm/suspicious for follicular neoplasm (FN/SFN, n = 4), and suspicious for malignancy (SM, n = 1). Of the seven cases with benign histology, six smears were classified as benign by the RosettaGX microRNA classifier, and one case was designated as suspicious. Five cases were negative by both ThyGenX oncogene panel and ThyraMIR microRNA classifier. One case was negative by ThyGenX and positive on follow-up ThyraMIR, and one case was positive for KRAS mutation and positive on ThyraMIR. Both the RosettaGX and ThyGenX/ThyraMIR tests demonstrated positive results for the three histologically malignant cases. CONCLUSION This study demonstrates that two molecular testing platforms performed equally well using our stained direct smears. Both molecular tests revealed a 100% negative predictive rate. RosettaGX showed a 75% positive predictive value in comparison to 60% for ThyGenX/ThyraMIR.
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Affiliation(s)
- Kristen L Partyka
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Melissa L Randolph
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Karen A Lawrence
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Harvey Cramer
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Howard H Wu
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Dom G, Frank S, Floor S, Kehagias P, Libert F, Hoang C, Andry G, Spinette A, Craciun L, de Saint Aubin N, Tresallet C, Tissier F, Savagner F, Majjaj S, Gutierrez-Roelens I, Marbaix E, Dumont JE, Maenhaut C. Thyroid follicular adenomas and carcinomas: molecular profiling provides evidence for a continuous evolution. Oncotarget 2018; 9:10343-10359. [PMID: 29535811 PMCID: PMC5828225 DOI: 10.18632/oncotarget.23130] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/14/2017] [Indexed: 12/18/2022] Open
Abstract
Non-autonomous thyroid nodules are common in the general population with a proportion found to be cancerous. A current challenge in the field is to be able to distinguish benign adenoma (FA) from preoperatively malignant thyroid follicular carcinoma (FTC), which are very similar both histologically and genetically. One controversial issue, which is currently not understood, is whether both tumor types represent different molecular entities or rather a biological continuum. To gain a better insight into FA and FTC tumorigenesis, we defined their molecular profiles by mRNA and miRNA microarray. Expression data were analyzed, validated by qRT-PCR and compared with previously published data sets. The majority of deregulated mRNAs were common between FA and FTC and were downregulated, however FTC showed additional deregulated mRNA. Both types of tumors share deregulated pathways, molecular functions and biological processes. The additional deregulations in FTC include the lipid transport process that may be involved in tumor progression. The strongest candidate genes which may be able to discriminate follicular adenomas and carcinomas, CRABP1, FABP4 and HMGA2, were validated in independent samples by qRT-PCR and immunohistochemistry. However, they were not able to adequately classify FA or FTC, supporting the notion of continuous evolving tumors, whereby FA and FTC appear to show quantitative rather than qualitative changes. Conversely, miRNA expression profiles showed few dysregulations in FTC, and even fewer in FA, suggesting that miRNA play a minor, if any, role in tumor progression.
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Affiliation(s)
- Geneviève Dom
- Institute of Interdisciplinary Research (IRIBHM), Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Sandra Frank
- Institute of Interdisciplinary Research (IRIBHM), Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Sebastien Floor
- Institute of Interdisciplinary Research (IRIBHM), Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Pashalina Kehagias
- Institute of Interdisciplinary Research (IRIBHM), Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Frederick Libert
- Institute of Interdisciplinary Research (IRIBHM), Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Catherine Hoang
- Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France
| | - Guy Andry
- Institut Jules Bordet, Brussels, Belgium
| | | | | | | | | | - Frederique Tissier
- Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France
| | | | | | - Ilse Gutierrez-Roelens
- Biolibrary of the King Albert II Institute, Cliniques Universitaires Saint-Luc, and Institut de Duve, Université Catholique de Louvain, Brussels, Belgium
| | - Etienne Marbaix
- Biolibrary of the King Albert II Institute, Cliniques Universitaires Saint-Luc, and Institut de Duve, Université Catholique de Louvain, Brussels, Belgium
| | - Jacques E. Dumont
- Institute of Interdisciplinary Research (IRIBHM), Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Carine Maenhaut
- Institute of Interdisciplinary Research (IRIBHM), Université libre de Bruxelles (ULB), Brussels, Belgium
- WELBIO, School of Medicine, Université libre de Bruxelles, Brussels, Belgium
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60
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Guseva NV, Jaber O, Stence AA, Sompallae K, Bashir A, Sompallae R, Bossler AD, Jensen CS, Ma D. Simultaneous detection of single-nucleotide variant, deletion/insertion, and fusion in lung and thyroid carcinoma using cytology specimen and an RNA-based next-generation sequencing assay. Cancer Cytopathol 2018; 126:158-169. [DOI: 10.1002/cncy.21963] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/03/2017] [Accepted: 10/17/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Natalya V. Guseva
- Department of Pathology; University of Iowa Hospitals and Clinics; Iowa City Iowa
| | - Omar Jaber
- Department of Pathology; King Hussein Cancer Center; Amman Jordan
| | - Aaron A. Stence
- Department of Pathology; University of Iowa Hospitals and Clinics; Iowa City Iowa
| | | | - Amani Bashir
- Department of Pathology; University of Iowa Hospitals and Clinics; Iowa City Iowa
| | | | - Aaron D. Bossler
- Department of Pathology; University of Iowa Hospitals and Clinics; Iowa City Iowa
| | - Chris S. Jensen
- Department of Pathology; University of Iowa Hospitals and Clinics; Iowa City Iowa
| | - Deqin Ma
- Department of Pathology; University of Iowa Hospitals and Clinics; Iowa City Iowa
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61
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Nishino M, Nikiforova M. Update on Molecular Testing for Cytologically Indeterminate Thyroid Nodules. Arch Pathol Lab Med 2018; 142:446-457. [PMID: 29336606 DOI: 10.5858/arpa.2017-0174-ra] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - Approximately 15% to 30% of thyroid nodules that undergo fine-needle aspiration are classified as cytologically indeterminate, presenting management challenges for patients and clinicians alike. During the past several years, several molecular tests have been developed to reduce the diagnostic uncertainty of indeterminate thyroid fine-needle aspirations. OBJECTIVE - To review the methodology, clinical validation, and recent peer-reviewed literature for 4 molecular tests that are currently marketed for cytologically indeterminate thyroid fine-needle aspiration specimens: Afirma, ThyroSeq, ThyGenX/ThyraMIR, and RosettaGX Reveal. DATA SOURCES - Peer-reviewed literature retrieved from PubMed search, data provided by company websites and representatives, and authors' personal experiences. CONCLUSIONS - The 4 commercially available molecular tests for thyroid cytology offer unique approaches to improve the risk stratification of thyroid nodules. Familiarity with data from the validation studies as well as the emerging literature about test performance in the postvalidation setting can help users to select and interpret these tests in a clinically meaningful way.
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Affiliation(s)
| | - Marina Nikiforova
- From the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Nishino); and the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Nikiforova)
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62
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Saiselet M, Pita JM, Augenlicht A, Dom G, Tarabichi M, Fimereli D, Dumont JE, Detours V, Maenhaut C. miRNA expression and function in thyroid carcinomas: a comparative and critical analysis and a model for other cancers. Oncotarget 2018; 7:52475-52492. [PMID: 27248468 PMCID: PMC5239568 DOI: 10.18632/oncotarget.9655] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/16/2016] [Indexed: 12/15/2022] Open
Abstract
As in many cancer types, miRNA expression profiles and functions have become an important field of research on non-medullary thyroid carcinomas, the most common endocrine cancers. This could lead to the establishment of new diagnostic tests and new cancer therapies. However, different studies showed important variations in their research strategies and results. In addition, the action of miRNAs is poorly considered as a whole because of the use of underlying dogmatic truncated concepts. These lead to discrepancies and limits rarely considered. Recently, this field has been enlarged by new miRNA functional and expression studies. Moreover, studies using next generation sequencing give a new view of general miRNA differential expression profiles of papillary thyroid carcinoma. We analyzed in detail this literature from both physiological and differential expression points of view. Based on explicit examples, we reviewed the progresses but also the discrepancies and limits trying to provide a critical approach of where this literature may lead. We also provide recommendations for future studies. The conclusions of this systematic analysis could be extended to other cancer types.
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Affiliation(s)
- Manuel Saiselet
- Institute of Interdisciplinary Research (IRIBHM), University of Brussels, Brussels, Belgium
| | - Jaime M Pita
- Institute of Interdisciplinary Research (IRIBHM), University of Brussels, Brussels, Belgium
| | - Alice Augenlicht
- Institute of Interdisciplinary Research (IRIBHM), University of Brussels, Brussels, Belgium
| | - Geneviève Dom
- Institute of Interdisciplinary Research (IRIBHM), University of Brussels, Brussels, Belgium
| | - Maxime Tarabichi
- Institute of Interdisciplinary Research (IRIBHM), University of Brussels, Brussels, Belgium
| | - Danai Fimereli
- Institute of Interdisciplinary Research (IRIBHM), University of Brussels, Brussels, Belgium
| | - Jacques E Dumont
- Institute of Interdisciplinary Research (IRIBHM), University of Brussels, Brussels, Belgium
| | - Vincent Detours
- Institute of Interdisciplinary Research (IRIBHM), University of Brussels, Brussels, Belgium
| | - Carine Maenhaut
- Institute of Interdisciplinary Research (IRIBHM), University of Brussels, Brussels, Belgium.,WELBIO, School of Medicine, University of Brussels, Brussels, Belgium
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Taye A, Gurciullo D, Miles BA, Gupta A, Owen RP, Inabnet WB, Beyda JN, Marti JL. Clinical performance of a next-generation sequencing assay (ThyroSeq v2) in the evaluation of indeterminate thyroid nodules. Surgery 2018; 163:97-103. [DOI: 10.1016/j.surg.2017.07.032] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/12/2017] [Accepted: 07/06/2017] [Indexed: 01/21/2023]
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64
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Sahli ZT, Smith PW, Umbricht CB, Zeiger MA. Preoperative Molecular Markers in Thyroid Nodules. Front Endocrinol (Lausanne) 2018; 9:179. [PMID: 29720964 PMCID: PMC5915469 DOI: 10.3389/fendo.2018.00179] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/03/2018] [Indexed: 12/12/2022] Open
Abstract
The need for distinguishing benign from malignant thyroid nodules has led to the pursuit of differentiating molecular markers. The most common molecular tests in clinical use are Afirma® Gene Expression Classifier (GEC) and Thyroseq® V2. Despite the rapidly developing field of molecular markers, several limitations exist. These challenges include the recent introduction of the histopathological diagnosis "Non-Invasive Follicular Thyroid neoplasm with Papillary-like nuclear features", the correlation of genetic mutations within both benign and malignant pathologic diagnoses, the lack of follow-up of molecular marker negative nodules, and the cost-effectiveness of molecular markers. In this manuscript, we review the current published literature surrounding the diagnostic value of Afirma® GEC and Thyroseq® V2. Among Afirma® GEC studies, sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) ranged from 75 to 100%, 5 to 53%, 13 to 100%, and 20 to 100%, respectively. Among Thyroseq® V2 studies, Se, Sp, PPV, and NPV ranged from 40 to 100%, 56 to 93%, 13 to 90%, and 48 to 97%, respectively. We also discuss current challenges to Afirma® GEC and Thyroseq® V2 utility and clinical application, and preview the future directions of these rapidly developing technologies.
