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Pekova B, Sykorova V, Mastnikova K, Vaclavikova E, Moravcova J, Vlcek P, Lastuvka P, Taudy M, Katra R, Bavor P, Kodetova D, Chovanec M, Drozenova J, Astl J, Hrabal P, Vcelak J, Bendlova B. NTRK Fusion Genes in Thyroid Carcinomas: Clinicopathological Characteristics and Their Impacts on Prognosis. Cancers (Basel) 2021; 13:1932. [PMID: 33923728 PMCID: PMC8073383 DOI: 10.3390/cancers13081932] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/08/2021] [Accepted: 04/11/2021] [Indexed: 12/18/2022] Open
Abstract
Chromosomal rearrangements of NTRK genes are oncogenic driver mutations in thyroid cancer (TC). This study aimed to identify NTRK fusion-positive thyroid tumors and to correlate them with clinical and pathological data and determine their prognostic significance. The cohort consisted of 989 different TC samples. Based on the detected mutation, samples were triaged, and those that were positive for a BRAF, HRAS, KRAS, NRAS, RET, RET/PTC or PAX8/PPARγ mutation were excluded from further analyses. NTRK fusion gene testing was performed in 259 cases, including 126 cases using next-generation sequencing. NTRK fusion genes were detected in 57 of 846 (6.7%) papillary thyroid carcinomas and in 2 of 10 (20.0%) poorly differentiated thyroid carcinomas. A total of eight types of NTRK fusions were found, including ETV6/NTRK3, EML4/NTRK3, RBPMS/NTRK3, SQSTM1/NTRK3, TPM3/NTRK1, IRF2BP2/NTRK1, SQSTM1/NTRK1 and TPR/NTRK1.NTRK fusion-positive carcinomas were associated with the follicular growth pattern, chronic lymphocytic thyroiditis and lymph node metastases. NTRK1-rearranged carcinomas showed a higher frequency of multifocality and aggressivity than NTRK3-rearranged carcinomas. Tumor size, presence of metastases, positivity for the NTRK3 or NTRK1 fusion gene and a late mutation event (TERT or TP53 mutation) were determined as factors affecting patient prognosis. NTRK fusion genes are valuable diagnostic and prognostic markers.
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Affiliation(s)
- Barbora Pekova
- Department of Molecular Endocrinology, Institute of Endocrinology, 11694 Prague, Czech Republic; (V.S.); (K.M.); (E.V.); (J.M.); (J.V.); (B.B.)
| | - Vlasta Sykorova
- Department of Molecular Endocrinology, Institute of Endocrinology, 11694 Prague, Czech Republic; (V.S.); (K.M.); (E.V.); (J.M.); (J.V.); (B.B.)
| | - Karolina Mastnikova
- Department of Molecular Endocrinology, Institute of Endocrinology, 11694 Prague, Czech Republic; (V.S.); (K.M.); (E.V.); (J.M.); (J.V.); (B.B.)
| | - Eliska Vaclavikova
- Department of Molecular Endocrinology, Institute of Endocrinology, 11694 Prague, Czech Republic; (V.S.); (K.M.); (E.V.); (J.M.); (J.V.); (B.B.)
| | - Jitka Moravcova
- Department of Molecular Endocrinology, Institute of Endocrinology, 11694 Prague, Czech Republic; (V.S.); (K.M.); (E.V.); (J.M.); (J.V.); (B.B.)
| | - Petr Vlcek
- Department of Nuclear Medicine and Endocrinology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, 15006 Prague, Czech Republic;
| | - Petr Lastuvka
- Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University and Motol University Hospital, 15006 Prague, Czech Republic; (P.L.); (M.T.)
| | - Milos Taudy
- Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University and Motol University Hospital, 15006 Prague, Czech Republic; (P.L.); (M.T.)
| | - Rami Katra
- Department of Ear, Nose and Throat, 2nd Faculty of Medicine, Charles University and Motol University Hospital, 15006 Prague, Czech Republic;
| | - Petr Bavor
- Department of Surgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, 15006 Prague, Czech Republic;
| | - Daniela Kodetova
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, 15006 Prague, Czech Republic;
| | - Martin Chovanec
- Department of Otorhinolaryngology, Charles University, 3rd Faculty of Medicine, University Hospital Kralovske Vinohrady, 10034 Prague, Czech Republic;
| | - Jana Drozenova
- Department of Pathology, Charles University, 3rd Faculty of Medicine, University Hospital Kralovske Vinohrady, 10034 Prague, Czech Republic;
| | - Jaromir Astl
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, 16902 Prague, Czech Republic;
| | - Petr Hrabal
- Department of Pathology, Military University Hospital, 16902 Prague, Czech Republic;
| | - Josef Vcelak
- Department of Molecular Endocrinology, Institute of Endocrinology, 11694 Prague, Czech Republic; (V.S.); (K.M.); (E.V.); (J.M.); (J.V.); (B.B.)
| | - Bela Bendlova
- Department of Molecular Endocrinology, Institute of Endocrinology, 11694 Prague, Czech Republic; (V.S.); (K.M.); (E.V.); (J.M.); (J.V.); (B.B.)
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Benderradji H, Beron A, Wémeau JL, Carnaille B, Delcroix L, Do Cao C, Baillet C, Huglo D, Lion G, Boury S, Cussac JF, Caiazzo R, Pattou F, Leteurtre E, Vantyghem MC, Ladsous M. Quantitative dual isotope 123iodine/ 99mTc-MIBI scintigraphy: A new approach to rule out malignancy in thyroid nodules. ANNALES D'ENDOCRINOLOGIE 2021; 82:83-91. [PMID: 33727116 DOI: 10.1016/j.ando.2021.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the role of dual isotope 123Iodine/99mTc-MIBI thyroid scintigraphy (IMS) in discriminating between malignant and benign lesions in indeterminate nodules using quantitative analysis methods. METHODS Thirty-five consecutive patients with thyroid nodules of indeterminate or non-diagnostic cytology and cold on 123Iodine scintigraphy (10 Bethesda I, 24 Bethesda III-IV, 1 in which cytology was impossible) underwent IMS between 2017 and 2019 with uptake quantification at two time points ahead of thyroidectomy: early and late. Images were analyzed by two blinded physicians. RESULTS Twelve nodules were malignant and 23 benign on histopathology. Mean uptake values were lower in benign than in malignant nodules at both time points: early, 8.7±4.1 versus 12.9±3.5 (P=0.005); and late, 5.3±2.7 versus 7.7±1.1 (P=0.008). Interobserver reproducibility was excellent. The intraclass correlation coefficient was 0.86 in benign and 0.92 in malignant lesions for early uptake result (ER) and 0.94 and 0.85 respectively for late uptake result (LR). The optimal LR cut-off to exclude a diagnosis of malignancy was set at 5.9 . The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of this cut-off were, respectively, 100%, 65.2%, 60%, 100% and 77.1%. CONCLUSION Despite some study limitations, quantitative analysis of 99mTc-MIBI thyroid scintigraphy had a good reproducibility, which could help to rule out malignancy in non-diagnostic or indeterminate thyroid nodules and thereby reducing the number of patients undergoing unnecessary surgery when LR is below 5.9.
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Affiliation(s)
- Hamza Benderradji
- Department of Endocrinology, Diabetology, and Metabolism, Lille University Hospital, Lille, France; Inserm, U 1172, Lille University, Lille, France.
| | - Amandine Beron
- Department of Nuclear Medicine, Lille University Hospital, Lille, France
| | - Jean-Louis Wémeau
- Department of Endocrinology, Diabetology, and Metabolism, Lille University Hospital, Lille, France
| | - Bruno Carnaille
- Department of General and Endocrine Surgery, Lille University Hospital, Lille, France
| | - Laurent Delcroix
- Department of Nuclear Medicine, Lille University Hospital, Lille, France
| | - Christine Do Cao
- Department of Endocrinology, Diabetology, and Metabolism, Lille University Hospital, Lille, France
| | - Clio Baillet
- Department of Nuclear Medicine, Lille University Hospital, Lille, France
| | - Damien Huglo
- Department of Nuclear Medicine, Lille University Hospital, Lille, France; Inserm, U 1189, Lille University, Lille, France
| | - Georges Lion
- Department of Nuclear Medicine, Lille University Hospital, Lille, France
| | - Samuel Boury
- Department of Radiology, Lille University Hospital, Lille, France
| | | | - Robert Caiazzo
- Department of General and Endocrine Surgery, Lille University Hospital, Lille, France; Inserm, U1190-EGID, Lille University, Lille, France
| | - François Pattou
- Department of General and Endocrine Surgery, Lille University Hospital, Lille, France; Inserm, U1190-EGID, Lille University, Lille, France
| | - Emmanuelle Leteurtre
- Department of Pathology, Lille University Hospital, Lille, France; Inserm, CNRS, UMR9020, U1277 - CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille University, Lille, France
| | - Marie-Christine Vantyghem
- Department of Endocrinology, Diabetology, and Metabolism, Lille University Hospital, Lille, France; Inserm, U1190-EGID, Lille University, Lille, France
| | - Miriam Ladsous
- Department of Endocrinology, Diabetology, and Metabolism, Lille University Hospital, Lille, France; Department of Endocrinology, Valenciennes General Hospital, Valenciennes, France
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Kondrotienė A, Daukša A, Pamedytytė D, Kazokaitė M, Žvirblienė A, Daukšienė D, Simanavičienė V, Klimaitė R, Golubickaitė I, Stakaitis R, Šarauskas V, Verkauskienė R, Žilaitienė B. Papillary Thyroid Carcinoma Tissue miR-146b, -21, -221, -222, -181b Expression in Relation with Clinicopathological Features. Diagnostics (Basel) 2021; 11:diagnostics11030418. [PMID: 33801319 PMCID: PMC8001862 DOI: 10.3390/diagnostics11030418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 11/28/2022] Open
Abstract
We analyzed miR-146b, miR-21, miR-221, miR-21, and miR-181b in formalin fixed paraffin-embedded papillary thyroid carcinoma (PTC) tissue samples of 312 individuals and evaluated their expression relationship with clinicopathological parameters. A higher expression of miR-21 was related to unifocal lesions (p < 0.011) and autoimmune thyroiditis (0.007). miR-221, miR-222 expression was higher in the PTC tissue samples with extrathyroidal extension (p = 0.049, 0.003, respectively). In a group of PTC patients with pT1a and pT1b sized tumors, the expression of miR-146b, miR-21, miR-221, and miR-222 in PTC tissue samples was lower than in patients with pT2, pT3, and pT4 (p = 0.032; 0.0044; 0.003; 0.001; 0.001, respectively). Patients with lymph node metastases had higher expression of miR-21, -221, -222, and -181b (p < 0.05). A high expression of miR-146b, miR-21, miR-221 panel was associated with decreased overall survival (OS) (Log rank p = 0.019). Univariate analysis revealed that presence of metastatic lymph nodes and high expression of miR-146b, miR-21, and miR-221 panels were associated with increased hazard of shorter OS. After multivariate analysis, only sex (male) and age (≥55 years) emerged as independent prognostic factors associated with shorter OS (HR 0.28 (95% CI 0.09–0.86) and HR 0.05 (95% CI 0.01–0.22), respectively). In conclusion, 5 analyzed miRs expression have significant relations to clinicopathologic parameters so further investigations of these molecules are expedient while searching for prognostic PTC biomarkers.
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Affiliation(s)
- Aistė Kondrotienė
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (A.K.); (M.K.); (D.D.); (R.K.); (R.V.)
| | - Albertas Daukša
- Institute of Digestive Research, Medical Academy, Faculty of Medicine, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania;
| | - Daina Pamedytytė
- Institute of Biotechnology, Life Sciences Center, Vilnius University, LT-10257 Vilnius, Lithuania; (D.P.); (A.Ž.); (V.S.)
| | - Mintautė Kazokaitė
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (A.K.); (M.K.); (D.D.); (R.K.); (R.V.)
| | - Aurelija Žvirblienė
- Institute of Biotechnology, Life Sciences Center, Vilnius University, LT-10257 Vilnius, Lithuania; (D.P.); (A.Ž.); (V.S.)
| | - Dalia Daukšienė
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (A.K.); (M.K.); (D.D.); (R.K.); (R.V.)
| | - Vaida Simanavičienė
- Institute of Biotechnology, Life Sciences Center, Vilnius University, LT-10257 Vilnius, Lithuania; (D.P.); (A.Ž.); (V.S.)
| | - Raimonda Klimaitė
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (A.K.); (M.K.); (D.D.); (R.K.); (R.V.)
| | - Ieva Golubickaitė
- Department of Genetics and Molecular Medicine, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania;
| | - Rytis Stakaitis
- Laboratory of Molecular Neurooncology, Neuroscience Institute, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania;
| | - Valdas Šarauskas
- Department of Pathology, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania;
| | - Rasa Verkauskienė
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (A.K.); (M.K.); (D.D.); (R.K.); (R.V.)
| | - Birutė Žilaitienė
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (A.K.); (M.K.); (D.D.); (R.K.); (R.V.)
- Correspondence: ; Tel.: +370-68649882
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Morris LGT. Molecular Profiling of Thyroid Nodules-Are These Findings Meaningful, or Merely Measurable?: A Review. JAMA Otolaryngol Head Neck Surg 2021; 146:845-850. [PMID: 32745207 DOI: 10.1001/jamaoto.2020.1851] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance Advances in genomic technologies have facilitated the development of sophisticated molecular diagnostic tests for thyroid nodules, in the hopes of better risk stratifying nodules with indeterminate cytopathologic diagnosis. It is unclear whether the widespread, or reflexive, use of these tests will improve outcomes for patients with thyroid nodules. Observations Thyroid nodules are a common and essentially normal finding. Even cytologically indeterminate thyroid nodules have a very low probability (approximately 1%) of representing clinically aggressive cancers and an even lower probability (approximately 0.1%) of representing lethal cancers. Therefore, most indeterminate thyroid nodules are low risk. Even if some will eventually require surgery, many can initially be kept under surveillance rather than requiring immediate surgery. Clinical and radiographic features can be helpful in risk stratifying these nodules. Molecular assays are marketed as tools to improve risk stratification for cytologically indeterminate thyroid nodules. However, the performance of these tests varies markedly across different practice settings, and the predictive value of these tests in real world practice may be lower than the numbers provided on laboratory reports. It is unclear whether these assays improve patient outcomes, such as survival or quality of life, or substantially reduce the number of thyroid surgeries performed. Conclusions and Relevance Because of variable performance, unclear benefit to patients, and questionable cost-effectiveness, clinical practice guidelines in the US and Europe currently do not recommend the universal, reflexive use of molecular assays for cytologically indeterminate thyroid nodules. These tests might offer value when used in selected scenarios, although this is not well understood. Future research should address whether the routine use of these molecular diagnostic tests leads to superior patient survival or quality-of-life outcomes compared with management based on clinical and radiographic criteria.
