1001
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Shrestha RT, Ruanpeng D, Hennessey JV. Cytomorphology of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features and the Impact of New Nomenclature on Molecular Testing. Med Sci (Basel) 2019; 7:E15. [PMID: 30678281 PMCID: PMC6410294 DOI: 10.3390/medsci7020015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 01/12/2019] [Accepted: 01/18/2019] [Indexed: 12/13/2022] Open
Abstract
The re-naming of noninvasive follicular variant papillary thyroid cancer to the apparently non-malignant, noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) impacts the prevalence of malignancy rates, thereby affecting mutation frequency in papillary thyroid cancer. Preoperative assessment of such nodules could affect management in the future. The original publications following the designation of the new nomenclature have been extensively reviewed. With the adoption of NIFTP terminology, a reduction in the follicular variant of papillary thyroid cancer (FVPTC) prevalence is anticipated, as is a modest reduction of papillary thyroid cancer (PTC) prevalence that would be distributed mainly across indeterminate thyroid nodules. Identifying NIFTP preoperatively remains challenging. RAS mutations are predominant but the presence of BRAF V600E mutation has been observed and could indicate inclusion of the classical PTC. The histological diagnosis of NIFTP to designate low-risk encapsulated follicular variant papillary thyroid cancers (EFVPTCs) would impact malignancy rates, thereby altering the mutation prevalence. The histopathologic criteria have recently been refined with an exclusion of well-formed papillae. The preoperative identification of NIFTP using cytomorphology and gene testing remains challenging.
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Affiliation(s)
- Rupendra T Shrestha
- University of Minnesota Twin Cities, Department of Medicine, Minneapolis, MN 55455, USA.
| | - Darin Ruanpeng
- University of Minnesota Twin Cities, Department of Medicine, Minneapolis, MN 55455, USA.
| | - James V Hennessey
- Division of Endocrinology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, GZ-6, Boston, MA 02215, USA.
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1002
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Ye W, Hannigan B, Zalles S, Mehrotra M, Barkoh BA, Williams MD, Cabanillas ME, Edeiken-Monroe B, Hu P, Duose D, Wistuba II, Medeiros LJ, Stewart J, Luthra R, Roy-Chowdhuri S. Centrifuged supernatants from FNA provide a liquid biopsy option for clinical next-generation sequencing of thyroid nodules. Cancer Cytopathol 2019; 127:146-160. [PMID: 30620446 DOI: 10.1002/cncy.22098] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/05/2018] [Accepted: 12/05/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Molecular testing is recommended as an adjunct to improve the preoperative diagnosis of fine-needle aspiration (FNA) of thyroid nodules. Centrifuged supernatants from FNA samples, which are typically discarded, have recently emerged as a novel liquid-based biopsy for molecular testing. This study evaluates the use of thyroid FNA supernatants for detecting clinically relevant mutations. METHODS Supernatants from thyroid FNA samples (n = 156) were evaluated. A 50-gene next-generation sequencing (NGS) assay was used, and mutation analysis results from a subset of samples were further compared with those of paired FNA smears and/or cell blocks. RESULTS All 156 samples yielded adequate DNA (median, 135 ng; range, 11-3180 ng), and 129 of these samples (83%) were successfully sequenced by NGS. The most frequently detected somatic mutations included BRAF and RAS mutations, which were followed by RET, TP53, PTEN, CDKN2A, and PIK3CA mutations. Eleven of 31 cases with an indeterminate cytologic diagnosis and 9 of 12 cases that were suspicious for malignancy had somatic mutations, including the BRAF V600E mutation, which is highly definitive for papillary thyroid carcinoma (PTC). Seven of the 9 indeterminate and suspicious cases with the BRAF V600E mutation had surgical follow-up, and they were all confirmed to be PTC. A comparison of the mutation profiles derived from supernatants with those of paired smears and/or cell blocks in a small subset of cases (n = 8) showed 100% concordance. CONCLUSIONS This study provides evidence that FNA supernatants can be used as a surrogate for thyroid molecular testing to improve diagnostic accuracy in indeterminate nodules, provide prognostic/predictive information, and improve overall patient management.
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Affiliation(s)
- Wenrui Ye
- Diagnostic Genetics, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brette Hannigan
- Diagnostic Genetics, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephanie Zalles
- Diagnostic Genetics, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Meenakshi Mehrotra
- Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bedia A Barkoh
- Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michelle D Williams
- Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Maria E Cabanillas
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Beth Edeiken-Monroe
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peter Hu
- Diagnostic Genetics, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dzifa Duose
- Department of Translational Molecular Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ignacio I Wistuba
- Department of Translational Molecular Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - L Jeffrey Medeiros
- Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John Stewart
- Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rajyalakshmi Luthra
- Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sinchita Roy-Chowdhuri
- Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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1003
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Johnson DN, Cavallo AB, Uraizee I, Tanager K, Lastra RR, Antic T, Cipriani NA. A Proposal for Separation of Nuclear Atypia and Architectural Atypia in Bethesda Category III (AUS/FLUS) Based on Differing Rates of Thyroid Malignancy. Am J Clin Pathol 2019; 151:86-94. [PMID: 30212867 DOI: 10.1093/ajcp/aqy109] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objectives Bethesda category III (atypia of undetermined significance/follicular lesion of undetermined significance) includes sparsely cellular specimens with nuclear atypia (3N) and/or architectural atypia (3A). This study investigates whether the two types of atypia have different rates of malignancy (ROMs). Methods Cytologic and histologic diagnoses of resected thyroid nodules were recorded. ROM was calculated for all Bethesda categories and for 3N and 3A subcategories. Possible noninvasive follicular thyroid neoplasms with papillary-like nuclear features were reviewed and removed from malignancies, and ROM was recalculated. Results A total of 1,396 nodules were included. ROM of 3N (33.3%-26.0%) was higher than 3A (7.7%-5.0%) (P < .0001) and was similar to suspicious for follicular neoplasm (25.0%-20.3%) (P = .3). ROM of 3A approached benign (2.4%-1.5%) (P = .02). Conclusions Strong consideration should be given to separating 3N (nuclear atypia with higher risk for papillary thyroid carcinoma) from 3A (architectural atypia with higher chance of being benign) to convey different ROMs.