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Affiliation(s)
- Zeyad T. Sahli
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Philip W. Smith
- Department of Surgery, University of Virginia, Charlottesville, VA, United States
| | - Christopher B. Umbricht
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Martha A. Zeiger
- Department of Surgery, University of Virginia, Charlottesville, VA, United States
- *Correspondence: Martha A. Zeiger,
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65
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Ferraz C. Can current molecular tests help in the diagnosis of indeterminate thyroid nodule FNAB? ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2018; 62:576-584. [PMID: 30624496 PMCID: PMC10118674 DOI: 10.20945/2359-3997000000081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/06/2018] [Indexed: 11/23/2022]
Abstract
Approximately 15-30% of all thyroid nodules evaluated with fine-needle aspiration biopsy (FNAB) are classified as cytologically indeterminate. The stepwise unraveling of the molecular etiology of thyroid nodules has provided the basis for a better understanding of indeterminate samples and an opportunity to decrease diagnostic surgery in this group of patients. Over the last 15 years, several studies have tested different methodologies to detect somatic mutations (by polymerase chain reaction and next-generation sequencing, for example), and to identify differentially expressed genes or microRNA, aiming at developing molecular tests to improve the presurgical diagnosis of cytologically indeterminate nodules. In this review, we will provide an overview of the currently available molecular tests and the impact of mutation testing on the diagnosis of thyroid cancer. We will also review current published data and future perspectives in molecular testing of thyroid nodule FNAB and describe the current Brazilian experience with this diagnostic approach. Based on currently available data, especially for countries outside the US-Europe axis, a rational use of these tests must be made to avoid errors with regard to test indication and interpretation of test outcomes. In addition to clinical, radiological, and cytological features, we still need to determine local malignancy rates and conduct more independent validation and comparative performance studies of these tests before including them into our routine approach to indeterminate FNAB.
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Li W, Sciallis A, Lew M, Pang J, Jing X. Implementing noninvasive follicular thyroid neoplasm with papillary-like nuclear features may potentially impact the risk of malignancy for thyroid nodules categorized as AUS/FLUS and FN/SFN. Diagn Cytopathol 2017; 46:148-153. [DOI: 10.1002/dc.23866] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/02/2017] [Accepted: 11/17/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Weihong Li
- Department of Pathology; The University of Michigan Health System; Ann Arbor Michigan
| | - Andrew Sciallis
- Department of Pathology; The University of Michigan Health System; Ann Arbor Michigan
| | - Madelyn Lew
- Department of Pathology; The University of Michigan Health System; Ann Arbor Michigan
| | - Judy Pang
- Department of Pathology; The University of Michigan Health System; Ann Arbor Michigan
| | - Xin Jing
- Department of Pathology; The University of Michigan Health System; Ann Arbor Michigan
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Poller DN, Glaysher S. Molecular pathology and thyroid FNA. Cytopathology 2017; 28:475-481. [DOI: 10.1111/cyt.12492] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2017] [Indexed: 12/15/2022]
Affiliation(s)
- D. N. Poller
- Department of Pathology & Cancer Laboratory; Queen Alexandra Hospital; Portsmouth UK
| | - S. Glaysher
- Department of Pathology & Cancer Laboratory; Queen Alexandra Hospital; Portsmouth UK
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Sahli ZT, Umbricht CB, Schneider EB, Zeiger MA. Thyroid Nodule Diagnostic Markers in the Face of the New NIFTP Category: Time for a Reset? Thyroid 2017; 27:1393-1399. [PMID: 28859553 DOI: 10.1089/thy.2017.0238] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Current thyroid molecular tests are specifically designed for the differential diagnosis of nodules with indeterminate or suspicious fine-needle aspiration (FNA) cytology. SUMMARY However, their clinical validity faces challenges from both variation among institutions in cancer prevalence and, most recently, the new category of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). The latter diagnosis was previously classified as malignant. Relevant to this, all molecular panels on the market today were originally tested and validated within the context of these entities being considered malignant. CONCLUSION This review examines possible effects of the NIFTP reclassification as a precancerous lesion on the original validation studies and, investigates the effect of the significant reported variability in thyroid cancer prevalence on the performance of these tests.
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MESH Headings
- Adenocarcinoma, Follicular/classification
- Adenocarcinoma, Follicular/epidemiology
- Adenocarcinoma, Follicular/genetics
- Adenocarcinoma, Follicular/pathology
- Biomarkers, Tumor/genetics
- Biopsy, Fine-Needle
- Carcinoma, Papillary/classification
- Carcinoma, Papillary/epidemiology
- Carcinoma, Papillary/genetics
- Carcinoma, Papillary/pathology
- Diagnosis, Differential
- Gene Expression Profiling
- Humans
- Predictive Value of Tests
- Prevalence
- Prognosis
- Terminology as Topic
- Thyroid Cancer, Papillary
- Thyroid Neoplasms/classification
- Thyroid Neoplasms/epidemiology
- Thyroid Neoplasms/genetics
- Thyroid Neoplasms/pathology
- Thyroid Nodule/classification
- Thyroid Nodule/epidemiology
- Thyroid Nodule/genetics
- Thyroid Nodule/pathology
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Affiliation(s)
- Zeyad T Sahli
- 1 Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Christopher B Umbricht
- 2 Departments of Oncology, Pathology, and Surgery, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Eric B Schneider
- 3 Health Services Outcomes Research Center, The Ohio State University College of Medicine , Department of Surgery, Columbus, Ohio
| | - Martha A Zeiger
- 1 Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine , Baltimore, Maryland
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Sollini M, Cozzi L, Pepe G, Antunovic L, Lania A, Di Tommaso L, Magnoni P, Erba PA, Kirienko M. [ 18F]FDG-PET/CT texture analysis in thyroid incidentalomas: preliminary results. Eur J Hybrid Imaging 2017; 1:3. [PMID: 29782578 PMCID: PMC5954705 DOI: 10.1186/s41824-017-0009-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 09/01/2017] [Indexed: 02/08/2023] Open
Abstract
Background significance of incidental thyroid 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) uptake on positron emission tomography/computed tomography (PET/CT) scans remains controversial. We aimed to evaluate the ability of [18F]FDG-PET/CT texture analysis to predict final diagnosis in thyroid incidentaloma. Methods We retrospectively evaluated medical records of all patients who performed a [18F]FDG-PET/CT from January 2012 to October 2016. Those patients who presented a thyroid incidentaloma described in the medical records and performed a fine needle aspiration in our institution were considered for the analysis. Cytological and/or histological results were used as reference standard to define the final diagnosis. In case of negative cytology, the nodule was considered benign. In case of non-diagnostic or inconclusive results ultrasound, follow-up and further cytology/histology were used as final diagnosis. For suspected or positive cytological result, histology was used as reference standard. PET images were segmented using a General Electric AW workstation running PET VCAR software (GE Healthcare, Waukesha, WI, USA) settled with a threshold of 40% SUVmax. LifeX software (http://www.lifexsoft.org) was used to perform texture analysis. Statistical analysis was performed with R package (https://www.r-project.org). Results We identified 55 patients with incidental thyroid [18F]FDG uptake. Five patients were excluded from the analysis because a final diagnosis was not available. Thirty-two out of 50 patients had benign nodules while in 18/50 cases a malignancy (primary thyroid cancer = 15, metastases = 3) was diagnosed. Conventional PET parameters and histogram-based features were calculated for all 50 patients, while other matrices-based features were available for 28/50 patients. SUVmax and skewness resulted significantly different in benign and malignant nodules (p = 0.01 and = 0.02, respectively). Using ROC analysis, seven features were identified as potential predictors. Among all the textural features tested, skewness showed the best area under the curve (= 0.66). SUV-based parameters resulted in the highest specificity while MTV, TLG, skewness and kurtosis, as well as correlationGLCM resulted better in sensitivity. Conclusions [18F]FDG-PET/CT texture analysis seems to be a promising approach to stratify the patients with thyroid incidentaloma identified on PET scans, with respect to the risk of the diagnosis of a malignant thyroid nodule and thus, could refine the selection of the patients to be referred for cytology.