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Affiliation(s)
- Luc G T Morris
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Ospina NS, Papaleontiou M. Thyroid Nodule Evaluation and Management in Older Adults: A Review of Practical Considerations for Clinical Endocrinologists. Endocr Pract 2021; 27:261-268. [PMID: 33588062 PMCID: PMC8092332 DOI: 10.1016/j.eprac.2021.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Contextualizing the evaluation of older adults with thyroid nodules is necessary to fully understand which management strategy is the most appropriate. Our goal was to summarize available clinical evidence to provide guidance in the care of older adults with thyroid nodules and highlight special considerations for thyroid nodule evaluation and management in this population. METHODS We conducted a literature search of PubMed and Ovid MEDLINE from January 2000 to November 2020 to identify relevant peer-reviewed articles published in English. References from the included articles as well as articles identified by the authors were also reviewed. RESULTS The prevalence of thyroid nodules increases with age. Although thyroid nodules in older adults have a lower risk of malignancy, identified cancers are more likely to be of high-risk histology. The goals of thyroid nodule evaluation and the tools used for diagnosis are similar for older and younger patients with thyroid nodules. However, limited evidence exists regarding thyroid nodule evaluation and management to guide personalized decision making in the geriatric population. CONCLUSION Considering patient context is significant in the diagnosis and management of thyroid nodules in older adults. When making management decisions in this population, it is essential to carefully weigh the risks and benefits of thyroid nodule diagnosis and treatment, in view of older adults' higher prevalence of high-risk thyroid cancer as well as increased risk for multimorbidity, functional and cognitive decline, and treatment complications.
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Affiliation(s)
- Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, Florida, 32606
| | - Maria Papaleontiou
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, 48109.
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Capezzone M, Cantara S, Di Santo A, Sagnella A, Pilli T, Brilli L, Ciuoli C, Maino F, Forleo R, Cartocci A, Castagna MG. The Combination of Sonographic Features and the Seven-Gene Panel May be Useful in the Management of Thyroid Nodules With Indeterminate Cytology. Front Endocrinol (Lausanne) 2021; 12:613727. [PMID: 33716969 PMCID: PMC7943869 DOI: 10.3389/fendo.2021.613727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/14/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction The management of patients with indeterminate thyroid nodules, which account for 10-25% of thyroid fine needle aspiration biopsies (FNABs), is still very challenging. Aim To verify the utility of the seven-gene panel in combination with ultrasound features in the clinical management of indeterminate thyroid nodules. Results The study group included 188 indeterminate thyroid nodules, divided into TIR3A (56.4%) and TIR3B (43.6%). A significant correlation between US categories and both cytological and molecular results was observed. In detail, TIR3B cytology was more frequent in EU-TIRADS 4 and 5 nodules (54.7 and 50%, respectively) than in EU-TIRADS 2 and 3 nodules (31%, p = 0.04). Similarly, the rate of a nodule with a mutation increased with the increase of US risk class (6.0% in EU-TIRADS 2 and 3, 9.3% in EUTIRADS-4 and 27.8% in EUTIRAD-5, p = 0.01). Among thyroid nodules submitted to surgery, final histology was benign in 61.4% nodules, while malignancy was diagnosed in 38.6% nodules. Using US score as tool for decision-making in TIR3A subgroup, we correctly classified 64.5% of thyroid nodules. The second tool (seven-gene panel test) was used in the subgroup of US high-risk nodules. By multiple tests with a series approach (US in all cases and US plus seven-gene panel in US high risk nodules) 84% of cases were correctly classified. In TIR3B nodules, using only seven-gene panel as tool for decision making, we correctly classified 61.9% of indeterminate nodules. By multiple tests with series approach (seven-gene panel in all cases and seven-gene panel plus US score in non-mutated nodules) only a slight improvement of thyroid nodule classification (66.6%) was observed. Conclusions US score seems able to correctly discriminate between TIR3A nodules in which a conservative approach may be used, and those in which additional test, such as molecular test, may be indicated. On the contrary, in TIR3B nodules both US risk stratification and seven-gene panel seem to be of little use, because the risk of thyroid cancer remains high regardless of US score and mutational status.
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Affiliation(s)
- Marco Capezzone
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Silvia Cantara
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | | | - Alfonso Sagnella
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Tania Pilli
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Lucia Brilli
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Cristina Ciuoli
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Fabio Maino
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Raffaella Forleo
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | | | - Maria Grazia Castagna
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
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Bardet S, Goardon N, Lequesne J, Vaur D, Ciappuccini R, Leconte A, Monpeyssen H, Saguet-Rysanek V, Clarisse B, Lasne-Cardon A, Ménégaux F, Leenhardt L, Buffet C. Diagnostic and prognostic value of a 7-panel mutation testing in thyroid nodules with indeterminate cytology: the SWEETMAC study. Endocrine 2021; 71:407-417. [PMID: 32638211 PMCID: PMC7881964 DOI: 10.1007/s12020-020-02411-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/27/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of this prospective study (ClinicalTrials.gov: NCT01880203) was to evaluate the diagnostic and prognostic value of a 7-panel mutation testing in the aspirates of thyroid nodules with indeterminate cytology (IC). METHODS Eligible patients had a thyroid nodule ≥15 mm with IC (Bethesda III-V) for which surgery had been recommended. Detection of BRAF and RAS mutations was performed using pyrosequencing and RET/PTC and PAX8/PPARγ rearrangements using Real-Time quantitative reverse transcription-polymerase chain reaction (RT-PCR). RESULTS Among 131 nodules with IC, 21 (16%) were malignant including 20 differentiated cancers and one thyroid lymphoma. Molecular abnormalities were identified in 15 nodules with IC corresponding to 10 malignant and 5 benign tumours. BRAF mutation was detected in 4 nodules all corresponding to classic PTC, and PAX8/PPARγ rearrangement in 2 HCC. In contrast, RAS mutation was identified in eight nodules, of which four were malignant, and one RET/PTC3 rearrangement in a follicular adenoma. This data resulted in an accuracy of 88%, sensitivity of 48%, specificity of 95%, positive-predictive value of 67%, and negative-predictive value of 91%. After a 56 month's follow-up, the proportion of excellent response was similar in patients with molecular alterations (67%) and those without (60%). CONCLUSIONS By increasing the overall risk of cancer from 16 to 67% in mutated nodules and by diminishing it to 9% in wild-type, this study confirms the relevance of the 7-panel mutation testing in the diagnostic of nodules with IC. Genetic testing, however, did not predict outcome in the cancer patient subgroup.
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Affiliation(s)
- Stéphane Bardet
- Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Caen, France.
| | - Nicolas Goardon
- Department of Molecular Biology, Centre François Baclesse, Caen, France
| | - Justine Lequesne
- Department of Clinical Research, Centre François Baclesse, Caen, France
| | - Dominique Vaur
- Department of Molecular Biology, Centre François Baclesse, Caen, France
| | - Renaud Ciappuccini
- Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Caen, France
| | - Alexandra Leconte
- Department of Clinical Research, Centre François Baclesse, Caen, France
| | | | | | | | | | - Fabrice Ménégaux
- Department of Endocrine Surgery, Pitié Salpêtrière Hospital, IUC, University Paris VI, Paris, France
| | - Laurence Leenhardt
- Thyroid and Endocrine Tumors Unit, Institute of Endocrinology, Pitié Salpêtrière Hospital, IUC Sorbonne University, Paris, France
| | - Camille Buffet
- Thyroid and Endocrine Tumors Unit, Institute of Endocrinology, Pitié Salpêtrière Hospital, IUC Sorbonne University, Paris, France
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de Leijer JF, Metman MJH, van der Hoorn A, Brouwers AH, Kruijff S, van Hemel BM, Links TP, Westerlaan HE. Focal Thyroid Incidentalomas on 18F-FDG PET/CT: A Systematic Review and Meta-Analysis on Prevalence, Risk of Malignancy and Inconclusive Fine Needle Aspiration. Front Endocrinol (Lausanne) 2021; 12:723394. [PMID: 34744999 PMCID: PMC8564374 DOI: 10.3389/fendo.2021.723394] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/20/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The rising demand for 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) has led to an increase of thyroid incidentalomas. Current guidelines are restricted in giving options to tailor diagnostics and to suit the individual patient. OBJECTIVES We aimed at exploring the extent of potential overdiagnostics by performing a systematic review and meta-analysis of the literature on the prevalence, the risk of malignancy (ROM) and the risk of inconclusive FNAC (ROIF) of focal thyroid incidentalomas (FTI) on 18F-FDG PET/CT. DATA SOURCES A literature search in MEDLINE, Embase and Web of Science was performed to identify relevant studies. STUDY SELECTION Studies providing information on the prevalence and/or ROM of FTI on 18F-FDG PET/CT in patients with no prior history of thyroid disease were selected by two authors independently. Sixty-one studies met the inclusion criteria. DATA ANALYSIS A random effects meta-analysis on prevalence, ROM and ROIF with 95% confidence intervals (CIs) was performed. Heterogeneity and publication bias were tested. Risk of bias was assessed using the quality assessment of diagnostic accuracy studies (QUADAS-2) tool. DATA SYNTHESIS Fifty studies were suitable for prevalence analysis. In total, 12,943 FTI were identified in 640,616 patients. The pooled prevalence was 2.22% (95% CI = 1.90% - 2.54%, I2 = 99%). 5151 FTI had cyto- or histopathology results available. The pooled ROM was 30.8% (95% CI = 28.1% - 33.4%, I2 = 57%). 1308 (83%) of malignant nodules were papillary thyroid carcinoma (PTC). The pooled ROIF was 20.8% (95% CI = 13.7% - 27.9%, I2 = 92%). LIMITATIONS The main limitations were the low to moderate methodological quality of the studies and the moderate to high heterogeneity of the results. CONCLUSION FTI are a common finding on 18F-FDG PET/CTs. Nodules are malignant in approximately one third of the cases, with the majority being PTC. Cytology results are non-diagnostic or indeterminate in one fifth of FNACs. These findings reveal the potential risk of overdiagnostics of FTI and emphasize that the workup of FTI should be performed within the context of the patient's disease and that guidelines should adopt this patient tailored approach.
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Affiliation(s)
- J. F. de Leijer
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - M. J. H. Metman
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - A. van der Hoorn
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - A. H. Brouwers
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - S. Kruijff
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - B. M. van Hemel
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - T. P. Links
- Department of Internal Medicine, Division of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - H. E. Westerlaan
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- *Correspondence: H. E. Westerlaan,
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Sodo A, Verri M, Palermo A, Naciu AM, Sponziello M, Durante C, Di Gioacchino M, Paolucci A, di Masi A, Longo F, Crucitti P, Taffon C, Ricci MA, Crescenzi A. Raman Spectroscopy Discloses Altered Molecular Profile in Thyroid Adenomas. Diagnostics (Basel) 2020; 11:diagnostics11010043. [PMID: 33383892 PMCID: PMC7823803 DOI: 10.3390/diagnostics11010043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022] Open
Abstract
Follicular patterned nodules are sometimes complex to be classified due to ambiguous nuclear features and/or questionable capsular or vascular invasion. In this setting, there is a poor inter-observer concordance even among expert pathologists. Raman spectroscopy was recently used to separate benign and malignant thyroid nodules based on their molecular fingerprint; anyway, some histologically proved follicular adenomas were clustered as having a characteristic profile of malignant lesions. In this study, we analyzed five follicular thyroid adenomas with a malignant spectroscopic profile compared to five follicular adenomas with a benign Raman spectrum in order to assess possible molecular differences between the two groups. Morphological, immunohistochemical, and molecular analyses evidenced expression of malignancy-associated proteins in four out of five malignant clustered adenomas. The remaining malignant clustered adenoma showed a TSHR mutation previously associated with autonomously functioning follicular carcinomas. In conclusion, thyroid follicular adenomas are a group of morphologically benign neoplasms that may have altered the mutational or expression profile; cases of adenomas with altered immunophenotype are recognized as showing a profile associated with malignancy by Raman spectroscopy. This correlation warrants a more extensive evaluation and suggests a potential predictive value of spectroscopic assessment in recognizing characteristics associated with tumor progression in follicular thyroid neoplasms.
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Affiliation(s)
- Armida Sodo
- Department of Sciences, University Roma Tre, 00146 Rome, Italy; (A.S.); (M.D.G.); (A.P.); (A.d.M.); (M.A.R.)
| | - Martina Verri
- Pathology Unit, Campus Bio-Medico University Hospital, 00128 Rome, Italy; (M.V.); (C.T.)
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, 00128 Rome, Italy; (A.P.); (A.M.N.)
| | - Anda Mihaela Naciu
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, 00128 Rome, Italy; (A.P.); (A.M.N.)
| | - Marialuisa Sponziello
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (M.S.); (C.D.)
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (M.S.); (C.D.)
| | - Michael Di Gioacchino
- Department of Sciences, University Roma Tre, 00146 Rome, Italy; (A.S.); (M.D.G.); (A.P.); (A.d.M.); (M.A.R.)
| | - Alessio Paolucci
- Department of Sciences, University Roma Tre, 00146 Rome, Italy; (A.S.); (M.D.G.); (A.P.); (A.d.M.); (M.A.R.)
| | - Alessandra di Masi
- Department of Sciences, University Roma Tre, 00146 Rome, Italy; (A.S.); (M.D.G.); (A.P.); (A.d.M.); (M.A.R.)
| | - Filippo Longo
- Unit of Thoracic Surgery, Campus Bio-Medico University Hospital, 00128 Rome, Italy; (F.L.); (P.C.)
| | - Pierfilippo Crucitti
- Unit of Thoracic Surgery, Campus Bio-Medico University Hospital, 00128 Rome, Italy; (F.L.); (P.C.)
| | - Chiara Taffon
- Pathology Unit, Campus Bio-Medico University Hospital, 00128 Rome, Italy; (M.V.); (C.T.)
| | - Maria Antonietta Ricci
- Department of Sciences, University Roma Tre, 00146 Rome, Italy; (A.S.); (M.D.G.); (A.P.); (A.d.M.); (M.A.R.)
| | - Anna Crescenzi
- Pathology Unit, Campus Bio-Medico University Hospital, 00128 Rome, Italy; (M.V.); (C.T.)