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Affiliation(s)
- M Sollini
- 1Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini, 20090 Pieve Emanuele (Milan), Italy
| | - L Cozzi
- 2Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy.,1Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini, 20090 Pieve Emanuele (Milan), Italy
| | - G Pepe
- 3Nuclear Medicine, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - L Antunovic
- 3Nuclear Medicine, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - A Lania
- 1Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini, 20090 Pieve Emanuele (Milan), Italy.,4Endocrinology, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - L Di Tommaso
- 1Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini, 20090 Pieve Emanuele (Milan), Italy.,5Pathology, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - P Magnoni
- 6Ultrasound Service, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - P A Erba
- 7Regional Center of Nuclear Medicine, University of Pisa, via Roma 55, 56025 Pisa, Italy
| | - M Kirienko
- 1Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini, 20090 Pieve Emanuele (Milan), Italy
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70
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Lasolle H, Riche B, Decaussin-Petrucci M, Dantony E, Lapras V, Cornu C, Lachuer J, Peix JL, Lifante JC, Capraru OM, Selmi-Ruby S, Rousset B, Borson-Chazot F, Roy P. Predicting thyroid nodule malignancy at several prevalence values with a combined Bethesda-molecular test. Transl Res 2017; 188:58-66.e1. [PMID: 28797549 DOI: 10.1016/j.trsl.2017.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 07/06/2017] [Accepted: 07/18/2017] [Indexed: 01/21/2023]
Abstract
Investigation of thyroid nodules using fine-needle aspiration cytology (FNAC) gives indeterminate results in up to 30% of samples using the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). We present a combined Bethesda-molecular predictor of nodule malignancy to improve the accuracy of the preoperative diagnosis of thyroid nodules. To detect a molecular signature of thyroid nodule malignancy, a molecular test was performed on FNACs from 128 thyroid nodules from prospectively included patients, collected in a tertiary center. The test relied on a transcriptomic array of 20 genes selected from a previous study. An optimal set of seven genes was identified using a logistic regression model. Comparison between the combined predictor (TBSRTC + molecular) and TBSRTC alone used the area under the ROC curve (AUC). Performance of the combined predictor was calculated according to various malignancy prevalence values and benefit-to-harm ratios (B/Hr) (favoring sensitivity or specificity). In our population (36% malignancy prevalence) and with a B/Hr of 1, the combined predictor achieved 95% specificity and 76% sensitivity. The AUC was 93.5%; higher than that of TBSRTC (P = 0.004). Among indeterminate nodules (30% malignancy prevalence), sensitivity and specificity were 52.2% and 96.2%, respectively, with a B/Hr of 1, or 95.7% and 64.2% with a B/Hr of 4 (favoring sensitivity), allowing avoidance of 64% of unnecessary surgeries at the cost of only one false-positive result. In conclusion, this predictor could improve the detection of thyroid nodule malignancy, taking into account malignancy prevalence and B/Hr, and reduce the number of unnecessary thyroidectomies.
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Affiliation(s)
- Hélène Lasolle
- Fédération d'Endocrinologie, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France; Université Lyon 1, Lyon, France; Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; CNRS UMR5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France.
| | - Benjamin Riche
- Université Lyon 1, Lyon, France; Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; CNRS UMR5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Myriam Decaussin-Petrucci
- Université Lyon 1, Lyon, France; Service d'anatomie-pathologique, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Emmanuelle Dantony
- Université Lyon 1, Lyon, France; Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; CNRS UMR5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Véronique Lapras
- Service de Radiologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Catherine Cornu
- Université Lyon 1, Lyon, France; INSERM, CIC1407, Bron, France; Service de Pharmacologie Clinique, Hospices Civils de Lyon, Bron, France
| | - Joël Lachuer
- Université Lyon 1, Lyon, France; Centre de Recherche en Cancérologie de Lyon, INSERM, U 1052, Lyon, France; ProfileXpert, SFR santé Lyon Est, UMS 3453 CNRS - US7 INSERM, Lyon, France
| | - Jean-Louis Peix
- Université Lyon 1, Lyon, France; Service de Chirurgie Digestive et Endocrinienne, Hôpital Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Jean-Christophe Lifante
- Université Lyon 1, Lyon, France; Service de Chirurgie Digestive et Endocrinienne, Hôpital Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Oana-Maria Capraru
- Fédération d'Endocrinologie, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France; Centre de Recherche en Cancérologie de Lyon, INSERM, U 1052, Lyon, France; University of Medicine and Pharmacy, Tirgu Mures, Romania
| | - Samia Selmi-Ruby
- Université Lyon 1, Lyon, France; Centre de Recherche en Cancérologie de Lyon, INSERM, U 1052, Lyon, France
| | - Bernard Rousset
- Université Lyon 1, Lyon, France; Centre de Recherche en Cancérologie de Lyon, INSERM, U 1052, Lyon, France
| | - Françoise Borson-Chazot
- Fédération d'Endocrinologie, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France; Université Lyon 1, Lyon, France; Centre de Recherche en Cancérologie de Lyon, INSERM, U 1052, Lyon, France
| | - Pascal Roy
- Université Lyon 1, Lyon, France; Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; CNRS UMR5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
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Young NA, Win KK, Pomo L, Anastasopoulou C, Minimo C, Mayrin J. An academic community hospital experience using commercially available molecular testing in the management of indeterminate thyroid nodules. J Am Soc Cytopathol 2017; 7:92-98. [PMID: 31043258 DOI: 10.1016/j.jasc.2017.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/28/2017] [Accepted: 09/08/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Molecular thyroid testing is increasingly being used to further stratify risk of malignancy in cytologically indeterminate thyroid nodules. We report our experience using three commercially available tests in a community hospital setting. MATERIALS AND METHODS All molecular test reports (Afirma, ThyroSeqV2, and ThyGENX/ThyraMIR) on thyroid nodules from Einstein Medical Center, Philadelphia, between April 2014 to March 2017 were compared with follow-up surgical results as part of a quality assurance exercise. Slides and records of disparities were reviewed. RESULTS Ninety-five thyroid nodules with molecular testing were identified with surgical follow up available on 19. No benign Afirma results had surgical follow-up. All 7 suspicious Afirma results had surgery, with 3 being benign on follow-up. Ten ThyroseqV2 tested nodules had follow-up surgery and included 2 papillary carcinomas following a completely negative result and another papillary carcinoma following over expression of the NIS gene reported as likely benign. One case with a TP53 mutation was benign on follow-up total thyroidectomy. Follow-up on 1 NRAS point mutation by ThyGenX/ThyraMIR was confirmed malignant although the microRNA portion of the test was negative. CONCLUSIONS Quality assurance review refined our utilization practices as we better appreciated the limitations of molecular testing and use relative to other factors in managing indeterminate thyroid nodules.
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Affiliation(s)
- Nancy A Young
- Department of Pathology and Laboratory Medicine, Einstein Medical Center, Philadelphia, Pennsylvania.
| | - Kay Khine Win
- Department of Endocrinology, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Lauren Pomo
- Department of Pathology and Laboratory Medicine, Einstein Medical Center, Philadelphia, Pennsylvania
| | | | - Corrado Minimo
- Department of Pathology and Laboratory Medicine, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Jane Mayrin
- Department of Endocrinology, Einstein Medical Center, Philadelphia, Pennsylvania
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Basolo F, Macerola E, Ugolini C, Poller DN, Baloch Z. The Molecular Landscape of Noninvasive Follicular Thyroid Neoplasm With Papillary-like Nuclear Features (NIFTP): A Literature Review. Adv Anat Pathol 2017; 24:252-258. [PMID: 28777140 DOI: 10.1097/pap.0000000000000163] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The encapsulated and noninvasive follicular variant of papillary thyroid carcinoma has been recently reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). These tumors demonstrate indolent behavior. This change in nomenclature will have great clinical impact by avoiding overtreatment of patients with NIFTP lesions who in the past were diagnosed with thyroid carcinoma and typically received completion thyroidectomy followed by radioactive iodine ablation. The pathologic diagnosis of NIFTP requires surgical removal of the thyroid lesion or the lobe harboring it, and thorough sampling of the complete interface between the tumor capsule and the thyroid parenchyma, to exclude foci of invasion. From a cytologic point of view, the unequivocal differential diagnosis between NIFTP and infiltrative follicular variant of papillary thyroid carcinoma in fine-needle aspiration is close to impossible based on cellular and architectural features. Therefore, use of adjunct molecular testing on fine-needle aspiration specimens may be essential for the preoperative diagnosis of low-risk tumors such as NIFTP for appropriate patient management. This review discusses and summarizes the existing known literature on molecular characteristics of NIFTP tumors, so far reported, including cases retrospectively classified or prospectively diagnosed as NIFTP. Brief reference is also made to new and promising approaches applicable to the diagnosis of this tumor.
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73
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Onenerk AM, Pusztaszeri MP, Canberk S, Faquin WC. Triage of the indeterminate thyroid aspirate: What are the options for the practicing cytopathologist? Cancer Cytopathol 2017; 125:477-485. [PMID: 28609009 DOI: 10.1002/cncy.21828] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 12/17/2016] [Accepted: 12/22/2016] [Indexed: 12/26/2022]
Abstract
Fine-needle aspiration (FNA) plays a key role in the early evaluation of patients with thyroid nodules; however, from 15% to 30% of FNA specimens are cytologically indeterminate. Molecular testing has proven useful when applied to indeterminate thyroid FNAs, and its use has been endorsed in the American Thyroid Association guidelines. In addition to the noncommercial ("in-house") application of v-Raf murine sarcoma viral oncogene homolog B1 (BRAF), rat sarcoma (RAS), rearranged in transformation/papillary thyroid carcinoma (RET/PTC), and peroxisome proliferator-activated receptor γ/paired box gene 8 (PPARγ/PAX8) testing, there are currently 3 commercially available molecular panels that vary in their relative reported performances, strengths, and limitations. Here, we discuss the role of molecular testing for indeterminate thyroid aspirates, taking into consideration the recent reclassification of the encapsulated follicular variant of papillary thyroid carcinoma (PTC) as "noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP)." Cancer Cytopathol 2017;125(6 suppl):477-85. © 2017 American Cancer Society.