- Correspondence: ; Tel.: +39-06-225411106
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Wong CKH, Liu X, Lang BHH. Cost-effectiveness of fine-needle aspiration cytology (FNAC) and watchful observation for incidental thyroid nodules. J Endocrinol Invest 2020; 43:1645-1654. [PMID: 32307641 DOI: 10.1007/s40618-020-01254-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/09/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES A trial-based comparison of the use of resources, costs and health utility outcomes of fine-needle aspiration cytology (FNAC), and watchful observation for incidental small (< 2 cm) thyroid nodules was performed using data from the randomized controlled trial (RCT). METHODS Using data from 314 patients, healthcare-related use of resources, costs, health utility, and quality-adjusted life years (QALYs) were estimated at 12 months after first presentation of incidental thyroid nodule(s) on an intention-to-treat basis with adjustment for covariates. Uncertainty about the incremental cost-effectiveness ratio for FNAC versus watchful management at 12 months of follow-up was incorporated using bootstrapping. Multiple imputation methods were used to deal with missing data. RESULTS FNAC management was associated with greater use of healthcare resources and mean direct healthcare costs per patient (US$542.47 vs US$411.55). Lower mean 12-month QALYs per patient in FNAC was observed in comparison to watchful observation (0.752 versus 0.758). The probability that FNAC management was cost-effective compared with watchful management at a willingness-to-pay threshold of US50,000 per QALY gained was 26.5%. CONCLUSION Based on 12-month data from RCT, watchful observation appeared cost-saving compared to FNAC in patients with incidental thyroid nodules that have a low-suspicion sonographic pattern and measure between 1.0 and 2.0 cm from healthcare provider perspective. CLINICALTRIALS. GOV IDENTIFIER NCT02398721.
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Affiliation(s)
- C K H Wong
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
| | - X Liu
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - B H H Lang
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
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Perdana AB, Putri RI, Rachmawati R, Andinata B, Brahma B. Clinical Utility of BRAF, NRAS, and TERT Promoter Mutation in Preoperative Thyroid Fine-Needle Aspiration Biopsy: A Diagnostic Study From Dharmais Cancer Hospital. Asian Pac J Cancer Prev 2020; 21:3267-3277. [PMID: 33247684 PMCID: PMC8033131 DOI: 10.31557/apjcp.2020.21.11.3267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Indexed: 01/08/2023] Open
Abstract
Objective: Molecular testing of thyroid nodules becomes important for improving the accuracy of fine-needle aspiration biopsy (FNAB). This study aimed to investigate the diagnostic utility of BRAF, NRAS, and TERT promoter mutation in thyroid nodules at Dharmais Cancer Hospital. Methods: We performed a prospective diagnostic study involving 50 patients with thyroid nodules who needed surgery between September 2013 and August 2014. Mutational hotspots in BRAF exon 15, NRAS exon 3, and TERT promoter region were analyzed by Sanger sequencing from FNAB specimens. Cytology and molecular data were compared to histopathology results. Results: Of the 50 cases included in the analysis, 39 cases (78%) were thyroid malignancies. Mutations of BRAF, NRAS, and TERT promoter were detected in 31% (12/39), 18% (7/39), and 13% (5/39) cases, respectively. BRAF and NRAS mutations were found mutually exclusive, while all of TERT promoter mutation was found coexistent either with BRAF (40%) or NRAS (60%). The combination of FNAB cytology and molecular testing resulted in 69% sensitivity, 100% specificity, 100% positive predictive value, 48% negative predictive value, and 76% accuracy. Conclusion: Molecular testing of BRAF, NRAS, and TERT mutations improve the sensitivity of thyroid FNAB and is beneficial for more definitive treatment in selective cases. However, the NPV is relatively low to avoid the need for diagnostic surgery. Therefore, further studies to identify more sensitive methods and more comprehensive molecular markers in the diagnosis of thyroid nodules are needed.
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Affiliation(s)
- Adhitya Bayu Perdana
- Department of Research and Development, Dharmais Cancer Hospital - National Cancer Center, Jakarta, Indonesia
| | - Rizky Ifandriani Putri
- Department of Anatomical Pathology, Dharmais Cancer Hospital - National Cancer Center, Jakarta, Indonesia
| | - Rachmawati Rachmawati
- Surgical Oncology Study Program, Department of Surgery, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Bob Andinata
- Department of Surgical Oncology, Dharmais Cancer Hospital - National Cancer Center, Jakarta, Indonesia
| | - Bayu Brahma
- Department of Surgical Oncology, Dharmais Cancer Hospital - National Cancer Center, Jakarta, Indonesia
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62
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Vielh P, Balogh Z, Suciu V, Richon C, Job B, Meurice G, Valent A, Lacroix L, Marty V, Motte N, Dessen P, Caillou B, Ghuzlan AA, Bidart JM, Lazar V, Hofman P, Scoazec JY, El-Naggar AK, Schlumberger M. DNA FISH Diagnostic Assay on Cytological Samples of Thyroid Follicular Neoplasms. Cancers (Basel) 2020; 12:cancers12092529. [PMID: 32899953 PMCID: PMC7564487 DOI: 10.3390/cancers12092529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/30/2020] [Accepted: 09/02/2020] [Indexed: 12/31/2022] Open
Abstract
Simple Summary Cytopathology cannot distinguish benign from malignant follicular lesions in 20–30% of cases. These indeterminate cases includes the so-called follicular neoplasms (FNs) according to The Bethesda System for Reporting Thyroid Cytopathology. Frozen samples from 66 classic follicular adenomas (cFAs) and carcinomas (cFTCs) studied by array-comparative genomic hybridization identified three specific alterations of cFTCs (losses of 1p36.33-35.1 and 22q13.2-13.31, and gain of whole chromosome X) confirmed by fluorescent in situ hybridization (FISH) in a second independent series of 60 touch preparations from frozen samples of cFAs and cFTCs. In a third independent set of 27 cases of already stained pre-operative fine-needle aspiration cytology samples diagnosed as FNs and histologically verified, FISH analysis using these three markers identified half of cFTCs. Specificity of our assay for identifying cFTCs is higher than 98% which might be comparable with BRAF600E testing in cases of suspicion of classic papillary thyroid carcinomas. Abstract Although fine-needle aspiration cytology (FNAC) is helpful in determining whether thyroid nodules are benign or malignant, this distinction remains a cytological challenge in follicular neoplasms. Identification of genomic alterations in cytological specimens with direct and routine techniques would therefore have great clinical value. A series of 153 cases consisting of 72 and 81 histopathologically confirmed classic follicular adenomas (cFAs) and classic follicular thyroid carcinomas (cFTCs), respectively, was studied by means of different molecular techniques in three different cohorts of patients (pts). In the first cohort (training set) of 66 pts, three specific alterations characterized by array comparative genomic hybridization (aCGH) were exclusively found in half of cFTCs. These structural abnormalities corresponded to losses of 1p36.33-35.1 and 22q13.2-13.31, and gain of whole chromosome X. The second independent cohort (validation set) of 60 pts confirmed these data on touch preparations of frozen follicular neoplasms by triple DNA fluorescent in situ hybridization using selected commercially available probes. The third cohort, consisting of 27 archived cytological samples from an equal number of pts that had been obtained for preoperative FNAC and morphologically classified as and histologically verified to be follicular neoplasms, confirmed our previous findings and showed the feasibility of the DNA FISH (DNA fluorescent in situ hybridization) assay. All together, these data suggest that our triple DNA FISH diagnostic assay may detect 50% of cFTCs with a specificity higher than 98% and be useful as a low-cost adjunct to cytomorphology to help further classify follicular neoplasms on already routinely stained cytological specimens.
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Affiliation(s)
- Philippe Vielh
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
- Correspondence: or
| | - Zsofia Balogh
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Voichita Suciu
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Catherine Richon
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Bastien Job
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Guillaume Meurice
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Alexander Valent
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Ludovic Lacroix
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Virginie Marty
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Nelly Motte
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Philippe Dessen
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Bernard Caillou
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Abir Al Ghuzlan
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Jean-Michel Bidart
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Vladimir Lazar
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology and Biobank, Pasteur Hospital, 06002 Nice, France;
| | - Jean-Yves Scoazec
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Adel K. El-Naggar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Martin Schlumberger
- Department of Endocrinology, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France;
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Kondrotienė A, Daukša A, Pamedytytė D, Kazokaitė M, Žvirblienė A, Daukšienė D, Simanavičienė V, Klimaitė R, Golubickaitė I, Stakaitis R, Šarauskas V, Verkauskienė R, Žilaitienė B. Plasma-Derived miRNA-222 as a Candidate Marker for Papillary Thyroid Cancer. Int J Mol Sci 2020; 21:ijms21176445. [PMID: 32899424 PMCID: PMC7503340 DOI: 10.3390/ijms21176445] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 12/14/2022] Open
Abstract
We analyzed five miRNA molecules (miR-221; miR-222; miR-146b; miR-21; miR-181b) in the plasma of patients with papillary thyroid cancer (PTC), nodular goiter (NG) and healthy controls (HC) and evaluated their diagnostic value for differentiation of PTC from NG and HC. Preoperative PTC plasma miRNA expression (n = 49) was compared with plasma miRNA in the HC group (n = 57) and patients with NG (n = 23). It was demonstrated that miR-221; miR-222; miR-146b; miR-21 and miR-181b were overexpressed in preoperative PTC plasma samples compared to HC (p < 0.0001; p < 0.0001; p < 0.0001; p < 0.0001; p < 0.002; respectively). The upregulation in tumor tissue of these miRNAs was consistent with The Cancer Genome Atlas Thyroid Carcinoma dataset. A significant decrease in miR-21; miR-221; miR-146b and miR-181b expression was observed in the plasma of PTC patients after total thyroidectomy (p = 0.004; p = 0.001; p = 0.03; p = 0.036; respectively). The levels of miR-222 were significantly higher in the preoperative PTC compared to the NG group (p = 0.004). ROC curve (receiver operating characteristic curve) analysis revealed miR-222 as a potential marker in distinguishing PTC from NG (AUC 0.711; p = 0.004). In conclusion; circulating miR-222 profiles might be useful in discriminating PTC from NG.
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Affiliation(s)
- Aistė Kondrotienė
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (A.K.); (M.K.); (D.D.); (R.K.); (R.V.)
| | - Albertas Daukša
- Institute of Digestive Research, Medical Academy, Faculty of Medicine, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania;
| | - Daina Pamedytytė
- Institute of Biotechnology, Life Sciences Center, Vilnius University, LT-10257 Vilnius, Lithuania; (D.P.); (A.Ž.); (V.S.)
| | - Mintautė Kazokaitė
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (A.K.); (M.K.); (D.D.); (R.K.); (R.V.)
| | - Aurelija Žvirblienė
- Institute of Biotechnology, Life Sciences Center, Vilnius University, LT-10257 Vilnius, Lithuania; (D.P.); (A.Ž.); (V.S.)
| | - Dalia Daukšienė
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (A.K.); (M.K.); (D.D.); (R.K.); (R.V.)
| | - Vaida Simanavičienė
- Institute of Biotechnology, Life Sciences Center, Vilnius University, LT-10257 Vilnius, Lithuania; (D.P.); (A.Ž.); (V.S.)
| | - Raimonda Klimaitė
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (A.K.); (M.K.); (D.D.); (R.K.); (R.V.)
| | - Ieva Golubickaitė
- Institute of Biology systems and genetic research, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania;
| | - Rytis Stakaitis
- Laboratory of Molecular Neurooncology, Neuroscience Institute, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania;
| | - Valdas Šarauskas
- Department of Pathology, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania;
| | - Rasa Verkauskienė
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (A.K.); (M.K.); (D.D.); (R.K.); (R.V.)
| | - Birutė Žilaitienė
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (A.K.); (M.K.); (D.D.); (R.K.); (R.V.)
- Correspondence: ; Tel.: +370-68649882
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Abstract
Over the last 50 years, the incidence of human thyroid cancer disease has seen a significative increment. This comes along with an even higher increment of surgery, since, according to the international guidelines, patients are sometimes addressed to surgery also when the fine needle aspiration gives undetermined cytological diagnosis. As a matter of fact, only 30% of the thyroid glands removed for diagnostic purpose have a post surgical histological report of malignancy: this implies that about 70% of the patients have suffered an unnecessary thyroid removal. Here we show that Raman spectroscopy investigation of thyroid tissues provides reliable cancer diagnosis. Healthy tissues are consistently distinguished from cancerous ones with an accuracy of \documentclass[12pt]{minimal}
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\begin{document}$$\sim $$\end{document}∼ 90%, and the three cancer typology with highest incidence are clearly identified. More importantly, Raman investigation has evidenced alterations suggesting an early stage of transition of adenoma tissues into cancerous ones. These results suggest that Raman spectroscopy may overcome the limits of current diagnostic tools.
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65
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Li D, Wu J, Liu Z, Qiu L, Zhang Y. Novel circulating protein biomarkers for thyroid cancer determined through data-independent acquisition mass spectrometry. PeerJ 2020; 8:e9507. [PMID: 32704452 PMCID: PMC7346861 DOI: 10.7717/peerj.9507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 06/17/2020] [Indexed: 12/02/2022] Open
Abstract
Background Distinguishing between different types of thyroid cancers (TC) remains challenging in clinical laboratories. As different tumor types require different clinical interventions, it is necessary to establish new methods for accurate diagnosis of TC. Methods Proteomic analysis of the human serum was performed through data-independent acquisition mass spectrometry for 29 patients with TC (stages I–IV): 13 cases of papillary TC (PTC), 10 cases of medullary TC (MTC), and six cases follicular TC (FTC). In addition, 15 patients with benign thyroid nodules (TNs) and 10 healthy controls (HCs) were included in this study. Subsequently, 17 differentially expressed proteins were identified in 291 patients with TC, including 247 with PTC, 38 with MTC, and six with FTC, and 69 patients with benign TNs and 176 with HC, using enzyme-linked immunosorbent assays. Results In total, 517 proteins were detected in the serum samples using an Orbitrap Q-Exactive-plus mass spectrometer. The amyloid beta A4 protein, apolipoprotein A-IV, gelsolin, contactin-1, gamma-glutamyl hydrolase, and complement factor H-related protein 1 (CFHR1) were selected for further analysis. The median serum CFHR1 levels were significantly higher in the MTC and FTC groups than in the PTC and control groups (P < 0.001). CFHR1 exhibited higher diagnostic performance in distinguishing patients with MTC from those with PTC (P < 0.001), with a sensitivity of 100.0%, specificity of 85.08%, area under the curve of 0.93, and detection cut-off of 0.92 ng/mL. Conclusion CFHR1 may serve as a novel biomarker to distinguish PTC from MTC with high sensitivity and specificity.