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Affiliation(s)
- Ayse M Onenerk
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Marc P Pusztaszeri
- Department of Pathology, Geneva University Hospitals, Geneva, Switzerland
| | - Sule Canberk
- Acibadem University, Department of Pathology, Istanbul, Turkey
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Rusinek D, Chmielik E, Krajewska J, Jarzab M, Oczko-Wojciechowska M, Czarniecka A, Jarzab B. Current Advances in Thyroid Cancer Management. Are We Ready for the Epidemic Rise of Diagnoses? Int J Mol Sci 2017; 18:E1817. [PMID: 28829399 PMCID: PMC5578203 DOI: 10.3390/ijms18081817] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 08/16/2017] [Accepted: 08/16/2017] [Indexed: 02/07/2023] Open
Abstract
A rising incidence of thyroid cancers (TCs) mainly small tumors, observed during recent years, lead to many controversies regarding treatment strategies. TCs represent a distinct molecular background and clinical outcome. Although in most cases TCs are characterized by a good prognosis, there are some aggressive forms, which do not respond to standard treatment. There are still some questions, which have to be resolved to avoid dangerous simplifications in the clinical management. In this article, we focused on the current advantages in preoperative molecular diagnostic tests and histopathological examination including noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). We discussed the controversies regarding the extent of thyroid surgery and adjuvant radioiodine therapy, as well as new treatment modalities for radioiodine-refractory differentiated thyroid cancer (RR-DTC). Considering medullary thyroid cancer (MTC), we analyzed a clinical management based on histopathology and RET (ret proto-oncogene) mutation genotype, disease follow-up with a special attention to serum calcitonin doubling time as an important prognostic marker, and targeted therapy applied in advanced MTC. In addition, we provided some data regarding anaplastic thyroid cancer (ATC), a highly lethal neoplasm, which lead to death in nearly 100% of patients due to the lack of effective treatment options.
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Affiliation(s)
- Dagmara Rusinek
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Institute-Cancer Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Ewa Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie Memorial Institute-Cancer Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Jolanta Krajewska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Institute-Cancer Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Michal Jarzab
- 3rd Department of Radiotherapy and Chemotherapy, Breast Unit, Maria Sklodowska-Curie Memorial Institute-Cancer Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Malgorzata Oczko-Wojciechowska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Institute-Cancer Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Agnieszka Czarniecka
- Department of Oncological and Reconstructive Surgery, Maria Sklodowska-Curie Memorial Institute-Cancer Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Barbara Jarzab
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Institute-Cancer Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
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González HE, Martínez JR, Vargas-Salas S, Solar A, Veliz L, Cruz F, Arias T, Loyola S, Horvath E, Tala H, Traipe E, Meneses M, Marín L, Wohllk N, Diaz RE, Véliz J, Pineda P, Arroyo P, Mena N, Bracamonte M, Miranda G, Bruce E, Urra S. A 10-Gene Classifier for Indeterminate Thyroid Nodules: Development and Multicenter Accuracy Study. Thyroid 2017; 27:1058-1067. [PMID: 28521616 PMCID: PMC5564024 DOI: 10.1089/thy.2017.0067] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND In most of the world, diagnostic surgery remains the most frequent approach for indeterminate thyroid cytology. Although several molecular tests are available for testing in centralized commercial laboratories in the United States, there are no available kits for local laboratory testing. The aim of this study was to develop a prototype in vitro diagnostic (IVD) gene classifier for the further characterization of nodules with an indeterminate thyroid cytology. METHODS In a first stage, the expression of 18 genes was determined by quantitative polymerase chain reaction (qPCR) in a broad histopathological spectrum of 114 fresh-tissue biopsies. Expression data were used to train several classifiers by supervised machine learning approaches. Classifiers were tested in an independent set of 139 samples. In a second stage, the best classifier was chosen as a model to develop a multiplexed-qPCR IVD prototype assay, which was tested in a prospective multicenter cohort of fine-needle aspiration biopsies. RESULTS In tissue biopsies, the best classifier, using only 10 genes, reached an optimal and consistent performance in the ninefold cross-validated testing set (sensitivity 93% and specificity 81%). In the multicenter cohort of fine-needle aspiration biopsy samples, the 10-gene signature, built into a multiplexed-qPCR IVD prototype, showed an area under the curve of 0.97, a positive predictive value of 78%, and a negative predictive value of 98%. By Bayes' theorem, the IVD prototype is expected to achieve a positive predictive value of 64-82% and a negative predictive value of 97-99% in patients with a cancer prevalence range of 20-40%. CONCLUSIONS A new multiplexed-qPCR IVD prototype is reported that accurately classifies thyroid nodules and may provide a future solution suitable for local reference laboratory testing.
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Affiliation(s)
- Hernán E. González
- Department of Surgical Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José R. Martínez
- Department of Surgical Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sergio Vargas-Salas
- Department of Surgical Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Antonieta Solar
- Department of Anatomic Pathology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Loreto Veliz
- Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Cruz
- Department of Radiology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tatiana Arias
- Department of Radiology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Soledad Loyola
- Department of Radiology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eleonora Horvath
- Department of Radiology, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - Hernán Tala
- Department of Radiology, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - Eufrosina Traipe
- Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Manuel Meneses
- Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Luis Marín
- Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Nelson Wohllk
- Department of Endocrinology, Hospital del Salvador, Universidad de Chile, Santiago, Chile
| | - René E. Diaz
- Department of Endocrinology, Hospital del Salvador, Universidad de Chile, Santiago, Chile
| | - Jesús Véliz
- Department of Endocrinology, Hospital del Salvador, Universidad de Chile, Santiago, Chile
| | - Pedro Pineda
- Sección Endocrinología y Diabetes, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | | | | | | | | | | | - Soledad Urra
- Department of Surgical Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
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76
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Comparative analysis of diagnostic performance, feasibility and cost of different test-methods for thyroid nodules with indeterminate cytology. Oncotarget 2017; 8:49421-49442. [PMID: 28472764 PMCID: PMC5564779 DOI: 10.18632/oncotarget.17220] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/22/2017] [Indexed: 01/07/2023] Open
Abstract
Since it is impossible to recognize malignancy at fine needle aspiration (FNA) cytology in indeterminate thyroid nodules, surgery is recommended for all of them. However, cancer rate at final histology is <30%. Many different test-methods have been proposed to increase diagnostic accuracy in such lesions, including Galectin-3-ICC (GAL-3-ICC), BRAF mutation analysis (BRAF), Gene Expression Classifier (GEC) alone and GEC+BRAF, mutation/fusion (M/F) panel, alone, M/F panel+miRNA GEC, and M/F panel by next generation sequencing (NGS), FDG-PET/CT, MIBI-Scan and TSHR mRNA blood assay.We performed systematic reviews and meta-analyses to compare their features, feasibility, diagnostic performance and cost. GEC, GEC+BRAF, M/F panel+miRNA GEC and M/F panel by NGS were the best in ruling-out malignancy (sensitivity = 90%, 89%, 89% and 90% respectively). BRAF and M/F panel alone and by NGS were the best in ruling-in malignancy (specificity = 100%, 93% and 93%). The M/F by NGS showed the highest accuracy (92%) and BRAF the highest diagnostic odds ratio (DOR) (247). GAL-3-ICC performed well as rule-out (sensitivity = 83%) and rule-in test (specificity = 85%), with good accuracy (84%) and high DOR (27) and is one of the cheapest (113 USD) and easiest one to be performed in different clinical settings.In conclusion, the more accurate molecular-based test-methods are still expensive and restricted to few, highly specialized and centralized laboratories. GAL-3-ICC, although limited by some false negatives, represents the most suitable screening test-method to be applied on a large-scale basis in the diagnostic algorithm of indeterminate thyroid lesions.
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77
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Paschke R, Cantara S, Crescenzi A, Jarzab B, Musholt TJ, Sobrinho Simoes M. European Thyroid Association Guidelines regarding Thyroid Nodule Molecular Fine-Needle Aspiration Cytology Diagnostics. Eur Thyroid J 2017; 6:115-129. [PMID: 28785538 PMCID: PMC5527175 DOI: 10.1159/000468519] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 03/02/2017] [Indexed: 01/19/2023] Open
Abstract
Molecular fine-needle aspiration (FNA) cytology diagnostics has the potential to address the inherent limitation of FNA cytology which is an indeterminate (atypia of undetermined significance/follicular lesion of undetermined significance follicular neoplasm) cytology. Because of the emerging role of molecular FNA cytology diagnostics, the European Thyroid Association convened a panel of international experts to review methodological aspects, indications, results, and limitations of molecular FNA cytology diagnostics. The panel reviewed the evidence for the diagnostic value of mutation panel assessment (including at least BRAF, NRAS, HRAS, KRAS, PAX8/PPARG, RET/PTC) of targeted next generation sequencing and of a microarray gene expression classifier (GEC) test in the diagnostic assessment of an indeterminate cytology thyroid nodule. Moreover, possible surgical consequences of molecular FNA diagnostic results of thyroid nodules and the evidence that analysis of a molecular FNA diagnostic panel of somatic mutations or a microarray GEC test can alter the follow-up were reviewed. Molecular tests may help clinicians to drive patient care and the surgical decision if the analysis is performed in specialized laboratories. These molecular tests require standardization of performance characteristics and appropriate calibration as well as analytic validation before clinical interpretation.