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Affiliation(s)
- Dandan Li
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Jie Wu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Zhongjuan Liu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Ling Qiu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Yimin Zhang
- Department of Clinical Laboratory, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
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66
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Li X, Du H, Luo J, Ding W, Lai B, He J, Xu S, Zhang Y. Comparison of the Clinical Validity of Droplet Digital PCR to ARMS-PCR for BRAF V600E Mutation Detection in Thyroid Nodules. J Clin Lab Anal 2020; 34:e23458. [PMID: 32671901 PMCID: PMC7676211 DOI: 10.1002/jcla.23458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Droplet digital PCR (ddPCR) has been reported to have a superior validity over PCR with amplification-refractory mutation system (ARMS-PCR) for detecting the BRAF V600E mutation in thyroid nodule fine-needle aspiration (FNA) samples using cytological diagnosis as the reference. However, the added value of ddPCR on surgical decision-making remains to be illustrated when the technique is combined with FNA cytology. METHODS A total of 277 consecutive patients with thyroid nodules were subjected to FNA cytology and BRAF V600E testing with ARMS-PCR. Within this patient cohort, 90 patients underwent surgical intervention with pathological diagnosis available. BRAF V600E testing with ddPCR was performed retrospectively using FNA frozen DNA specimens. The clinical validity and utility of ddPCR in comparison with ARMS-PCR were compared using surgical pathology as the reference. RESULTS Overall, 101 BRAF V600E mutations were detected by ddPCR, including five ARMS negative patients, four of whom were confirmed to have papillary thyroid cancer (PTC) by surgical pathology. Of the 90 patients with surgical pathology, which is considered the gold standard, ddPCR BRAF V600E testing yielded a sensitivity of 91.3% and specificity of 100% for PTC diagnosis, higher than that of ARMS (sensitivity 83.1%, specificity 100%). However, ddPCR only identified one more candidate patient for surgical intervention than ARMS when the techniques were combined with cytology. CONCLUSIONS This study highlighted the superior performance of ddPCR over ARMS in BRAF V600E detection from thyroid nodule FNA samples. Further studies are needed to evaluate the cost-effectiveness of replacing ARMS-PCR with ddPCR for surgical decision-making.
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Affiliation(s)
- Xiubo Li
- Department of Pathology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Hong Du
- Department of Pathology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Jingyan Luo
- Forevergen Biosciences Center, Guangzhou, China.,Guangdong Forevergen Medical Technology Co., Ltd, Foshan, China
| | - Wenshuang Ding
- Department of Pathology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Bingquan Lai
- Forevergen Biosciences Center, Guangzhou, China.,Guangdong Forevergen Medical Technology Co., Ltd, Foshan, China
| | - Jiqian He
- Forevergen Biosciences Center, Guangzhou, China.,Guangdong Forevergen Medical Technology Co., Ltd, Foshan, China
| | - Shaofei Xu
- Forevergen Biosciences Center, Guangzhou, China.,Guangdong Forevergen Medical Technology Co., Ltd, Foshan, China
| | - Yuying Zhang
- Forevergen Biosciences Center, Guangzhou, China.,Department of Urology, The Sixth Affiliated Hospital of Guangzhou Medical University (Qingyuan People's Hospital), Qingyuan, China
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67
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Thyroid surgery in children and young adults: potential overtreatment and complications. Langenbecks Arch Surg 2020; 405:451-460. [PMID: 32462478 PMCID: PMC7359175 DOI: 10.1007/s00423-020-01896-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 05/15/2020] [Indexed: 01/02/2023]
Abstract
Purpose Thyroid nodules in the pediatric population are more frequently associated with malignant thyroid disease than in adult cohorts. Yet, there is a potential risk of surgical overtreatment. With this single center study, an analysis of potential overtreatment for suspected malignant thyroid disease in children and young adults was aimed for. Methods In a period from 2005 to 2018, 155 thyroid operations in children and young adults performed at the University Medical Center Mainz, Germany, were analyzed (patient age 3–20 years, 117 female). Cases were categorized for preoperative diagnosis: non-malignant (group I, n = 45) and malignant thyroid disease (group II, n = 110). Postoperative parameters (histology, complication rates) were assessed and compared between groups. Results 91.1% of group I were histologically benign. 44.5% of group II harbored malignancy. Permanent hypoparathyroidism was documented in group I (2.7%) and in group II (1.4%, p = 1.000). Wound infections were absent in group I but observed in group II (0.9%, p = 1.000). Transient vocal cord palsy was recorded only in group I (2.3%, 2/85 vs. 0/177 nerves at risk, p = 0.104). Permanent vocal cord palsies were absent. Conclusion Preoperative diagnoses were correct in over 90% of group I and in nearly 45% of group II. The high proportion of carcinomas in group II ruled out the issue of potential overtreatment. The risk of severe postoperative complications was equally low in both patient groups. Electronic supplementary material The online version of this article (10.1007/s00423-020-01896-x) contains supplementary material, which is available to authorized users.
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Castagna MG, Pilli T, Maino F, Marzocchi C, Cairano GD, Cantara S. EIF1AX c.338-2A>T splice site mutation in a patient with trabecular adenoma and cytological indeterminate lesion. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2020; 64:185-189. [PMID: 32236306 PMCID: PMC10118949 DOI: 10.20945/2359-3997000000208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 09/16/2019] [Indexed: 11/23/2022]
Abstract
The EIF1AX gene mutations have been recently associated with papillary thyroid carcinoma and anaplastic thyroid cancer. According with these reports, the gene as been considered as a drive gene for thyroid cancer development. However, the occurrence of these alterations in benign thyroid lesions is not known and is still under investigation. Some authors have already reported the presence of EIF1AX variants in follicular adenomas and hyperplastic nodules. Here, we describe for the first time a case of a man with the EIF1AX c.338-2A>T splice site mutation in an indeterminate FNA lesion with trabecular adenoma at final histology in the absence of other pathogenetic mutations, demonstrating that further studies are required to better understand EIF1AX role in the tumorigenesis of thyroid carcinoma.
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Affiliation(s)
- Maria Grazia Castagna
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Tania Pilli
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Fabio Maino
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Carlotta Marzocchi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Giovanni Di Cairano
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Silvia Cantara
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
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Lai S, Chen Y, Chen Z, Wang L, Cong S, Kuang J. [Accuracy of two thyroid imaging, reporting and data systems for differential diagnosis of benign and malignant thyroid nodules]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:400-406. [PMID: 32376572 DOI: 10.12122/j.issn.1673-4254.2020.03.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To compare the accuracy of two widely used thyroid imaging, reporting and data systems (TI-RADS), namely ACR TI-RADS and Kwak TI-RADS, in the differential diagnosis of benign and malignant thyroid nodules. METHODS We reviewed the data of 350 thyroid nodules with definite diagnoses by surgical histopathology (n=144, 41.14%) or fine needle aspiration (FNA) cytopathology (n=206, 58.86%). The nodules were graded using ACR TI-RADS and Kwak TI-RADS based on the ultrasound images, and the diagnostic accuracy of these two systems was evaluated by the area under the receiveroperating characteristic curve (AUC). RESULTS The AUCs of ACR TI-RADS and Kwak TI-RADS were both 0.879. For a differential diagnosis of the thyroid nodules, ACR TI-RADS had a diagnostic sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, Youden's index and accuracy of 77.3%, 89.1%, 83.0%, 85.1%, 7.101, 0.255, 27.848, 0.664 and 0.843, respectively, with an optimal threshold of TR5, as compared with 84.8%, 84.0%, 78.3%, 89.0%, 5.283, 0.181, 29.265, 0.688 and 0.843, respectively, of Kwak TI-RADS, which had an optimal threshold of 4c. CONCLUSIONS Both ACR TI-RADS and Kwak TI-RADS have good performance for differential diagnosis of thyroid nodules, but ACR TI-RADS has a higher specificity and a lower sensitivity compared with Kwak TI-RADS.
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Affiliation(s)
- Shuiqing Lai
- Department of Endocrinology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yuancheng Chen
- Department of Endocrinology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Zhijiang Chen
- Department of Endocrinology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Long Wang
- Department of Endocrinology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Shuzhen Cong
- Department of Ultrasound, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Jian Kuang
- Department of Endocrinology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
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Trimboli P, Scappaticcio L, Treglia G, Guidobaldi L, Bongiovanni M, Giovanella L. Testing for BRAF (V600E) Mutation in Thyroid Nodules with Fine-Needle Aspiration (FNA) Read as Suspicious for Malignancy (Bethesda V, Thy4, TIR4): a Systematic Review and Meta-analysis. Endocr Pathol 2020; 31:57-66. [PMID: 31811566 DOI: 10.1007/s12022-019-09596-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In patients with thyroid fine-needle aspiration (FNA) report of suspicious for malignancy (SFM), both lobectomy and thyroidectomy might be considered. BRAF mutation analysis could guide towards accurate surgical therapy. The primary outcome was the reliability of BRAF (V600E) in detecting malignancy in nodules with FNA reading of SFM. The secondary outcome was to analyze its positive predictive value (PPV) and negative predictive value (NPV) considering the surgical histology as gold standard. A literature search of online databases was performed in June 2019. BRAF prevalence among thyroid nodules with FNA read as SFM according to the most popular classification systems (i.e., Bethesda V, Thy4, TIR4 category) was searched. The random-effects model was used. Three hundred sixty original articles were identified and 34 were finally included in the study. There were 1428 thyroid nodules with FNA read as SFM and 1287 (90.1%) lesions underwent surgery with a cancer rate 89.6%. The pooled prevalence of BRAF (V600E) mutation among all nodules with SFM cytology was 47% (95% CI = 40 to 54, I2 = 85.5%). Pooled PPV and NPV of BRAF testing were 99% (95% CI, 97-99) and 24% (95% CI, 16-32), respectively. BRAF (V600E) mutation was found in about one in two nodules with thyroid FNA read as SFM, its PPV to detect cancers was excellent, and its NPV was very poor. The routine BRAF testing in FNA read as SFM cannot be recommended. BRAF (V600E) test may be useful to extend surgical approach in selected cases with further suspicious clinical/ultrasound features.
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Affiliation(s)
- Pierpaolo Trimboli
- Department of Nuclear Medicine and Thyroid Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
| | - Lorenzo Scappaticcio
- Department of Nuclear Medicine and Thyroid Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Unit of Endocrinology and Metabolic Diseases, University of Campania "L. Vanvitelli", Naples, Italy
| | - Giorgio Treglia
- Department of Nuclear Medicine and Thyroid Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Leo Guidobaldi
- Azienda Sanitaria Unità Sanitaria Locale Roma 2, Rome, Italy
| | - Massimo Bongiovanni
- Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Luca Giovanella
- Department of Nuclear Medicine and Thyroid Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Medical School Zürich, University of Zürich, Zürich, Switzerland
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71
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Seneldir H, Kir G, Soylemez T, Girgin RB, Ozbay N, Ozen F, Ankarali H, Bas G, Alimoglu O. Diagnostic accuracy of molecular testing with three molecular markers on thyroid fine-needle aspiration cytology with abnormal category. Diagn Cytopathol 2020; 48:507-515. [PMID: 32031330 DOI: 10.1002/dc.24394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/12/2020] [Accepted: 01/30/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cases with abnormal category, determined by thyroid fine-needle aspiration (FNA), frequently undergo surgical resection, despite the majority of cases being identified as benign after resection. Additional diagnostic markers are needed to guide the management of patients with abnormal thyroid nodules. MATERIALS AND METHODS The retrospective study enrolled 150 cases diagnosed abnormal by FNA cytology that had undergone molecular testing with three markers (BRAF V600E, NRAS, and KRAS) on the cell block. Seventy-one cases had a surgical follow-up. RESULTS When NIFTP is not considered as malignant, positive predictive values (PPVs) of cytology and combined cytology and molecular testing (CC-MT) were 67.6% (95% CI: 0.555-0.782) and 89.2% (95% CI: 0.746-0.970) (P = .004), respectively. The sensitivity of the CC-MT was 68.8%, specificity was 82.5%, and the false-positive rate was 17.4%. When NIFTP is considered as malignant, PPVs of cytology and CC-MT were 83.1% (95% CI: 0.743-0.918) and 94.6% (95% CI: 0.873-1.018) (P = .047), respectively. The sensitivity of the CC-MT was 59.3%, specificity was 83.3%, and the false-positive rate was 16.7%. CONCLUSION The addition of molecular testing with a small panel to FNA cytology may increase the PPV of cytology in abnormal categories. Small panel (BRAF V600E, KRAS, and NRAS) with high specificity and high PPVs may be used particularly for the detection of thyroid malignancy. Cell blocks can be an especially useful and straightforward method for molecular diagnostic studies.
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Affiliation(s)
- Hatice Seneldir
- Department of Pathology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Gozde Kir
- Department of Pathology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Tuce Soylemez
- Department of Pathology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Rabia B Girgin
- Department of Pathology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Nurver Ozbay
- Department of Pathology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Filiz Ozen
- Department of Medical Genetics, Istanbul Medeniyet University, Istanbul, Turkey
| | - Handan Ankarali
- Department of Biostatistics and Medical Informatics, Istanbul Medeniyet University, Istanbul, Turkey
| | - Gurhan Bas
- Department of General Surgery, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Orhan Alimoglu
- Department of General Surgery, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
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Oczko-Wojciechowska M, Kotecka-Blicharz A, Krajewska J, Rusinek D, Barczyński M, Jarząb B, Czarniecka A. European perspective on the use of molecular tests in the diagnosis and therapy of thyroid neoplasms. Gland Surg 2020; 9:S69-S76. [PMID: 32175247 DOI: 10.21037/gs.2019.10.26] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Thyroid nodules are frequently observed, particularly in individuals of over 60 years of age. On the other hand, most of the detected changes are benign and they do not require surgery. Therefore, differentiation between benign and malignant lesions in preoperative diagnosis is of crucial importance. Currently, the use of fine-needle aspiration biopsy (FNAB) and cytological assessment are the gold standard in the diagnosis of thyroid nodules. This procedure significantly reduces the need for diagnostic surgical intervention. However, approximately 15-30% of cytological results are classified as indeterminate. This is mainly due to the lack of specific cytomorphologic features that would facilitate the diagnosis based on cell evaluation under microscopic assessment. For the diagnoses of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), the assessment of invasion is crucial. Such an evaluation is not possible in cytology. Recently, molecular tests have been developed. They improve cytological diagnosis, particularly in the case of indeterminate results. Commercially available tests are developed based on the North American population. It is important to assess whether such tests can be used in the evaluation of e.g., European population.
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Affiliation(s)
- Małgorzata Oczko-Wojciechowska
- Department of Nuclear Medicine and Endocrine Oncology, Laboratory of Molecular Diagnostic and Functional Genomics, Maria Sklodowska-Curie Institute-Oncology Center, Gliwice Branch, Gliwice, Poland
| | - Agnieszka Kotecka-Blicharz
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Institute-Oncology Center, Gliwice Branch, Gliwice, Poland
| | - Jolanta Krajewska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Institute-Oncology Center, Gliwice Branch, Gliwice, Poland
| | - Dagmara Rusinek
- Department of Nuclear Medicine and Endocrine Oncology, Laboratory of Molecular Diagnostic and Functional Genomics, Maria Sklodowska-Curie Institute-Oncology Center, Gliwice Branch, Gliwice, Poland
| | - Marcin Barczyński
- Department of Endocrine Surgery, Third Chair of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Barbara Jarząb
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Institute-Oncology Center, Gliwice Branch, Gliwice, Poland
| | - Agnieszka Czarniecka
- The Oncologic and Reconstructive Surgery Clinic, Maria Sklodowska-Curie Institute-Oncology Center, Gliwice Branch, Gliwice, Poland
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Staubitz JI, Musholt TJ. [Individualization of the surgical procedure in response to overdiagnosis and overtreatment in differentiated thyroid carcinomas]. DER PATHOLOGE 2020; 40:342-346. [PMID: 31705233 DOI: 10.1007/s00292-019-00699-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Advances in diagnostic methods have led to an early detection of thyroid nodules with debatable malignant potential in numerous cases. This can result in a potential overtreatment of thyroid lesions with very good prognosis. OBJECTIVES To avoid surgical overtreatment, an individualized, risk-adapted management is required that respects the different tumor biology of the underlying histological entities. METHODS The current guidelines of the leading professional societies, the American Thyroid Association (ATA) and the German Association of Endocrine Surgeons (CAEK), were compared and critically studied, to describe risk-adapted, more conservative treatment options for certain types of thyroid neoplasms according to the 2017 WHO definition. RESULTS The German CAEK recommends thyroidectomy as a routine operation in the case of thyroid carcinoma. Exceptions are papillary thyroid microcarcinoma and minimally invasive follicular thyroid carcinoma, which can be treated by lobectomy. The ATA proposes an "active surveillance" for papillary thyroid microcarcinoma and lobectomy in cases of differentiated thyroid carcinoma <4 cm in diameter in the absence of clearly predefined risk factors. CONCLUSIONS The pre- or intraoperative pathological diagnosis of the underlying tumor entity is the key point, which allows for an adaption of the resection strategy for thyroid malignancy. Depending on the type of carcinoma, the current guidelines of international expert societies allow for parenchyma-sparing operations and, according to the ATA, even an "active surveillance."
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Affiliation(s)
- J I Staubitz
- Sektion Endokrine Chirurgie, Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - T J Musholt
- Sektion Endokrine Chirurgie, Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland.
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Singh Ospina N, Iñiguez-Ariza NM, Castro MR. Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment. BMJ 2020; 368:l6670. [PMID: 31911452 DOI: 10.1136/bmj.l6670] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Thyroid nodules are extremely common and can be detected by sensitive imaging in more than 60% of the general population. They are often identified in patients without symptoms who are undergoing evaluation for other medical complaints. Indiscriminate evaluation of thyroid nodules with thyroid biopsy could cause a harmful epidemic of diagnoses of thyroid cancer, but inadequate selection of thyroid nodules for biopsy can lead to missed diagnoses of clinically relevant thyroid cancer. Recent clinical guidelines advocate a more conservative approach in the evaluation of thyroid nodules based on risk assessment for thyroid cancer, as determined by clinical and ultrasound features to guide the need for biopsy. Moreover, newer evidence suggests that for patients with indeterminate thyroid biopsy results, a combined assessment including the initial ultrasound risk stratification or other ancillary testing (molecular markers, second opinion on thyroid cytology) can further clarify the risk of thyroid cancer and the management strategies. This review summarizes the clinical importance of adequate evaluation of thyroid nodules, focuses on the clinical evidence for diagnostic tests that can clarify the risk of thyroid cancer, and highlights the importance of considering the patient's values and preferences when deciding on management strategies in the setting of uncertainty about the risk of thyroid cancer.
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Affiliation(s)
- Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Nicole M Iñiguez-Ariza
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - M Regina Castro
- Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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75
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Bellevicine C, Migliatico I, Sgariglia R, Nacchio M, Vigliar E, Pisapia P, Iaccarino A, Bruzzese D, Fonderico F, Salvatore D, Biondi B, Masone S, Novizio V, Scavuzzo F, Serino D, De Palma M, Chiofalo MG, Botti G, Pezzullo L, Nuzzo V, Spiezia S, De Chiara G, Iorio S, Conzo G, Docimo G, Faggiano A, Bongiovanni M, Malapelle U, Colao A, Triassi M, Troncone G. Evaluation of
BRAF
,
RAS
,
RET/PTC
, and
PAX8/PPARg
alterations in different Bethesda diagnostic categories: A multicentric prospective study on the validity of the 7‐gene panel test in 1172 thyroid FNAs deriving from different hospitals in South Italy. Cancer Cytopathol 2019; 128:107-118. [DOI: 10.1002/cncy.22217] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/05/2019] [Accepted: 11/13/2019] [Indexed: 12/21/2022]
Affiliation(s)
| | - Ilaria Migliatico
- Department of Public Health University of Naples Federico II Naples Italy
| | - Roberta Sgariglia
- Department of Public Health University of Naples Federico II Naples Italy
| | | | - Elena Vigliar
- Department of Public Health University of Naples Federico II Naples Italy
| | - Pasquale Pisapia
- Department of Public Health University of Naples Federico II Naples Italy
| | - Antonino Iaccarino
- Department of Public Health University of Naples Federico II Naples Italy
| | - Dario Bruzzese
- Department of Public Health University of Naples Federico II Naples Italy
| | - Francesco Fonderico
- Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Domenico Salvatore
- Department of Public Health University of Naples Federico II Naples Italy
| | - Bernadette Biondi
- Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Stefania Masone
- Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Vincenzo Novizio
- Department of Endocrinology Aziena Ospedaliera di Rilievo Nazionale A. Cardarelli Naples Italy
| | - Francesco Scavuzzo
- Department of Endocrinology Aziena Ospedaliera di Rilievo Nazionale A. Cardarelli Naples Italy
| | - Domenico Serino
- Department of Endocrinology Aziena Ospedaliera di Rilievo Nazionale A. Cardarelli Naples Italy
| | - Maurizio De Palma
- Department of Surgery Aziena Ospedaliera di Rilievo Nazionale A. Cardarelli Naples Italy
| | | | | | - Luciano Pezzullo
- Thyroid and Parathyroid Surgery Unit IRCCS G. Pascale Naples Italy
| | - Vincenzo Nuzzo
- Department of Endocrinology Hospital of the Sea‐Azienda Sanitaria Locale Naples 1 Center Naples Italy
| | - Stefano Spiezia
- Department of Endocrine Surgery Hospital of the Sea‐Azienda Sanitaria Locale Naples 1 Center Naples Italy
| | - Giovanni De Chiara
- Department of Pathology Aziena Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino Italy
| | - Sergio Iorio
- Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences University of Campania Luigi Vanvitelli Caserta Italy
| | - Giovanni Conzo
- Department of Cardiothoracic and Respiratory Sciences University of Campania Luigi Vanvitelli Caserta Italy
| | - Giovanni Docimo
- Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences University of Campania Luigi Vanvitelli Caserta Italy
| | | | | | - Umberto Malapelle
- Department of Public Health University of Naples Federico II Naples Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Maria Triassi
- Department of Public Health University of Naples Federico II Naples Italy
| | - Giancarlo Troncone
- Department of Public Health University of Naples Federico II Naples Italy
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76
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Li X, Li E, Du J, Wang J, Zheng B. BRAF mutation analysis by ARMS-PCR refines thyroid nodule management. Clin Endocrinol (Oxf) 2019; 91:834-841. [PMID: 31441082 DOI: 10.1111/cen.14079] [Citation(s) in RCA: 15] [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] [Received: 05/06/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Fine-needle aspiration (FNA) of thyroid nodules leads to nearly 25% indeterminate nodules, while BRAFV600E mutation helps to predicting papillary thyroid carcinoma (PTC). However, the clinical validity and utility of the BRAFV600E mutation detected using preoperative FNA samples in a large cohort were rarely reported. AIM To explore the clinical significance of the BRAFV600E mutation on preoperative diagnosis and decision-making in a large FNA cohort in China. DESIGN This was a prospective study of BRAFV600E mutation analysis using an amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) in FNA samples. PATIENTS The study involved 2640 samples from 2307 patients undergoing FNA procedures in a Chinese medical centre. RESULTS A high mutation rate of 86.7% was found in the PTC population. For indeterminate thyroid nodules, the malignant rate of BRAFV600E+ and BRAFV600E- was 87.8% and 39.5% in the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) III, and 88.2% and 31.8% in the BSRTC IV, respectively. A cost-effective diagnostic model combining both BSRTC grading and BRAFV600E mutation status showed the highest sensitivity of 82.9% and specificity of 85.4%. Central lymph node metastasis (CLNM) was independent of the BRAF mutation status and accounted for 34.2% of the patients with PTC. CT values of BRAFV600E of patients with PTMC were significantly lower in young patients and patients with CLNM. CONCLUSIONS The combined analysis of cytological results and BRAFV600E mutation is highly recommended in BRAFV600E high-prevalence regions, including China. Prophylactic central neck dissection should be performed in selected patients without regard to the BRAF mutation status.
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Affiliation(s)
- Xinyang Li
- Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Enling Li
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jing Du
- Department of Ultrasonography, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jiadong Wang
- Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Bing Zheng
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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77
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Freesmeyer M, Kühnel C, Gühne F, Seifert P. Standard Needle Magnetization for Ultrasound Needle Guidance: First Clinical Experiences in Fine-Needle Aspiration Cytology of Thyroid Nodules. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3311-3319. [PMID: 31190439 DOI: 10.1002/jum.15066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/21/2019] [Accepted: 05/26/2019] [Indexed: 06/09/2023]
Abstract
Fine-needle aspiration cytology using a novel ultrasound needle guidance system on the basis of standard needle magnetization was consecutively performed in 30 (15 in-plane and 15 out-of-plane) suspicious thyroid nodules. Nondedicated, commercially available needles were used. The technical effectiveness and safety of the system were satisfying; system failures were observed in 2 cases. The needle tip could be (at least occasionally) visualized inside the thyroid nodule in 96%, and the subjective procedure ratings were excellent in 57%. The out-of-plane technique was significantly superior in both respects (P = .021 and .027, respectively). Standard needle magnetization ultrasound needle guidance was easy to apply and cost-effective and has the potential to improve fine-needle aspiration cytology performance.
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Affiliation(s)
| | - Christian Kühnel
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Falk Gühne
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Philipp Seifert
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
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78
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Macerola E, Poma AM, Proietti A, Romani R, Torregrossa L, Ugolini C, Rago T, Vitti P, Basolo F. Digital Gene Expression Analysis on Cytology Smears Can Rule Out Malignancy in Follicular-Patterned Thyroid Tumors. J Mol Diagn 2019; 22:179-187. [PMID: 31751679 DOI: 10.1016/j.jmoldx.2019.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 09/03/2019] [Accepted: 09/27/2019] [Indexed: 01/06/2023] Open
Abstract
Patients with indeterminate thyroid nodules (Bethesda III and IV) are often treated with diagnostic lobectomy, which in most cases represents an overtreatment. A reliable rule-out molecular test could spare patients unnecessary surgery. Stained smears of 88 indeterminate thyroid nodules with histologic diagnosis of follicular-patterned tumors were selected: 34 follicular adenomas (FAs), 34 follicular variant papillary thyroid carcinomas (FVPTCs), and 20 noninvasive follicular neoplasms with papillary-like nuclear features (NIFTPs). The expression level of 126 genes was measured by digital counting. Mutation testing was performed for the main gene mutations and fusions. Performance of gene expression and mutation tests was calculated by receiver operating characteristic analysis. The gene expression model showed an area under the curve (AUC) of 88%, with 91% negative predictive value in FAs and FVPTCs only. Part of NIFTPs was labeled as benign, and part was labeled as malignant; thus, the classifier performance worsened. Two FAs (5.9%), eight NIFTPs (40%), and 22 FVPTCs (64.7%) were mutation positive. Mutation testing AUC was 79% in FAs and FVPTCs, and decreased by including NIFTPs. This gene expression-based test was feasible in thyroid-stained smears, showed higher AUC than mutation test, and had a high negative predictive value-making it a good candidate as a rule-out test for indeterminate thyroid cytology. NIFTPs have a heterogeneous phenotype, and their preoperative diagnosis requires further investigation.
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Affiliation(s)
- Elisabetta Macerola
- Department of Surgical, Medical, Molecular Pathology and Critical Area (Anatomical Pathology Section), University of Pisa, Pisa, Italy
| | - Anello M Poma
- Department of Surgical, Medical, Molecular Pathology and Critical Area (Anatomical Pathology Section), University of Pisa, Pisa, Italy
| | - Agnese Proietti
- Division of Anatomical Pathology, University Hospital of Pisa, Pisa, Italy
| | - Rossana Romani
- Division of Anatomical Pathology, University Hospital of Pisa, Pisa, Italy
| | | | - Clara Ugolini
- Division of Anatomical Pathology, University Hospital of Pisa, Pisa, Italy
| | - Teresa Rago
- Department of Clinical and Experimental Medicine (Endocrinology Section), University of Pisa, Pisa, Italy
| | - Paolo Vitti
- Department of Clinical and Experimental Medicine (Endocrinology Section), University of Pisa, Pisa, Italy
| | - Fulvio Basolo
- Department of Surgical, Medical, Molecular Pathology and Critical Area (Anatomical Pathology Section), University of Pisa, Pisa, Italy.