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Affiliation(s)
- Ralf Paschke
- Division of Endocrinology and Metabolism, Departments of Medicine, Pathology, Oncology and Arnie Charbonneau Cancer Institute, Calgary, AB, Canada
- *Ralf Paschke, MD, PhD, Division of Endocrinology, Cumming School of Medicine, University of Calgary, HMRB, Room 382B, 3330 Hospital Dr NW, Calgary, AB T2N 4N1 (Canada), E-Mail
| | - Silvia Cantara
- Department of Medical, Surgical, and Neurological Sciences, Endocrinology Section, University of Siena, Siena, Italy
| | - Anna Crescenzi
- Pathology Unit, University Hospital Campus Bio-Medico, Rome, Italy
| | - Barbara Jarzab
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Thomas J. Musholt
- Endocrine Surgery Section, Department of General, Visceral, and Transplantation Surgery, University Medicine of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Eszlinger M, Lau L, Ghaznavi S, Symonds C, Chandarana SP, Khalil M, Paschke R. Molecular profiling of thyroid nodule fine-needle aspiration cytology. Nat Rev Endocrinol 2017; 13:415-424. [PMID: 28361927 DOI: 10.1038/nrendo.2017.24] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The differential diagnosis and malignancy risk stratification of thyroid nodules requires multidisciplinary expertise and knowledge of both local ultrasonography practices and the local malignancy rates for a given fine-needle aspiration (FNA) result. Even in such a multidisciplinary setting, FNA cytology has the inherent limitation that indeterminate cytology results cannot distinguish between follicular adenomas, follicular thyroid carcinomas or follicular variant papillary thyroid carcinomas. Accumulating evidence suggests that this limitation can be overcome by using molecular diagnostic approaches. In this Review, we present the advantages and disadvantages of the different molecular diagnostic methodologies, which can be divided into two approaches: those that 'rule out' malignancy (to reduce the overtreatment of benign nodules) and those that 'rule in' malignancy (to optimize surgical planning). We identify microRNA classifiers as potential additional markers for use in a two-step diagnostic approach, consider the potential implications of the reclassification of noninvasive encapsulated follicular variant papillary thyroid carcinomas to noninvasive follicular thyroid neoplasms with papillary-like nuclear features and discuss the cost-effectiveness of molecular testing. Molecular FNA diagnostics is an important complementary addition to FNA cytology that could substantially reduce unnecessary surgery and better define the need for appropriate surgery in patients who have thyroid nodules with indeterminate FNA cytology.
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Affiliation(s)
- Markus Eszlinger
- Department of Oncology, Cumming School of Medicine, University of Calgary, Tom Baker Cancer Centre, 1331 - 29th Street NW, Calgary, Alberta T2N 4N2, Canada
- Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre, 3280 Hospital Drive, Calgary, Alberta T2T 4Z6, Canada
| | - Lorraine Lau
- Division of Endocrinology, Department of Medicine, Cumming School of Medicine, University of Calgary, Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Road SW, Calgary, Alberta T2T 5C7, Canada
| | - Sana Ghaznavi
- Division of Endocrinology, Department of Medicine, Cumming School of Medicine, University of Calgary, Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Road SW, Calgary, Alberta T2T 5C7, Canada
| | - Christopher Symonds
- Division of Endocrinology, Department of Medicine, Cumming School of Medicine, University of Calgary, Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Road SW, Calgary, Alberta T2T 5C7, Canada
| | - Shamir P Chandarana
- Department of Oncology, Cumming School of Medicine, University of Calgary, Tom Baker Cancer Centre, 1331 - 29th Street NW, Calgary, Alberta T2N 4N2, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Foothills Medical Centre, North Tower 1012, 1403 - 29th Street NW, Calgary, Alberta T2N 2T9, Canada
| | - Moosa Khalil
- Department of Pathology and Laboratory Medicine, University of Calgary, Foothills Medical Centre, McCaig Tower, 1403 - 29th Street NW, Calgary, Alberta T2N 2T9, Canada
| | - Ralf Paschke
- Department of Oncology, Cumming School of Medicine, University of Calgary, Tom Baker Cancer Centre, 1331 - 29th Street NW, Calgary, Alberta T2N 4N2, Canada
- Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre, 3280 Hospital Drive, Calgary, Alberta T2T 4Z6, Canada
- Division of Endocrinology, Department of Medicine, Cumming School of Medicine, University of Calgary, Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Road SW, Calgary, Alberta T2T 5C7, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, North Tower 9th floor, 1403 - 29th Street NW, Calgary, Alberta T2N 2T9, Canada
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre, 3280 Hospital Drive, Calgary, Alberta T2N 4Z6, Canada
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79
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Poller D, Johnson S. Recent Developments in the Pathology of Thyroid Cancer. Clin Oncol (R Coll Radiol) 2017; 29:278-282. [DOI: 10.1016/j.clon.2017.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 01/16/2017] [Indexed: 01/21/2023]
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80
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Rosario PW, Calsolari MR. Importance of cytological subclassification of thyroid nodules with Bethesda category III cytology (AUS/FLUS) into architectural atypia only and nuclear atypia: A prospective study. Diagn Cytopathol 2017; 45:604-607. [DOI: 10.1002/dc.23734] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/03/2017] [Accepted: 04/06/2017] [Indexed: 11/07/2022]
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81
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Improving accuracy of RNA-based diagnosis and prognosis of oral cancer by using noninvasive methods. Oral Oncol 2017; 69:62-67. [PMID: 28559022 DOI: 10.1016/j.oraloncology.2017.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 03/23/2017] [Accepted: 04/01/2017] [Indexed: 12/13/2022]
Abstract
RNA-based diagnosis and prognosis of squamous cell carcinoma has been slow to come to the clinic. Improvements in RNA measurement, statistical evaluation, and sample preservation, along with increased sample numbers, have not made these methods reproducible enough to be used clinically. We propose that, in the case of squamous cell carcinoma of the oral cavity, a chief source of variability is sample dissection, which leads to variable amounts of stroma mixed in with tumor epithelium. This heterogeneity of the samples, which requires great care to avoid, makes it difficult to see changes in RNA levels specific to tumor cells. An evaluation of the data suggests that, paradoxically, brush biopsy samples of oral lesions may provide a more reproducible method than surgical acquisition of samples for miRNA measurement. The evidence also indicates that body fluid samples can show similar changes in miRNAs with oral squamous cell carcinoma (OSCC) as those seen in tumor brush biopsy samples - suggesting much of the miRNA in these samples is coming from the same source: tumor epithelium. We conclude that brush biopsy or body fluid samples may be superior to surgical samples in allowing miRNA-based diagnosis and prognosis of OSCC in that they feature a rapid method to obtain homogeneous tumor cells and/or RNA.
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Zafon C, Díez JJ, Galofré JC, Cooper DS. Nodular Thyroid Disease and Thyroid Cancer in the Era of Precision Medicine. Eur Thyroid J 2017; 6:65-74. [PMID: 28589087 PMCID: PMC5422742 DOI: 10.1159/000457793] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 01/19/2017] [Indexed: 12/27/2022] Open
Abstract
The management of thyroid nodules, one of the main clinical challenges in endocrine clinical practice, is usually straightforward. Although the most important concern is ruling out malignancy, there are grey areas where uncertainty is frequently present: the nodules labelled as indeterminate by cytology and the extent of therapy when thyroid cancer is diagnosed pathologically. There is evidence that the current available precision medicine tools (from all the "-omics" to molecular analysis, fine-tuning imaging or artificial intelligence) may help to fill present gaps in the future. We present here a commentary on some of the current challenges faced by endocrinologists in the field of thyroid nodules and cancer, and illustrate how precision medicine may improve their diagnostic and therapeutic capabilities in the future.
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Affiliation(s)
- Carles Zafon
- Department of Endocrinology, Hospital Vall d'Hebron, and Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona and CIBERDEM (ISCIII), Barcelona, Spain
| | - Juan J. Díez
- Department of Endocrinology and Nutrition, Hospital Ramón y Cajal, Madrid, Spain
- Department of Medicine, University of Alcalá de Henares, Madrid, Spain
| | - Juan C. Galofré
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
- IdiSNA (Instituto de investigación en la salud de Navarra), Pamplona, Spain
- *Dr. Juan C. Galofré, Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, University of Navarro, Avenida Pio XII, 36, ES-31080 Pamplona (Spain), E-Mail
| | - David S. Cooper
- Division of Endocrinology, Diabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Eszlinger M, Böhme K, Ullmann M, Görke F, Siebolts U, Neumann A, Franzius C, Adam S, Molwitz T, Landvogt C, Amro B, Hach A, Feldmann B, Graf D, Wefer A, Niemann R, Bullmann C, Klaushenke G, Santen R, Tönshoff G, Ivancevic V, Kögler A, Bell E, Lorenz B, Kluge G, Hartenstein C, Ruschenburg I, Paschke R. Evaluation of a Two-Year Routine Application of Molecular Testing of Thyroid Fine-Needle Aspirations Using a Seven-Gene Panel in a Primary Referral Setting in Germany. Thyroid 2017; 27:402-411. [PMID: 28071986 DOI: 10.1089/thy.2016.0445] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Major differences with respect to the diagnostic performance of a "ruling in" approach in the presurgical diagnosis of indeterminate thyroid fine-needle aspirations (FNAs) have been reported. Therefore, the aim of this prospective multicenter study was to investigate the specific diagnostic impact of mutation testing using a seven-gene panel in a routine primary referral setting analyzing FNAs from endocrinology and nuclear medicine practices in Germany. METHODS RNA and DNA was extracted from 564 routine air-dried FNA smears obtained from 64 physicians and cytologically graded by one experienced cytopathologist. PAX8/PPARG and RET/PTC rearrangements were detected by quantitative polymerase chain reaction, while BRAF and RAS mutations were detected by pyrosequencing. Molecular data were compared to histology and follow-up >1 year, which were available for 322/348 patients undergoing surgery and 33/74 patients having follow-up. Histology results were obtained from the local routine pathologists who were blinded to the molecular test results. RESULTS BRAF and RET/PTC mutations were associated with carcinoma in 98% and 100% of samples, respectively. RAS and PAX8/PPARG mutations were associated with carcinoma in 31% and 0% of samples, respectively. Thirty-six percent of the carcinomas were identified by molecular testing in the atypia of undetermined significance/follicular lesion of undetermined significance and follicular neoplasm/suspicious for a follicular neoplasm categories, with malignancy rates of 15% and 17%, respectively. Due to a low percentage of RAS mutation-positive carcinomas in combination with a rather high percentage of RAS mutation-positive benign nodules, the positive predictive values of 41% and 36% in the atypia of undetermined significance/follicular lesion of undetermined significance and follicular neoplasm/suspicious for a follicular neoplasm categories offer only limited diagnostic potential. CONCLUSION In conclusion, the data suggest that the application of the current seven-gene panel in a routine primary referral setting does not improve the presurgical diagnosis of thyroid FNAs. While the diagnostic relevance of RAS mutations in thyroid tumors needs further investigation, more comprehensive mutation panels with more cancer-specific mutations may improve the presurgical diagnosis of thyroid FNAs.