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79
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Stewart R, Leang YJ, Bhatt CR, Grodski S, Serpell J, Lee JC. Quantifying the differences in surgical management of patients with definitive and indeterminate thyroid nodule cytology. Eur J Surg Oncol 2019; 46:252-257. [PMID: 31648951 DOI: 10.1016/j.ejso.2019.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/16/2019] [Accepted: 10/05/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Thyroid nodules are increasingly common. Despite being an essential pre-operative diagnostic tool, up to 30% of fine needle aspirate cytology (FNAC) yields a non-definitive diagnosis. This study aimed to quantify differences in surgical management of patients with definitive and indeterminate thyroid nodule cytology, and determine if clinical factors can improve cytological diagnosis. MATERIALS AND METHODS Patients who underwent thyroidectomy for nodules from 2001 to 2015 were recruited. Those with benign and malignant preoperative cytology were included in the "definitive diagnosis" (DC) group; patients with all other preoperative cytology results were included in the "indeterminate diagnosis" (IC) group. We compared demographics and procedures between these groups. Clinical factors and demographics were also compared between patients with benign and malignant histology in the IC group. RESULTS A total of 3821 cases were included. A significantly larger proportion of the IC patients had a hemithyroidectomy (IC 69% vs. DC 39%, p < 0.001) initially, and also had a significantly higher rate of two-stage surgery compared to the DC group (IC 17% vs. DC 11%, p < 0.001). Patients in the DC group were twice as likely to undergo concurrent central lymph node dissection for papillary and medullary cancers than the IC group (p < 0.001). Overall, up to 60% of IC patients had been over- or under-treated at initial surgery. The clinical factors examined were not significantly associated with higher risk of malignancy in IC patients. CONCLUSION This study highlights the potential for improved preoperative diagnosis to streamline decision making for surgical management of patients with thyroid nodules.
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Affiliation(s)
- Rose Stewart
- Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Australia
| | - Yit Jern Leang
- Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Australia
| | - Chhavi Raj Bhatt
- Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia; Department of Emergency Medicine, Monash Health, Melbourne, Australia
| | - Simon Grodski
- Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia; Department of Surgery, Monash Health, Melbourne, Australia
| | - Jonathan Serpell
- Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia
| | - James C Lee
- Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia; Department of Surgery, Monash Health, Melbourne, Australia.
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80
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Seifert P, Winkens T, Kühnel C, Gühne F, Freesmeyer M. I-124-PET/US Fusion Imaging in Comparison to Conventional Diagnostics and Tc-99m Pertechnetate SPECT/US Fusion Imaging for the Function Assessment of Thyroid Nodules. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2298-2308. [PMID: 31196748 DOI: 10.1016/j.ultrasmedbio.2019.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/30/2019] [Accepted: 05/09/2019] [Indexed: 06/09/2023]
Abstract
The purpose of this study is to investigate I-124 positron emission tomography (PET)/ultrasound (US) fusion imaging for function assessment of thyroid nodules. In 70 patients, 201 lesions were examined with conventional diagnostics (CD) (thyroid US, laboratory findings and Tc-99m pertechnetate scintigraphy), Tc-99m pertechnetate single photon emission computed tomography (SPECT) and I-124 PET/computed tomography (CT). Subsequently, US fusion imaging (SPECT/US and PET/US) was performed by three experienced investigators. Patients referred for thyroid diagnostics in a clinical routine setting were included in this study if CD produced equivocal results. PET/US was superior to CD and SPECT/US in 96% and 86%, respectively, and ambiguous findings in CD were clarified by PET/US in 96% of the 70 patients. Regarding nodule-based function assessment, 10% (66%), 39% (14%) and 71% (4%) of the 201 lesions were rated with absolute certainty (equivocal or uncertain) using CD, SPECT/US and PET/US, respectively (p < 0.001). PET/US has the potential to improve the function assessment of thyroid nodules in comparison to CD.
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Affiliation(s)
- Philipp Seifert
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Thomas Winkens
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Christian Kühnel
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Falk Gühne
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Martin Freesmeyer
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany.
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81
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Bongiovanni M, Bellevicine C, Troncone G, Sykiotis GP. Approach to cytological indeterminate thyroid nodules. Gland Surg 2019; 8:S98-S104. [PMID: 31475096 DOI: 10.21037/gs.2018.12.06] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The indeterminate thyroid nodules diagnosed by fine-needle aspiration cytology (FNAC)represents a problem for both cytopathologists and clinicians. The former sometimes use this diagnostic category as a sort of basket, putting in cases that they do not know exactly how to classify. The latter are faced with a highly variable risk of malignancy and consequently the management remains a challenge. On the histopathological side, the new WHO classification of tumors of the thyroid introduced the concept of tumors with uncertain and low malignant potential, and the concept of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), whose prognosis and management are still to be completely elucidated. While the risk of malignancy of the indeterminate diagnostic category has decreased due to the re-classification of certain types of papillary thyroid carcinomas of the follicular variant into a low malignant potential form (the NIFTP), cases diagnosed cytologically as indeterminate will probably increase in the future to avoid false positive diagnosis. Thus, the indeterminate thyroid diagnostic category still remains a challenge, both at the diagnostic level and for its management. The new version of the Bethesda system for reporting thyroid cytopathology suggests managing these patients with a repeat FNA, diagnostic lobectomy and/or molecular testing.
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Affiliation(s)
- Massimo Bongiovanni
- Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Claudio Bellevicine
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Giancarlo Troncone
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Gerasimos P Sykiotis
- Service of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
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82
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Staubitz JI, Musholt PB, Musholt TJ. The surgical dilemma of primary surgery for follicular thyroid neoplasms. Best Pract Res Clin Endocrinol Metab 2019; 33:101292. [PMID: 31434622 DOI: 10.1016/j.beem.2019.101292] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Follicular thyroid carcinoma is the second most prevalent form of differentiated thyroid carcinoma, following papillary thyroid carcinoma. Preoperative diagnosis is hampered by the fact that fine-needle aspiration cytology as well as supplemental molecular analysis cannot unambiguously distinguish between follicular thyroid carcinoma and benign follicular thyroid adenoma. The 2017 WHO classification defines three histological subtypes of follicular thyroid carcinoma: minimally invasive (excellent prognosis), encapsulated angioinvasive, and widely invasive type (higher risk of recurrence and metastatic spread). The fact that definite characterization of follicular neoplasms is predominantly a postoperative histological diagnosis (core criteria: capsular, vascular and adjacent tissue invasion) translates into the challenge for the thyroid surgeon to plan preoperatively for presence of malignancy and, if required, to adapt the surgical strategy according to intraoperative (frozen section) or postoperative histological findings. Until improved tools for pre-/intraoperative diagnosis are available, the malignant potential of a follicular thyroid lesion can be assessed by stratifying the patient according to clinical risk factors (presence of metastases, advanced patient age, tumor size). A stepwise, escalating surgical approach with restricted primary resection (hemithyroidectomy) and completion surgery based on the definite histopathology is another option to solve this dilemma. The currently recommended surgical treatment strategies for FTCs as published by ATA, BTA, CAEK and ESES are discussed. There is consensus that prophylactic lymphadenectomy is not required for FTCs and that hemithyroidectomy is sufficient in low-risk FTCs (capsular invasion only) whereas thyroidectomy with postoperative radioiodine therapy is indicated in high-risk FTCs (angioinvasion; widely invasive FTC).
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Affiliation(s)
- Julia I Staubitz
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medicine Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Petra B Musholt
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medicine Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Thomas J Musholt
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medicine Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
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83
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Roy-Chowdhuri S, Pisapia P, Salto-Tellez M, Savic S, Nacchio M, de Biase D, Tallini G, Troncone G, Schmitt F. Invited review-next-generation sequencing: a modern tool in cytopathology. Virchows Arch 2019; 475:3-11. [PMID: 30877381 DOI: 10.1007/s00428-019-02559-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 02/26/2019] [Accepted: 03/04/2019] [Indexed: 02/05/2023]
Abstract
In recent years, cytopathology has established itself as an independent diagnostic modality to guide clinical management in many different settings. The application of molecular techniques to cytological samples to identify prognostic and predictive biomarkers has played a crucial role in achieving this goal. While earlier studies have demonstrated that single biomarker testing is feasible on cytological samples, currently, this provides only limited and increasingly insufficient information in an era where an increasing number of biomarkers are required to guide patient care. More recently, multigene mutational assays, such as next-generation sequencing (NGS), have gained popularity because of their ability to provide genomic information on multiple genes. The cytopathologist plays a key role in ensuring success of NGS in cytological samples by influencing the pre-analytical steps, optimizing preparation types and adequacy requirement in terms of cellularity and tumor fraction, and ensuring optimal nucleic acid extraction for DNA input requirements. General principles of the role and potential of NGS in molecular cytopathology in the universal healthcare (UHC) European environment and examples of principal clinical applications were discussed in the workshop that took place at the 30th European Congress of Pathology in Bilbao, European Society of Pathology, whose content is here comprehensively described.
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Affiliation(s)
- Sinchita Roy-Chowdhuri
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pasquale Pisapia
- Department of Public Health, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Manuel Salto-Tellez
- Northern Ireland Molecular Pathology Laboratory, Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Spasenija Savic
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Mariantonia Nacchio
- Department of Public Health, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Dario de Biase
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Giovanni Tallini
- Anatomic Pathology, University of Bologna Medical Center, Bologna, Italy
| | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - Fernando Schmitt
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
- Department of Pathology, Medical Faculty of Porto University, Porto, Portugal
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84
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Javaid MK, Boyce A, Appelman-Dijkstra N, Ong J, Defabianis P, Offiah A, Arundel P, Shaw N, Pos VD, Underhil A, Portero D, Heral L, Heegaard AM, Masi L, Monsell F, Stanton R, Dijkstra PDS, Brandi ML, Chapurlat R, Hamdy NAT, Collins MT. Best practice management guidelines for fibrous dysplasia/McCune-Albright syndrome: a consensus statement from the FD/MAS international consortium. Orphanet J Rare Dis 2019; 14:139. [PMID: 31196103 PMCID: PMC6567644 DOI: 10.1186/s13023-019-1102-9] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/21/2019] [Indexed: 02/07/2023] Open
Abstract
Fibrous Dysplasia / McCune Albright syndrome (FD/MAS) represents a wide spectrum of diseases due to somatic gain-of-function mutations of the GNAS gene. The mutation leads to overactivity in the target tissues and to a wide phenotype of clinical features that vary in severity and age of onset. The rarity of the disease and its variable presentation to multiple specialities often leads to misdiagnosis and inappropriate variability in investigations and treatments. To address this, our international consortium of clinicians, researchers, and patients’ advocates has developed pragmatic clinical guidelines for best clinical practice for the definition, diagnosis, staging, treatment and monitoring for FD/MAS to empower patients and support clinical teams in both general and specialised healthcare settings. With the lack of strong evidence to inform care, the guidelines were developed based on review of published literature, long-standing extensive experience of authors, input from other healthcare professionals involved in the care of FD/MAS patients and feedback from patients and patient groups across the globe. This has led to the formulation of a set of statements to inform healthcare professionals, patients, their families, carers and patient groups of the best practice of care. It is anticipated the implementation of these recommendations will lead to improvement in the care of patients with FD/MAS internationally.
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Affiliation(s)
- Muhammad Kassim Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - Alison Boyce
- Skeletal Disorders and Mineral Homeostasis Section, National Institute of Dental and Craniofacial Research, Bethesda, MD, USA
| | - Natasha Appelman-Dijkstra
- Department of Medicine, Division of Endocrinology & Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
| | - Juling Ong
- Department of Plastic Surgery, Craniofacial Centre, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | | | - Amaka Offiah
- Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
| | - Paul Arundel
- Metabolic Bone Team, Sheffield Children's Hospital, Sheffield, UK
| | - Nick Shaw
- Endocrine Department, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Valter Dal Pos
- European Association of Friends of McCune-Albright Syndrome (TO), Turino, Italy
| | - Ann Underhil
- Fibrous Dysplasia Support Society, Birmingham, UK
| | | | - Lisa Heral
- Fibrous Dysplasia Foundation, Grandville, USA
| | - Anne-Marie Heegaard
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Laura Masi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Fergal Monsell
- Paediatric Orthopaedic and Trauma Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Robert Stanton
- Department of Orthopaedic Surgery, Nemours Children's Hospital, Orlando, Florida, USA
| | | | - Maria Luisa Brandi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | | | - Neveen Agnes Therese Hamdy
- Department of Medicine, Division of Endocrinology & Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
| | - Michael Terrence Collins
- Skeletal Disorders and Mineral Homeostasis Section, National Institute of Dental and Craniofacial Research, Bethesda, MD, USA
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85
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Stadler TM, Morand GB, Rupp NJ, Freiberger SN, Broglie MA. [Benefits of Molecular Analyses in Thyroid Carcinoma]. PRAXIS 2019; 108:535-540. [PMID: 31185849 DOI: 10.1024/1661-8157/a003240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Benefits of Molecular Analyses in Thyroid Carcinoma Abstract. The widespread access to neck ultrasonography has led to high detection rates of thyroid nodules, whose vast majority will remain clinically silent. In daily practice it is a challenge to filter out the thyroid nodules that require medical attention. This is usually achieved by a combination of sonomorphologic criteria and fine-needle aspiration cytology. In recent years, there is a trend toward deescalation in diagnostic and therapeutic measures for thyroid nodules. Some authors even advocate active surveillance instead of surgical approaches for very low-risk thyroid carcinoma. This approach requires an accurate assessment of the malignant potential of each thyroid nodule. As recent studies have allowed better understanding of molecular pathogenesis of thyroid cancer, the mutational profile of thyroid nodules has emerged as a new tool for assessment of thyroid nodules. Its exact clinical application in daily routine remains, however, unclear.
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Affiliation(s)
- Thomas M Stadler
- 1 Klinik für Ohren-, Nasen-, Hals- und Gesichtschirurgie, Universitätsspital Zürich
| | - Grégoire B Morand
- 1 Klinik für Ohren-, Nasen-, Hals- und Gesichtschirurgie, Universitätsspital Zürich
| | - Niels J Rupp
- 2 Institut für Pathologie und Molekularpathologie, Universitätsspital Zürich
| | - Sandra N Freiberger
- 2 Institut für Pathologie und Molekularpathologie, Universitätsspital Zürich
| | - Martina A Broglie
- 1 Klinik für Ohren-, Nasen-, Hals- und Gesichtschirurgie, Universitätsspital Zürich
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86
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Borowczyk M, Szczepanek-Parulska E, Olejarz M, Więckowska B, Verburg FA, Dębicki S, Budny B, Janicka-Jedyńska M, Ziemnicka K, Ruchała M. Evaluation of 167 Gene Expression Classifier (GEC) and ThyroSeq v2 Diagnostic Accuracy in the Preoperative Assessment of Indeterminate Thyroid Nodules: Bivariate/HROC Meta-analysis. Endocr Pathol 2019; 30:8-15. [PMID: 30591992 DOI: 10.1007/s12022-018-9560-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The objective of this meta-analysis was to evaluate the performance of the Gene Expression Classifier (GEC) and ThyroSeq v2 (ThyroSeq) in the preoperative diagnosis of thyroid nodules with indeterminate fine-needle aspiration biopsy results. We searched literature databases from January 2001 to April 2018. The bivariate model analysis was performed to estimate pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), positive predictive value (PPV), and negative predictive value (NPV). Pooled data from 1086 nodules with histopathologic confirmation from 16 GEC studies enabled calculation of diagnostic parameters (95% confidence interval): sensitivity 98% (96-99%), specificity 12% (8-20%), PPV 45% (37-53%), and NPV 91% (85-96%). Pooled data from five ThyroSeq studies assessing 459 nodules showed sensitivity of 84% (74-91%), specificity 78% (50-92%), PPV 58% (31-81%), and NPV 93% (89-97%). When both tools were compared, GEC had a significantly higher sensitivity (p = 0.003), while ThyroSeq had a significantly higher specificity (p < 0.001) and accuracy (p = 0.015). Pooled LR+ was higher for ThyroSeq: 3.79 (1.40-10.27) vs. 1.12 (1.05-1.20). Pooled LR- was higher for GEC, 0.20 (0.10-0.39) vs. 0.13 (0.05-0.31). The bivariate summary estimates of sensitivity and specificity for GEC and ThyroSeq and their pooled accuracy showed a superiority of the ThyroSeq test. The GEC with a high sensitivity and NPV may be helpful in ruling out malignancy in cases of indeterminate thyroid nodule cytology. ThyroSeq has a significantly higher specificity and accuracy with an acceptable sensitivity so that it has the potential for use as an all-round test of malignancy of thyroid nodules.
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Affiliation(s)
- Martyna Borowczyk
- Department of Endocrinology, Metabolism and Internal Medicine, Poznań University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland.
| | - Ewelina Szczepanek-Parulska
- Department of Endocrinology, Metabolism and Internal Medicine, Poznań University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
| | - Michał Olejarz
- Department of Endocrinology, Metabolism and Internal Medicine, Poznań University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
| | - Barbara Więckowska
- Department of Computer Science and Statistics, Poznań University of Medical Sciences, Poznań, Poland
| | - Frederik A Verburg
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Szymon Dębicki
- Department of Endocrinology, Metabolism and Internal Medicine, Poznań University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
| | - Bartłomiej Budny
- Department of Endocrinology, Metabolism and Internal Medicine, Poznań University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
| | | | - Katarzyna Ziemnicka
- Department of Endocrinology, Metabolism and Internal Medicine, Poznań University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
| | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Medicine, Poznań University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
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87
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Raj SD, Ram R, Sabbag DJ, Sultenfuss MA, Matejowsky R. Thyroid Fine Needle Aspiration: Successful Prospective Implementation of Strategies to Eliminate Unnecessary Biopsy in the Veteran Population. Curr Probl Diagn Radiol 2019; 48:127-131. [DOI: 10.1067/j.cpradiol.2017.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/27/2017] [Accepted: 12/12/2017] [Indexed: 01/25/2023]
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88
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Sanchez A, Bocklage T. Precision cytopathology: expanding opportunities for biomarker testing in cytopathology. J Am Soc Cytopathol 2019; 8:95-115. [PMID: 31287426 DOI: 10.1016/j.jasc.2018.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 12/14/2018] [Accepted: 12/15/2018] [Indexed: 06/09/2023]
Abstract
Precision cytopathology refers to therapeutically linked biomarker testing in cytopatology, a dynamically growing area of the discipline. This review describes basic steps to expand precision cytopathology services. Focusing exclusively on solid tumors, the review is divided into four sections: Section 1: Overview of precision pathology- opportunities and challenges; Section 2: Basic steps in establishing or expanding a precision cytopathology laboratory; Section 3: Cytopathology specimens suitable for next generation sequencing platforms; and Section 4: Summary. precision cytopathology continues to rapidly evolve in parallel with expanding targeted therapy options. Biomarker assays (companion diagnostics) comprise a multitude of test types including immunohistochemistry, in situ hybridization and molecular genetic tests such as PCR and next generation sequencing all of which are performable on cytology specimens. Best practices for precision cytopathology will incorporate traditional diagnostic approaches allied with careful specimen triage to enable successful biomarker analysis. Beyond triaging, cytopathologists knowledgeable about molecular test options and capabilities have the opportunity to refine diagnoses, prognoses and predictive information thereby assuming a lead role in precision oncology biomarker testing.
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Affiliation(s)
| | - Thèrése Bocklage
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, MS.
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89
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Mulligan LM. GDNF and the RET Receptor in Cancer: New Insights and Therapeutic Potential. Front Physiol 2019; 9:1873. [PMID: 30666215 PMCID: PMC6330338 DOI: 10.3389/fphys.2018.01873] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/11/2018] [Indexed: 12/15/2022] Open
Abstract
The Glial cell line-derived neurotrophic Family Ligands (GFL) are soluble neurotrophic factors that are required for development of multiple human tissues, but which are also important contributors to human cancers. GFL signaling occurs through the transmembrane RET receptor tyrosine kinase, a well-characterized oncogene. GFL-independent RET activation, through rearrangement or point mutations occurs in thyroid and lung cancers. However, GFL-mediated activation of wildtype RET is an increasingly recognized mechanism promoting tumor growth and dissemination of a much broader group of cancers. RET and GFL expression have been implicated in metastasis or invasion in diverse human cancers including breast, pancreatic, and prostate tumors, where they are linked to poorer patient prognosis. In addition to directly inducing tumor growth in these diseases, GFL-RET signaling promotes changes in the tumor microenvironment that alter the surrounding stroma and cellular composition to enhance tumor invasion and metastasis. As such, GFL RET signaling is an important target for novel therapeutic approaches to limit tumor growth and spread and improve disease outcomes.
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Affiliation(s)
- Lois M. Mulligan
- Division of Cancer Biology and Genetics, Department of Pathology and Molecular Medicine, Cancer Research Institute, Queen’s University, Kingston, ON, Canada
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90
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Tumino D, Grani G, Di Stefano M, Di Mauro M, Scutari M, Rago T, Fugazzola L, Castagna MG, Maino F. Nodular Thyroid Disease in the Era of Precision Medicine. Front Endocrinol (Lausanne) 2019; 10:907. [PMID: 32038482 PMCID: PMC6989479 DOI: 10.3389/fendo.2019.00907] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 12/12/2019] [Indexed: 12/31/2022] Open
Abstract
Management of thyroid nodules in the era of precision medicine is continuously changing. Neck ultrasound plays a pivotal role in the diagnosis and several ultrasound stratification systems have been proposed in order to predict malignancy and help clinicians in therapeutic and follow-up decision. Ultrasound elastosonography is another powerful diagnostic technique and can be an added value to stratify the risk of malignancy of thyroid nodules. Moreover, the development of new techniques in the era of "Deep Learning," has led to a creation of machine-learning algorithms based on ultrasound examinations that showed similar accuracy to that obtained by expert radiologists. Despite new technologies in thyroid imaging, diagnostic surgery in 50-70% of patients with indeterminate cytology is still performed. Molecular tests can increase accuracy in diagnosis when performed on "indeterminate" nodules. However, the more updated tools that can be used to this purpose in order to "rule out" (Afirma GSC) or "rule in" (Thyroseq v3) malignancy, have a main limitation: the high costs. In the last years various image-guided procedures have been proposed as alternative and less invasive approaches to surgery for symptomatic thyroid nodules. These minimally invasive techniques (laser and radio-frequency ablation, high intensity focused ultrasound and percutaneous microwave ablation) results in nodule shrinkage and improvement of local symptoms, with a lower risk of complications and minor costs compared to surgery. Finally, ultrasound-guided ablation therapy was introduced with promising results as a feasible treatment for low-risk papillary thyroid microcarcinoma or cervical lymph node metastases.
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Affiliation(s)
- Dario Tumino
- Endocrinology Unit, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Marta Di Stefano
- Division of Endocrine and Metabolic Diseases, Department of Clinical Sciences and Community Health, IRCCS Istituto Auxologico Italiano, Università degli Studi di Milano, Milan, Italy
| | - Maria Di Mauro
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maria Scutari
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Teresa Rago
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Laura Fugazzola
- Division of Endocrine and Metabolic Diseases, Department of Clinical Sciences and Community Health, IRCCS Istituto Auxologico Italiano, Università degli Studi di Milano, Milan, Italy
| | - Maria Grazia Castagna
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Fabio Maino
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
- *Correspondence: Fabio Maino
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91
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Walasik-Szemplińska D, Kamiński G, Mańczak M, Widłak J, Sudoł-Szopińska I. A Comparison of Doppler Flow Parameters in the Ophthalmic Artery and Central Retinal Artery in Patients With Graves' Disease and Toxic Nodular Goiter. Front Endocrinol (Lausanne) 2019; 10:707. [PMID: 31681176 PMCID: PMC6811511 DOI: 10.3389/fendo.2019.00707] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/02/2019] [Indexed: 11/15/2022] Open
Abstract
Purpose: Despite unquestionable clinical usefulness of Clinical Activity Score, the evaluating system needs frequent supplementation. One of such diagnostic tools is Doppler imaging that is used for the analysis of flow in the retrobulbar vessels. The improvement of the reliability and sensibility of measurements could make Doppler imaging an everyday clinical tool and improve the efficacy of treatment in patients with active thyroid-associated orbitopathy. However, the systemic influence of hyperthyroidism on the orbital vessels can falsify the assessment of local inflammation severity. Methods: To eliminate the influence of systemic hyperthyroidism on orbital vessels, we compared peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI) in the central retinal artery (CRA), and ophthalmic artery (OA) in patients with hyperthyroidism in the course of Graves' disease without any detectable orbital changes, (CAS = 0) and toxic nodular goiter. Results: There were no statistically significant differences between the patients with Graves' disease and toxic nodular goiter in terms of the examined parameters in either of the arteries. However, higher PSV and RI and lower EDV in the CRA as well as higher PSV and EDV and unchanged RI in the OA were found in the patients with Graves' diseases and toxic nodular goiter. Conclusion: Hyperthyroidism and hyperthyroidism-induced hyperkinetic flow have a systemic influence on the orbital vessels, irrespective of the cause of hyperthyreosis. Thus, it is necessary to compare the flow parameters in retrobulbar vessels in Graves' patients with the toxic nodular goiter patients to eliminate the systemic influence of hyperthyroidism on the orbital vessels.
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Affiliation(s)
| | - Grzegorz Kamiński
- Department of Endocrinology and Radioisotope Therapy, Military Institute of Medicine, Warsaw, Poland
| | - Małgorzata Mańczak
- Department of Gerontology, Public Health and Didactics National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Joanna Widłak
- Division of Thyrology and Radionuclide Therapy, Bielanski Hospital, Warsaw, Poland
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics Rheumatology and Rehabilitation, Warsaw, Poland
- Department of Medical Imaging, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
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92
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Wu Y, Xu T, Cao X, Zhao X, Deng H, Wang J, Li X, Yao Q, Ye X, Shen M, Wu X. BRAF V600E vs. TIRADS in predicting papillary thyroid cancers in Bethesda system I, III, and V nodules. Cancer Biol Med 2019; 16:131-138. [PMID: 31119053 PMCID: PMC6528444 DOI: 10.20892/j.issn.2095-3941.2018.0291] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective Bethesda System for Reporting Thyroid Cytopathology (BSRTC) categories I, III, and V account for a significant proportion of fine needle aspiration cytology (FNAC) diagnoses. This study aimed to compare the diagnostic efficacy of BRAFV600E mutation and the Thyroid Imaging Reporting and Data System (TIRADS) classification in differentiating papillary thyroid cancers (PTCs) from benign lesions among BSRTC I, III, and V nodules.
Methods A total of 472 patients with 479 nodules were enrolled in this prospective study. Ultrasound, BRAFV600E mutation testing, and FNAC were performed in each nodule, followed by surgery or regular ultrasound examination.
Results In the BSRTC I category, BRAFV600E showed similar sensitivity, higher specificity, and lower accuracy when compared with TIRADS. In the BSRTC III/V category, the sensitivity, specificity, and accuracy of BRAFV600E were similar to those of TIRADS. In comparison to BRAFV600E alone, the combination of the two methods significantly improved sensitivity (BSRTC I: 93.6% vs. 67.7%, P < 0.01; BSRTC III: 93.8% vs. 75.0%, P < 0.01; BSRTC V: 96.0% vs. 85.3%, P < 0.001). When compared with TIRADS alone, the combination improved sensitivity in BSRTC I nodules (93.6% vs. 74.2%, P < 0.05), increased sensitivity and decreased accuracy in BSRTC III nodules (93.8% vs. 75.0%, P < 0.01, 91.0% vs. 93.6%, P < 0.01), and improved both sensitivity and accuracy in BSRTC V nodules (96.0% vs. 82.0%, P < 0.001; 94.2% vs. 81.3%, P < 0.001).
Conclusions BRAFV600E exhibited higher specificity and lower accuracy compared with TIRADS in BSRTC I nodules, while the two methods showed similar diagnostic value in BSRTC III/V nodules. The combination of the two methods distinctly improved sensitivity in the diagnosis of PTCs in BSRTC I, III, and V nodules.