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MESH Headings
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/genetics
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/surgery
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Biopsy, Fine-Needle
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/genetics
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/surgery
- Female
- Germany
- Humans
- Male
- Middle Aged
- Molecular Diagnostic Techniques
- PAX8 Transcription Factor/genetics
- PPAR gamma/genetics
- Patched-1 Receptor/genetics
- Prospective Studies
- Proto-Oncogene Proteins B-raf/genetics
- Proto-Oncogene Proteins c-ret/genetics
- Thyroid Cancer, Papillary
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/genetics
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/surgery
- Thyroidectomy
- Young Adult
- ras Proteins/genetics
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Affiliation(s)
- Markus Eszlinger
- 1 Department of Oncology and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary , Calgary, Canada
| | - Katharina Böhme
- 2 Divisions of Endocrinology and Nephrology, University of Leipzig , Leipzig, Germany
| | - Maha Ullmann
- 2 Divisions of Endocrinology and Nephrology, University of Leipzig , Leipzig, Germany
| | - Fabian Görke
- 2 Divisions of Endocrinology and Nephrology, University of Leipzig , Leipzig, Germany
| | - Udo Siebolts
- 3 Department of Pathology, University Hospital Halle , Halle, Germany
| | - Anna Neumann
- 4 Amedes MVZ wagnerstibbe für Laboratoriumsmedizin, Hämostaseologie, Humangenetik und Mikrobiologie , Hannover, Germany
| | | | | | | | | | - Bassam Amro
- 9 Praxis für Nuklearmedizin , Oldenburg, Germany
| | - Anja Hach
- 10 Institut für Radiologie & Nuklearmedizin , Bremerhaven, Germany
| | - Berit Feldmann
- 11 Endokrinologie & Diabetologie im Zentrum , Stuttgart, Germany
| | - Dieter Graf
- 12 Praxisgemeinschaft auf dem Meere , Lüneburg, Germany
| | - Antje Wefer
- 13 Radiologie und Nuklearmedizin in der Gottorpstraße , Oldenburg, Germany
| | - Rainer Niemann
- 14 Radiologie Oldenburg, Praxis Stehen und Partner GbR , Oldenburg, Germany
| | | | | | - Reinhard Santen
- 17 Endokrinologische Gemeinschaftspraxis , Zentrum für Hormon- und Stoffwechselstörungen, Frankfurt/Main, Germany
| | | | - Velimir Ivancevic
- 19 Radiologisch-Nuklearmedizinische Gemeinschaftspraxis , Celle, Germany
| | - Andreas Kögler
- 19 Radiologisch-Nuklearmedizinische Gemeinschaftspraxis , Celle, Germany
| | | | - Bernd Lorenz
- 21 Schilddrüsen- und Hormon-Praxis , Gera, Germany
| | - Gerald Kluge
- 22 Diagnostisches Zentrum Göttingen, Gemeinschaftspraxis für Radiologie und Nuklearmedizin , Göttingen, Germany
| | - Christoph Hartenstein
- 23 Schilddrüse Stuttgart, Fachärzte für Innere Medizin und Nuklearmedizinische Schilddrüsendiagnostik , Stuttgart, Germany
| | - Ilka Ruschenburg
- 24 MVZ wagnerstibbe für Gynäkologie, Reproduktionsmedizin, Zytologie, Pathologie und Innere Medizin GmbH , Einbeck, Germany
| | - Ralf Paschke
- 25 Division of Endocrinology, Department of Medicine, and Departments of Oncology, and Biochemistry and Molecular Biology, and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary , Calgary, Canada
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Valderrabano P, Khazai L, Leon ME, Thompson ZJ, Ma Z, Chung CH, Hallanger-Johnson JE, Otto KJ, Rogers KD, Centeno BA, McIver B. Evaluation of ThyroSeq v2 performance in thyroid nodules with indeterminate cytology. Endocr Relat Cancer 2017; 24:127-136. [PMID: 28104680 PMCID: PMC7771306 DOI: 10.1530/erc-16-0512] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/19/2017] [Indexed: 01/03/2023]
Abstract
ThyroSeq v2 claims high positive (PPV) and negative (NPV) predictive values in a wide range of pretest risks of malignancy in indeterminate thyroid nodules (ITNs) (categories B-III and B-IV of the Bethesda system). We evaluated ThyroSeq v2 performance in a cohort of patients with ITNs seen at our Academic Cancer Center from September 2014 to April 2016, in light of the new diagnostic criteria for non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Our study included 182 patients (76% female) with 190 ITNs consecutively tested with ThyroSeq v2. Patient treatment followed our institutional thyroid nodule clinical pathway. Histologies of nodules with follicular variant papillary thyroid carcinoma or NIFTP diagnoses were reviewed, with reviewers blinded to molecular results. ThyroSeq v2 performance was calculated in nodules with histological confirmation. We identified a mutation in 24% (n = 45) of the nodules. Mutations in RAS were the most prevalent (n = 21), but the positive predictive value of this mutation was much lower (31%) than that in prior reports. In 102 resected ITNs, ThyroSeq v2 performance was as follows: sensitivity 70% (46-88), specificity 77% (66-85), PPV 42% (25-61) and NPV 91% (82-97). The performance in B-IV nodules was significantly better than that in B-III nodules (area under the curve 0.84 vs 0.57, respectively; P = 0.03), where it was uninformative. Further studies evaluating ThyroSeq v2 performance are needed, particularly in B-III.
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Affiliation(s)
- Pablo Valderrabano
- Department of Head and Neck-Endocrine OncologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Laila Khazai
- Department of Anatomic PathologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Marino E Leon
- Department of Anatomic PathologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Zachary J Thompson
- Department of Biostatistics and BioinformaticsH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Zhenjun Ma
- Department of Biostatistics and BioinformaticsH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Christine H Chung
- Department of Head and Neck-Endocrine OncologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Julie E Hallanger-Johnson
- Department of Head and Neck-Endocrine OncologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Kristen J Otto
- Department of Head and Neck-Endocrine OncologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Kara D Rogers
- Department of Head and Neck-Endocrine OncologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Barbara A Centeno
- Department of Anatomic PathologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Bryan McIver
- Department of Head and Neck-Endocrine OncologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
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Baca SC, Wong KS, Strickland KC, Heller HT, Kim MI, Barletta JA, Cibas ES, Krane JF, Marqusee E, Angell TE. Qualifiers of atypia in the cytologic diagnosis of thyroid nodules are associated with different Afirma gene expression classifier results and clinical outcomes. Cancer Cytopathol 2017; 125:313-322. [PMID: 28152275 PMCID: PMC5484344 DOI: 10.1002/cncy.21827] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 12/20/2016] [Accepted: 12/22/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Thyroid nodules with atypia of undetermined significance (AUS) on fine‐needle aspiration (FNA) have a low risk of malignancy that appears to vary based on specific features described in the AUS diagnosis. The Afirma gene expression classifier (GEC) is a molecular test designed to improve preoperative risk stratification of thyroid nodules, but its performance for different patterns of AUS has not been defined. The objective of this study was to assess GEC results and clinical outcomes in AUS nodules with architectural atypia (AUS‐A), cytologic atypia (AUS‐C) or both (AUS‐C/A). METHODS This was a retrospective review of all thyroid nodules with AUS cytopathology that underwent GEC testing at the authors' institution over a period of >4 years. RESULTS In 227 nodules that had AUS cytology results and Afirma GEC testing, the rate of benign GEC results was higher in AUS‐A nodules (70 of 107; 65%) than in AUS‐C/A nodules (25 of 65; 38%; P = .0008), and AUS‐C nodules exhibited an intermediate rate of benign results (27 of 55 nodules; 59%). The risk of cancer among patients who had GEC‐suspicious nodules, 86% of whom underwent resection, was 19% (6 of 25) for AUS‐A nodules compared with 57% (21 of 37) for AUS‐C/A nodules (P = .003) and 45% (10 of 22) for AUS‐C nodules (P = .07). In nodules that had an indeterminate repeat cytology result, no difference was observed in the rate of benign GEC results or in the malignancy rate compared with nodules that had a single cytology result. CONCLUSIONS The performance characteristics of Afirma GEC testing vary, depending on qualifiers of cytologic atypia. Recognition of these differences may enable clinicians to provide improved counseling and treatment recommendations to patients. Cancer Cytopathol 2017;125:313–322. © 2017 American Cancer Society. Thyroid nodules with atypia of undetermined significance cytology and Afirma gene expression classifier (GEC) testing are analyzed based on the presence of architectural, cytologic, or both cytologic and architectural atypia. Nodules with architectural atypia are the most likely to have a benign GEC result and least likely to be malignant, suggesting that clinicians should be aware of these cytologic qualifiers when advising patients regarding GEC testing and the risk of malignancy.
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Affiliation(s)
- Sylvan C Baca
- Department of Medicine, The Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kristine S Wong
- Department of Pathology, The Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kyle C Strickland
- Department of Pathology, The Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Howard T Heller
- Department of Radiology, The Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Matthew I Kim
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes, The Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Justine A Barletta
- Department of Pathology, The Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Edmund S Cibas
- Department of Pathology, The Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jeffrey F Krane
- Department of Pathology, The Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ellen Marqusee
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes, The Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Trevor E Angell
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes, The Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Sorrenti S, Baldini E, Tartaglia F, Catania A, Arcieri S, Pironi D, Calò PG, Filippini A, Ulisse S. Nodular thyroid disease in the elderly: novel molecular approaches for the diagnosis of malignancy. Aging Clin Exp Res 2017; 29:7-13. [PMID: 27832468 DOI: 10.1007/s40520-016-0654-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/12/2016] [Indexed: 12/14/2022]
Abstract
Epithelial thyroid cancers (TC) comprise two differentiated histotypes (DTC), the papillary (PTC) and the follicular (FTC) thyroid carcinomas which, following dedifferentiation, are assumed to give rise to the poorly differentiated thyroid carcinomas and the rare, but highly aggressive and invariably fatal, anaplastic thyroid carcinomas. Although thyroid cancer mortality has not been changed, its annual incidence has increased over the last two decades, mainly because of the improved ability to diagnose malignant transformation in small non-palpable thyroid nodules. Despite DTC patients have a favorable prognosis, aggressive disease is more frequently observed in the elderly showing a higher disease-specific mortality. Of relevance is the high prevalence of nodular thyroid disease in aged patients being higher than 90%, in women older than 60 year, and 60% in men older than 80 year. This implies a careful evaluation of thyroid nodules in this group of patients in order to exclude malignancy. In fact, despite the tremendous progress in the comprehension of the underlying molecular mechanisms deregulated in DTC progression, several aspects of their clinical management remain to be solved and novel diagnostic strategies are sorely needed. Here, we will attempt to review new molecular approaches, which are currently being exploited in order to ameliorate the diagnosis of thyroid nodules.
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87
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Kloos RT. Molecular Profiling of Thyroid Nodules: Current Role for the Afirma Gene Expression Classifier on Clinical Decision Making. Mol Imaging Radionucl Ther 2017; 26:36-49. [PMID: 28117288 PMCID: PMC5283710 DOI: 10.4274/2017.26.suppl.05] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Thyroid fine-needle aspiration biopsy results are cytologically indeterminate in 15-30% of cases. When these nodules undergo diagnostic surgery, approximately three-quarters are histologically benign. These unnecessary surgeries diminish quality of life, generate complications, and increase healthcare costs. The Afirma gene expression classifier (GEC) is validated to pre-operatively identify cytologically indeterminate nodules likely to be truly benign so that surgery can be avoided. Its performance is supported by robust multicenter prospective and blinded clinical validation studies, and supported by extensive independent clinical utility publications which show a marked reduction in surgery among patients with benign Afirma GEC results. To rule-out cancer and avoid unnecessary diagnostic surgery, Afirma’s quality and depth of validation stand alone. The accuracy of a benign result is the negative predictive value (NPV). Afirma achieves an NPV ≥94% among cytologically indeterminate nodules (Bethesda III or IV). Thirteen clinical utility studies describing 1468 GEC benign patients demonstrate that few Afirma GEC benign nodules undergo surgery, including after 3 years of follow-up. With a specificity of 52%, over half of the truly benign nodules with indeterminate cytology receive a benign GEC result. High test sensitivity is critical to safely rule out cancer. The Afirma GEC’s 90% sensitivity means that regardless of the pre-test risk of malignancy, 90% of all malignant nodules are GEC suspicious. The Afirma GEC has transformed patient care. Where the majority of cytologically indeterminate patients were once operated to determine if the nodule was benign or malignant, now nearly half of these surgeries can be avoided.
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Affiliation(s)
- Richard T Kloos
- Veracyte, Inc., Department of Medical Affairs, Senior Medical Director-Endocrinology, California, USA, Phone: +1(650)243-6300, E-mail:
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88
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Castelblanco E, Zafon C, Maravall J, Gallel P, Martinez M, Capel I, Bella MR, Halperin I, Temprana J, Iglesias C, Puig-Domingo M, Robledo M, Matias-Guiu X, Mauricio D. APLP2, RRM2, and PRC1: New Putative Markers for the Differential Diagnosis of Thyroid Follicular Lesions. Thyroid 2017; 27:59-66. [PMID: 27796194 DOI: 10.1089/thy.2016.0094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Current methods based on fine-needle aspiration biopsy (FNAB) are not sufficient to distinguish among follicular thyroid lesions, follicular adenoma (FA), follicular thyroid carcinoma (FTC), and the follicular variant of papillary thyroid cancer (FVPTC). Furthermore, none of the immunohistochemical markers currently available are sensitive or specific enough to be used in the clinical setting, necessitating a diagnostic hemithyroidectomy. The aim of this study was to identify proteins of value for differential diagnosis between benign and malignant thyroid follicular lesions. METHODS This retrospective analysis is based on an assessment of the immunoexpression of 19 proteins on 81 benign thyroid lesions (FA) and 50 malignant tumors (FTC/FVPTC). The resulting expression profile allowed the design of a scoring system model to improve the differential diagnosis of benign and malignant thyroid lesions. The model was validated using an independent series of 69 FA and 40 FTC and an external series of 40 nodular hyperplasias, and was further tested in a series of 38 FNAB cell blocks. RESULTS A model based on the nuclear and cytoplasmic expression of APLP2, RRM2, and PRC1 discriminated between benign and malignant lesions with 100% sensitivity in both main and validation groups, with specificities of 71.3% and 50.7%, respectively. For the nodular hyperplasia series, specificity reached 94.8%. Finally, in FNAB samples, the sensitivity was 100% and the specificity was 45% for discrimination between benign and malignant lesions. CONCLUSIONS These findings suggest that the identified APLP2, RRM2, and PRC1 signature could be useful for distinguishing between benign (FA) and malignant (FTC and FVPTC) tumors of the thyroid follicular epithelium.
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Affiliation(s)
- Esmeralda Castelblanco
- 1 Department of Endocrinology and Nutrition, Health Sciences Research Institute and University Hospital Germans Trias i Pujol , Badalona, Spain
- 2 Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM) , ISCIII, Badalona, Spain
- 3 Consortium for the study of thyroid cancer (CECaT) , Badalona, Spain
| | - Carles Zafon
- 2 Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM) , ISCIII, Badalona, Spain
- 3 Consortium for the study of thyroid cancer (CECaT) , Badalona, Spain
- 4 Diabetes and Metabolism Research Unit (VHIR) and Department of Endocrinology, University Hospital Vall d'Hebron and Autonomous University of Barcelona , Barcelona, Spain
| | - Javier Maravall
- 3 Consortium for the study of thyroid cancer (CECaT) , Badalona, Spain
- 5 Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova and University of Lleida , Biomedical Research Institute of Lleida, Lleida, Spain
| | - Pilar Gallel
- 6 Department of Pathology and Molecular Genetics, University Hospital Arnau de Vilanova and University of Lleida , Biomedical Research Institute of Lleida, Lleida, Spain
| | - Montserrat Martinez
- 7 Biostatistics and Epidemiology Unit, Biomedical Research Institute of Lleida , Lleida, Spain
| | - Ismael Capel
- 3 Consortium for the study of thyroid cancer (CECaT) , Badalona, Spain
- 8 Department of Endocrinology and Nutrition, University Hospital Parc Taulí Sabadell , Barcelona, Spain
| | - Maria Rosa Bella
- 3 Consortium for the study of thyroid cancer (CECaT) , Badalona, Spain
- 9 Department of Pathology, University Hospital Parc Taulí Sabadell , Barcelona, Spain
| | - Irene Halperin
- 3 Consortium for the study of thyroid cancer (CECaT) , Badalona, Spain
- 10 Department of Endocrinology and Nutrition, University Hospital Clinic Barcelona , Barcelona, Spain
| | - Jordi Temprana
- 3 Consortium for the study of thyroid cancer (CECaT) , Badalona, Spain
- 11 Department of Pathology, Vall d'Hebron University Hospital and Autonomous University of Barcelona , Barcelona, Spain
| | - Carmela Iglesias
- 3 Consortium for the study of thyroid cancer (CECaT) , Badalona, Spain
- 11 Department of Pathology, Vall d'Hebron University Hospital and Autonomous University of Barcelona , Barcelona, Spain
| | - Manel Puig-Domingo
- 1 Department of Endocrinology and Nutrition, Health Sciences Research Institute and University Hospital Germans Trias i Pujol , Badalona, Spain
- 2 Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM) , ISCIII, Badalona, Spain
- 3 Consortium for the study of thyroid cancer (CECaT) , Badalona, Spain
| | - Mercedes Robledo
- 12 Hereditary Endocrine Cancer Group, Spanish National Cancer Centre , Madrid, Spain
- 13 Centre for Biomedical Research on Rare Diseases (CIBERER) , ISCIII, Madrid, Spain
| | - Xavier Matias-Guiu
- 6 Department of Pathology and Molecular Genetics, University Hospital Arnau de Vilanova and University of Lleida , Biomedical Research Institute of Lleida, Lleida, Spain
| | - Didac Mauricio
- 1 Department of Endocrinology and Nutrition, Health Sciences Research Institute and University Hospital Germans Trias i Pujol , Badalona, Spain
- 2 Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM) , ISCIII, Badalona, Spain
- 3 Consortium for the study of thyroid cancer (CECaT) , Badalona, Spain
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89
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miRNA expression profiling of 'noninvasive follicular thyroid neoplasms with papillary-like nuclear features' compared with adenomas and infiltrative follicular variants of papillary thyroid carcinomas. Mod Pathol 2017; 30:39-51. [PMID: 27586203 DOI: 10.1038/modpathol.2016.157] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/21/2016] [Accepted: 07/22/2016] [Indexed: 12/25/2022]
Abstract
Follicular variants of papillary thyroid carcinoma include encapsulated (with or without capsular/vascular invasion) and infiltrative forms, which have different clinical behaviors. The encapsulated forms that lack capsular invasion have an indolent clinical behavior that is similar to benign lesions; therefore, they were recently reclassified as 'noninvasive follicular thyroid neoplasms with papillary-like nuclear features' (NIFTPs). Because NIFTPs have nuclear features of papillary carcinomas, distinguishing between NIFTPs and infiltrative follicular variant of papillary thyroid carcinoma is almost impossible with cytological examination. The aim of this study is to determine whether miRNA expression profiles may help distinguish between NIFTPs versus follicular adenomas and infiltrative follicular variant of papillary thyroid carcinomas. The expression profiling of 798 miRNAs was tested in 54 thyroid tumors, including 18 follicular adenomas, 19 NIFTPs and 17 infiltrative follicular variant of papillary thyroid carcinomas, using nCounter Nanostring. We found that miR-146-5p, miR-221-5p, miR-222-3p, miR-30e-3p, and miR-152-3p could discriminate between benign and malignant lesions with a very high level of significance (P-value<0.001). High expression levels of miR-146-5p, miR-199a-5p, miR-199b-5p, miR-1285-5p, miR-1915-3p, and miR-4516, and low miR-148b-3p expression were associated with infiltrative growth of follicular variant of papillary thyroid carcinomas. Interestingly, miR-152-3p, miR-185-5p, and miR-574-3p were significantly downregulated in NIFTPs compared with follicular adenomas, whereas miR-10a-5p and miR-320e can discriminate between NIFTPs and infiltrative forms of follicular variant of papillary thyroid carcinomas. In conclusion, a panel of these markers could have high diagnostic potential as well as could be applied to presurgical fine-needle aspiration, especially for lesions classified as indeterminate thyroid nodules.