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Affiliation(s)
- Ya Wu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ting Xu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.,Department of Endocrinology, Jiangsu Province Official Hospital, Nanjing 210009, China
| | - Xingyue Cao
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xin Zhao
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | | | | | | | | | | | - Meiping Shen
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xiaohong Wu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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93
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Seagrove-Guffey MA, Hatic H, Peng H, Bates KC, Odugbesan AO. Malignancy rate of atypia of undetermined significance/follicular lesion of undetermined significance in thyroid nodules undergoing FNA in a suburban endocrinology practice: A retrospective cohort analysis. Cancer Cytopathol 2018; 126:881-888. [PMID: 30335212 DOI: 10.1002/cncy.22054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/12/2018] [Accepted: 07/31/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was created to establish a standard terminology regarding thyroid nodules that can be shared between endocrinologists, pathologists, radiologists, and surgeons. Since its inception and use in 2009, multiple large hospitals and academic institutions have performed retrospective studies to compare their classification rates, specifically those of atypia of undetermined significance (AUS) and follicular lesion of undetermined significance (FLUS), with the recommended rates created by the National Cancer Institute. The current study compared AUS/FLUS rates at a private suburban endocrine practice with those of previous publications from large institutions and the rates established by the National Cancer Institute. METHODS Charts from 893 patients with fine-needle aspiration (FNA) performed in 2015 were reviewed. Data specific to thyroid aspirates classified as AUS/FLUS were organized into whether patients underwent surgery, underwent subsequent repeat FNA, or required continued observation. These results then were calculated to reveal the rate of malignancy in the AUS/FLUS category with surgical pathology in the study institution. RESULTS A total of 893 patients underwent FNA, with 43 patients (4.82%) shown to have AUS/FLUS. A total of 21 patients proceeded to undergo thyroidectomy or lobectomy, with 7 patients (33.3%) found to have papillary or follicular thyroid carcinoma. CONCLUSIONS The rate of use of the AUS/FLUS category for thyroid nodules examined at the study institution was found to be within the recommended range set forth by TBSRTC. However, the malignancy rates on histopathology in the study institution were found to be higher than the new proposed malignancy rates from TBSRTC published in 2017. This finding is comparable to those of multiple other community and academic institutions performed prior to and after institution of the new guidelines.
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Affiliation(s)
- Maighan A Seagrove-Guffey
- Endocrinology Fellowship Program, East Carolina University, Brody School of Medicine, Greenville, North Carolina
| | - Haris Hatic
- Internal Medicine Residency Program, Gwinnett Medical Center, Lawrenceville, Georgia
| | - Haoran Peng
- Internal Medicine Residency Program, Gwinnett Medical Center, Lawrenceville, Georgia
| | - Kimberly C Bates
- Internal Medicine Residency Program, Gwinnett Medical Center, Lawrenceville, Georgia
| | - A Ola Odugbesan
- North Atlanta Endocrinology and Diabetes, Lawrenceville, Georgia
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94
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Pan X, Wang L. Comparison of diagnostic values between ultrasound elastography and ultrasound-guided thyroid nodular puncture in thyroid nodules. Oncol Lett 2018; 16:5209-5213. [PMID: 30250589 PMCID: PMC6144663 DOI: 10.3892/ol.2018.9257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/24/2018] [Indexed: 12/25/2022] Open
Abstract
Diagnostic value between ultrasound elastography and ultrasound-guided fine needle puncture biopsy in thyroid nodules was compared to provide reference for the selection of thyroid nodule (TN) diagnostic mode. A total of 194 patients with TN, admitted from June 2014 to June 2015, were selected to be treated with ultrasound elastography and ultrasound-guided fine needle puncture biopsy. The ultrasonic elasticity score and results of ultrasound-guided TN puncture were compared with diagnostic results of surgical or ultrasound follow-up for 12 months, and the sensitivity, specificity and accuracy of differentiating and diagnosing TN of the two methods were calculated to compare the clinical diagnostic values. A total of 194 patients were diagnosed with TN 217, including 129 benign and 88 malignant lesions. All the nodules were obtained by effective ultrasound elastography and ultrasound-guided fine needle puncture cytological pathological specimens, and it was diagnosed by ultrasound elastography that there were 75 benign nodules and 142 malignant nodules. It was diagnosed by ultrasound-guided fine needle puncture that there were 112 benign, 78 malignant and 27 uncertain nodules. The specificity and accuracy of ultrasound-guided fine needle puncture in the diagnosis of TN were higher than that of ultrasound elastography and the differences were statistically significant (P<0.05), while there was no statistically significant difference between the sensitivity of ultrasound elastography and ultrasound-guided fine needle puncture biopsy in the diagnosis of TN (P>0.05). Ultrasound elastography in the diagnosis of TN has a low specificity and the diagnosis of ultrasound-guided fine needle puncture biopsy may have uncertain results. There are some defects in the two diagnostic schemes and their combined application can complement each other's advantages and improve the early diagnostic efficiency of TN.
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Affiliation(s)
- Xiaojie Pan
- Department of Ultrasound, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Lei Wang
- Department of Ultrasound, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
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95
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Biron VL, Matkin A, Kostiuk M, Williams J, Cote DW, Harris J, Seikaly H, O'Connell DA. Analytic and clinical validity of thyroid nodule mutational profiling using droplet digital polymerase chain reaction. J Otolaryngol Head Neck Surg 2018; 47:60. [PMID: 30249281 PMCID: PMC6154415 DOI: 10.1186/s40463-018-0299-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 08/26/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Recent guidelines for the management of thyroid nodules incorporate mutation testing as an adjunct for surgical decision-making, however current tests are costly with limited accuracy. Droplet digital PCR (ddPCR) is an ultrasensitive method of nucleic acid detection that is particularly useful for identifying gene mutations. This study aimed to assess the analytic and clinical validity of RAS and BRAF ddPCR mutational testing as a diagnostic tool for thyroid fine needle aspirate biopsy (FNAB). METHODS Patients with thyroid nodules meeting indication for FNAB were prospectively enrolled from March 2015 to September 2017. In addition to clinical protocol, an additional FNAB was obtained for ddPCR. Optimized ddPCR probes were used to detect mutations including HRASG12 V, HRASQ61K, HRASQ61R, NRASQ61R, NRASQ61K and BRAFV600E. The diagnostic performance of BRAF and RAS mutations was assessed individually or in combination with Bethesda classification against final surgical pathology. RESULTS A total of 208 patients underwent FNAB and mutational testing with the following Bethesda cytologic classification: 26.9% non-diagnostic, 55.2% benign, 5.3% FLUS/AUS, 2.9% FN/SPN, 2.4% SFM and 7.2% malignant. Adequate RNA was obtained from 91.3% (190) FNABs from which mutations were identified in 21.1% of HRAS, 11.5% of NRAS and 7.4% of BRAF. Malignant cytology or BRAFV600E was 100% specific for malignancy. Combining cytology with ddPCR BRAF600E mutations testing increased the sensitivity of Bethesda classification from 41.7 to 75%. Combined BRAFV600E and Bethesda results had a positive predictive value (PPV) of 100% and negative predictive value (NPV) of 89.7% for thyroid malignancy in our cohort. CONCLUSIONS DdPCR offers a novel and ultrasensitive method of detecting RAS and BRAF mutations from thyroid FNABs. BRAFV600E mutation testing by ddPCR may serve as a useful adjunct to increase sensitivity and specificity of thyroid FNAB.
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Affiliation(s)
- Vincent L Biron
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada. .,Alberta Head and Neck Centre for Oncology and Reconstruction, Walter MacKenzie Health Sciences Centre, Edmonton, AB, Canada. .,Otolaryngology-Head and Neck Surgery Research Laboratory of Alberta, University of Alberta, Edmonton, AB, Canada.
| | - Ashlee Matkin
- Alberta Head and Neck Centre for Oncology and Reconstruction, Walter MacKenzie Health Sciences Centre, Edmonton, AB, Canada.,Faculty of Medicine and Dentistry, Undergraduate Medical Education, University of Alberta, Edmonton, AB, Canada
| | - Morris Kostiuk
- Alberta Head and Neck Centre for Oncology and Reconstruction, Walter MacKenzie Health Sciences Centre, Edmonton, AB, Canada.,Otolaryngology-Head and Neck Surgery Research Laboratory of Alberta, University of Alberta, Edmonton, AB, Canada
| | - Jordana Williams
- Otolaryngology-Head and Neck Surgery Research Laboratory of Alberta, University of Alberta, Edmonton, AB, Canada
| | - David W Cote
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada
| | - Jeffrey Harris
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada.,Alberta Head and Neck Centre for Oncology and Reconstruction, Walter MacKenzie Health Sciences Centre, Edmonton, AB, Canada
| | - Hadi Seikaly
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada.,Alberta Head and Neck Centre for Oncology and Reconstruction, Walter MacKenzie Health Sciences Centre, Edmonton, AB, Canada
| | - Daniel A O'Connell
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada.,Alberta Head and Neck Centre for Oncology and Reconstruction, Walter MacKenzie Health Sciences Centre, Edmonton, AB, Canada
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96
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Malheiros DC, Canberk S, Poller DN, Schmitt F. Thyroid FNAC: Causes of false-positive results. Cytopathology 2018; 29:407-417. [PMID: 29768677 DOI: 10.1111/cyt.12575] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2018] [Indexed: 12/17/2022]
Abstract
In this paper, we aim to focus on false positive results in the evaluation of thyroid aspirations, covering cystic, inflammatory, follicular and oncocytic lesions, papillary carcinoma, and medullary carcinoma of thyroid. The recently described entity noninvasive follicular thyroid neoplasm with papillary-like nuclear features is also discussed detailing the impact of its introduction on the sensitivity and specificity of thyroid FNA, as well as the use of molecular tests for diagnostics. Medicolegal issues in relation to current practice in English law are also described.
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Affiliation(s)
- D C Malheiros
- Faculdade de Ciências, Médicas da Santa Casa de São Paulo, São Paulo, Brasil.,IPATIMUP, Institute of Molecular Pathology and Immunology of University of Porto, Porto, Portugal
| | - S Canberk
- IPATIMUP, Institute of Molecular Pathology and Immunology of University of Porto, Porto, Portugal.,I3S, Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Department of Pathology subdivision of Cytopathology, Acibadem University, Atasehir-Istanbul, Turkey
| | - D N Poller
- Department of Pathology, Queen Alexandra Hospital, Portsmouth, UK
| | - F Schmitt
- IPATIMUP, Institute of Molecular Pathology and Immunology of University of Porto, Porto, Portugal.,I3S, Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Medical Faculty of Porto University, Porto, Portugal
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97
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Bongiovanni M, Papadakis GE, Rouiller N, Marino L, Lamine F, Bisig B, Ziadi S, Sykiotis GP. The Bethesda System for Reporting Thyroid Cytopathology Explained for Practitioners: Frequently Asked Questions. Thyroid 2018; 28:556-565. [PMID: 29591914 DOI: 10.1089/thy.2017.0685] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The recent update of The Bethesda System for Reporting Thyroid Cytology (TBSRTC) is a very important development in the evaluation of thyroid nodules. Clinical experience and scientific literature both show that practitioners performing thyroid fine-needle aspiration are accustomed to basing the clinical management of patients on reports using TBSRTC. Specifically, clinicians are familiar with the percent risk of malignancy corresponding to each TBSRTC diagnostic category (DC), as well as with the respective recommendation for clinical management. However, most clinicians are much less familiar with the specific considerations that lie between a given DC, on the one end, and the respective risk of malignancy and associated management recommendation, on the other end. SUMMARY A deeper understanding of the system can enlighten the clinician's thinking about the specific nodule under examination and can guide the decision-making process in a more meaningful way. Such an understanding can only be developed via close two-way communication between cytopathologists and clinicians. Through this type of interaction in the authors' tertiary medical center, recurring issues of particular importance for clinical practice were identified, which are reported here in the form of 16 frequently asked questions posed by the clinician to the cytopathologist. CONCLUSIONS For each frequently asked question, an answer is provided based on the literature, the authors' experience, the new version of TBSRTC, and the new World Health Organization classification of tumors of endocrine organs.
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Affiliation(s)
- Massimo Bongiovanni
- 1 Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital , Lausanne, Switzerland
| | - Georgios E Papadakis
- 2 Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital , Lausanne, Switzerland
| | - Nathalie Rouiller
- 2 Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital , Lausanne, Switzerland
| | - Laura Marino
- 2 Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital , Lausanne, Switzerland
| | - Faiza Lamine
- 2 Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital , Lausanne, Switzerland
| | - Bettina Bisig
- 1 Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital , Lausanne, Switzerland
| | - Sonia Ziadi
- 1 Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital , Lausanne, Switzerland
| | - Gerasimos P Sykiotis
- 2 Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital , Lausanne, Switzerland
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98
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HMGA2 Gene Expression in Fine-needle Aspiration Samples of Thyroid Nodules as a Marker for Preoperative Diagnosis of Thyroid Cancer. Appl Immunohistochem Mol Morphol 2018; 27:471-476. [PMID: 29406334 DOI: 10.1097/pai.0000000000000637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
There is a great interest in molecular markers that would help in the preoperative diagnosis of malignant thyroid nodules in cases of indeterminate fine-needle aspiration cytology. The aim of this study was to determine the diagnostic accuracy of HMGA2 gene expression in discriminating benign from malignant thyroid nodules. In this study, 237 preoperative thyroid fine-needle aspiration samples were analyzed prospectively for the expression of the HMGA2 gene by real-time reverse transcription polymerase chain reaction. The results were evaluated against the postoperative histopathologic diagnosis or definitive cytologic diagnosis in cases of nodular goiter and Hashimoto thyroiditis. Among 237 samples from patients with thyroid nodules that were analyzed, 231 were adequate for real-time reverse transcription polymerase chain reaction analysis. With a cutoff value of 8.71 for relative gene expression, HMGA2 was positive in 19 (16.4%) of 116 nodular goiter, 1 (2.6%) of 39 Hashimoto thyroiditis, 9 (28.1%) of 32 follicular adenoma, 0 (0%) of 5 Hurthle cell adenoma, 32 (88.9%) of 36 papillary carcinoma, and 3 (100%) of 3 follicular carcinoma samples. In discriminating between malignant and benign thyroid nodules, HMGA2 has shown specificity of 84.5%, sensitivity of 91.9%, positive predictive value of 53.1%, and negative predictive value of 98.2%. High sensitivity and negative predictive value of HMGA2 for preoperative detection of malignant thyroid nodules shown in this study indicate that it may have a role as an ancillary marker in cytology in the management of patients with thyroid nodules.
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99
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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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100
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Navas-Carrillo D, Rodriguez JM, Montoro-García S, Orenes-Piñero E. High-resolution proteomics and metabolomics in thyroid cancer: Deciphering novel biomarkers. Crit Rev Clin Lab Sci 2017; 54:446-457. [DOI: 10.1080/10408363.2017.1394266] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Diana Navas-Carrillo
- Department of Surgery, Hospital de la Vega Lorenzo Guirao, University of Murcia, Murcia, Spain
| | - José Manuel Rodriguez
- Department of Surgery, Hospital Universitario Virgen de la Arrixaca, University of Murcia, Murcia, Spain
| | | | - Esteban Orenes-Piñero
- Proteomic Unit, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Universidad de Murcia, Murcia, Spain
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