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90
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Glass R, Kahn L, Khalid K, Siddiqui MT, Cocker R. Predicting histological subtypes of follicular variant of papillary thyroid carcinoma based on cytomorphology. Can cytomorphology optimize use of molecular testing? J Am Soc Cytopathol 2016; 5:345-350. [PMID: 31042546 DOI: 10.1016/j.jasc.2016.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Follicular variant papillary thyroid carcinoma (FVPTC) can be further subclassified into one of 3 subtypes: non-invasive encapsulated FVPTC, invasive encapsulated FVPTC, and infiltrative FVPTC. Longitudinal and molecular studies have demonstrated that, in terms of both molecular profiles and prognosis, encapsulated FVPTC is comparable to follicular adenoma, invasive FVPTC to follicular carcinoma, and infiltrative FVPTC to classic PTC. To improve triaging and prevent overtreatment of patients with FVPTC, we sought to determine cytologic features likely to occur within each subtype. METHODS A laboratory database search from 2010-2015 was conducted to identify patients with biopsy-proven FVPTC and prior fine-needle aspiration. Surgical specimens were reviewed to determine the appropriate subcategorization. Accompanying cytology reports were reviewed for features common in classic PTC and follicular neoplasms. RESULTS Encapsulated variants were more likely to be graded as Bethesda category 4 compared with invasive or infiltrative variants. In contrast, infiltrative variants were more likely to be graded as Bethesda categories 5 and 6 compared with invasive or encapsulated variants. Compared with the encapsulated variant, infiltrative FVPTC was more likely to have nuclear pseudo-inclusions (31.82% versus 8.11%, P = 0.0468) and less likely to have microfollicular architecture (22.73% versus 54.05%, P = 0.0374). CONCLUSION This study identified cytomorphologic differences between encapsulated and infiltrative FVPTC. With a higher threshold of suspicion for FVPTC, improved awareness of the differences between these subtypes and incorporation of molecular testing, it is likely that the Bethesda category can be revised and patient triaging can be significantly improved.
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Affiliation(s)
- Ryan Glass
- Department of Pathology, Northwell Health, 6 Ohio Drive, Lake Success, New York, 11042
| | - Leonard Kahn
- Department of Pathology, Northwell Health, 6 Ohio Drive, Lake Success, New York, 11042
| | - Kashan Khalid
- Department of Pathology, Northwell Health, 6 Ohio Drive, Lake Success, New York, 11042
| | - Momin T Siddiqui
- Department of Pathology, Emory University Hospital, Atlanta, Georgia
| | - Rubina Cocker
- Department of Pathology, Northwell Health, 6 Ohio Drive, Lake Success, New York, 11042.
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91
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Bellevicine C, Sgariglia R, Malapelle U, Vigliar E, Nacchio M, Ciancia G, Eszlinger M, Paschke R, Troncone G. Young investigator challenge: Can the Ion AmpliSeq Cancer Hotspot Panel v2 be used for next-generation sequencing of thyroid FNA samples? Cancer Cytopathol 2016; 124:776-784. [DOI: 10.1002/cncy.21780] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 08/30/2016] [Accepted: 09/01/2016] [Indexed: 01/21/2023]
Affiliation(s)
- Claudio Bellevicine
- Department of Public Health; University of Naples “Federico II,”; Naples Italy
| | - Roberta Sgariglia
- Department of Public Health; University of Naples “Federico II,”; Naples Italy
| | - Umberto Malapelle
- Department of Public Health; University of Naples “Federico II,”; Naples Italy
| | - Elena Vigliar
- Department of Public Health; University of Naples “Federico II,”; Naples Italy
| | - Mariantonia Nacchio
- Department of Public Health; University of Naples “Federico II,”; Naples Italy
| | - Giuseppe Ciancia
- Department of Advanced Biomedical Sciences; University of Naples “Federico II,”; Naples Italy
| | - Markus Eszlinger
- Department of Oncology, Cumming School of Medicine; University of Calgary; Calgary Alberta Canada
| | - Ralf Paschke
- Department of Endocrinology, Cumming School of Medicine; University of Calgary; Calgary Alberta Canada
- Department of Oncology, Cumming School of Medicine; University of Calgary; Calgary Alberta Canada
| | - Giancarlo Troncone
- Department of Public Health; University of Naples “Federico II,”; Naples Italy
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92
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Zhang M, Lin O. Molecular Testing of Thyroid Nodules: A Review of Current Available Tests for Fine-Needle Aspiration Specimens. Arch Pathol Lab Med 2016; 140:1338-1344. [DOI: 10.5858/arpa.2016-0100-ra] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Fine-needle aspiration of thyroid nodules is a reliable diagnostic method to determine the nature of thyroid nodules. Nonetheless, indeterminate cytology diagnoses remain a diagnostic challenge. The development of multiplex molecular techniques and the identification of genetic alterations associated with different follicular cell–derived cancers in the thyroid have led to the introduction of several commercially available tests.
Objective.—
To summarize the most common commercially available molecular testing in thyroid cancer, focusing on the technical features and test performance validation.
Data Sources.—
Peer-reviewed original articles, review articles, and published conference abstracts were reviewed to analyze the advantages and limitations of the most common tests used in the evaluation of thyroid needle aspirations.
Conclusions.—
The most common tests available include the Afirma Gene Expression Classifier, ThyGenX, and ThyroSeq. The excellent negative predictive value (NPV) of the Afirma test allows it to be used as a “rule out” test. ThyGenX analyzes a panel of DNA mutations and RNA translocation fusion markers to assess the risk of malignancy with good NPV and positive predictive value. ThyroSeq is a next-generation sequencing–based gene mutation and fusion test that has been reported to have the best NPV and positive predictive value combined, suggesting that it can be used as a “rule in” and “rule out” test. Molecular testing of cytology specimens from thyroid nodules has the potential to play a major role in the evaluation of indeterminate thyroid lesions.
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Affiliation(s)
- Ming Zhang
- From the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
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93
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Samulski TD, LiVolsi VA, Wong LQ, Baloch Z. Usage trends and performance characteristics of a "gene expression classifier" in the management of thyroid nodules: An institutional experience. Diagn Cytopathol 2016; 44:867-873. [PMID: 27534929 DOI: 10.1002/dc.23559] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/25/2016] [Accepted: 08/04/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The gene expression classifier (GEC; Afirma-Veracyte) has proven to be an effective triage modality in the management of thyroid nodules. We evaluate our institutional experience with GEC, specifically examining performance as a first line testing strategy versus in conjunction with repeat fine needle aspiration (FNA), usage trends based on clinical setting, and performance related to diagnostic categories of The Bethesda System for Reporting Thyroid Cytology (TBSRTC). METHODS All nodules undergoing GEC analysis from 1/2011 to 12/2015 at the Hospital of the University of Pennsylvania were identified using electronic database search methods. Corresponding cytologic diagnoses, GEC results, origin of the sample (in-house vs. satellite site), number and diagnosis of prior FNA's, and clinical and histologic follow-up were collected. RESULTS The cohort included 294 nodules. Of these, 145 (49%) were classified as benign, 136 (46%) as suspicious, and 13 (5%) as quantity insufficient by GEC. Surgical resection was performed in 130 (130/294-44%) cases (107, 82% "suspicious" by GEC); final histopathologic diagnosis was benign in 85 (65%) and malignant in 45 (35%) cases. Three false negative diagnoses were identified in the setting of GEC analysis as a first line testing strategy. Most cases with GEC as a first line testing strategy came from satellite clinical sites (112, 66%). CONCLUSIONS The GEC showed improved performance characteristics when coupled with a repeat FNA. It continues to be of low specificity and positive predictive value in oncocytic follicular lesions. Diagn. Cytopathol. 2016;44:867-873. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- T Danielle Samulski
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Virginia A LiVolsi
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lawrence Q Wong
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zubair Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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94
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Beca F, Schmitt F. MicroRNA signatures in cytopathology: Are they ready for prime time? Cancer Cytopathol 2016; 124:613-5. [DOI: 10.1002/cncy.21728] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 04/01/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Francisco Beca
- Department of Pathology, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Fernando Schmitt
- National Laboratory of Health; University of Luxembourg; Dudelange Luxembourg
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