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Affiliation(s)
| | | | - Imran Uraizee
- Department of Pathology, University of Chicago, Chicago, IL
| | - Kevin Tanager
- Department of Pathology, University of Chicago, Chicago, IL
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago, Chicago, IL
- Division of Cytopathology, University of Chicago, Chicago, IL
- Division of Surgical Pathology, University of Chicago, Chicago, IL
| | - Tatjana Antic
- Department of Pathology, University of Chicago, Chicago, IL
- Division of Cytopathology, University of Chicago, Chicago, IL
- Division of Surgical Pathology, University of Chicago, Chicago, IL
| | - Nicole A Cipriani
- Department of Pathology, University of Chicago, Chicago, IL
- Division of Surgical Pathology, University of Chicago, Chicago, IL
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1004
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Chereau N, Greilsamer T, Mirallié E, Sadowski SM, Pusztaszeri M, Triponez F, Baud G, Pattou F, Christou N, Mathonnet M, Brunaud L, Santucci N, Goudet P, Guérin C, Sebag F, Donatini G, Kraimps JL, Tissier F, Lussey-Lepoutre C, Leenhardt L, Menegaux F. NIFT-P: Are they indolent tumors? Results of a multi-institutional study. Surgery 2019; 165:12-16. [DOI: 10.1016/j.surg.2018.04.089] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/03/2018] [Accepted: 04/09/2018] [Indexed: 11/26/2022]
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1005
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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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1006
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Luster M, Aktolun C, Amendoeira I, Barczyński M, Bible KC, Duntas LH, Elisei R, Handkiewicz-Junak D, Hoffmann M, Jarząb B, Leenhardt L, Musholt TJ, Newbold K, Nixon IJ, Smit J, Sobrinho-Simões M, Sosa JA, Tuttle RM, Verburg FA, Wartofsky L, Führer D. European Perspective on 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: Proceedings of an Interactive International Symposium. Thyroid 2019; 29:7-26. [PMID: 30484394 DOI: 10.1089/thy.2017.0129] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The American Thyroid Association (ATA) management guidelines for patients with thyroid nodules and differentiated thyroid cancer (DTC) are highly influential practice recommendations. The latest revision appeared in 2015 ("ATA 2015"). These guidelines were developed predominantly by North American experts. European experts frequently have different perspectives, given epidemiological, technological/methodological, practice organization, and medicolegal differences between the respective regions. SUMMARY Divergent viewpoints were the focus of an invited symposium organized by the European Association of Nuclear Medicine involving 17 European thyroidologists, four ATA Guidelines Taskforce members, and an audience of 200 international experts. The group discussed the preoperative assessment of thyroid nodules, surgery and the role of pathology, radioiodine (RAI) therapy (RAIT), the assessment of initial therapy and dynamic risk stratification, and the treatment of persistent disease, recurrences, and advanced thyroid cancer. The dialogue resulted in this position paper contrasting European and ATA 2015 perspectives on key issues. One difference pertains to the permissiveness of ATA 2015 regarding lobectomy for primary tumors ≤4 cm. European panelists cited preclusion of RAIT, potential need for completion thyroidectomy, frequent inability to avoid chronic thyroid hormone replacement, and limitations of supportive evidence as arguments against widely applying lobectomy. Significant divergence involved ATA 2015's guidance regarding RAIT. European panelists favored wider use of postoperative RAIT than does ATA 2015. Rationales included the modality's association with favorable patient outcomes and generally limited toxicity, and lack of high-quality evidence supporting withholding RAIT. Additionally, European panelists favored recombinant human thyrotropin (rhTSH) in more settings than does ATA 2015, citing avoidance of hypothyroid morbidity and quality-of-life impairment, without apparent sacrifice in oncologic outcomes. Based on clinical evidence plus theoretical advantages, European experts advocated dosimetric versus fixed-activity RAIT approaches for advanced DTC. European panelists noted that the ATA 2015 risk-stratification system requires information sometimes unavailable in everyday practice. ATA 2015 recommendations regarding RAI-refractory DTC should consider potential palliative benefits of RAIT in patients who also have RAI-susceptible lesions. CONCLUSIONS European panelists suggested modifications to approximately one-third of ATA 2015 recommendations. Varying European and ATA 2015 perspectives can stimulate analysis and discussion of the literature and performance of primary research to resolve discrepant recommendations and potentially improve patient outcomes.
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Affiliation(s)
- Markus Luster
- 1 Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Cumali Aktolun
- 2 Department of Nuclear Medicine, School of Medicine, Izmir Ekonomi Universitesi, Izmir, Turkey
| | - Isabel Amendoeira
- 3 University Hospital of São João, Medical Faculty and Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Marcin Barczyński
- 4 Department of Endocrine Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Keith C Bible
- 5 Division of Medical Oncology, Department of Oncology, The Mayo Clinic, Rochester, Minnesota
| | - Leonidas H Duntas
- 6 Endocrine Unit, Evgenidion Hospital, University of Athens, Athens, Greece
| | - Rossella Elisei
- 7 Endocrine Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Daria Handkiewicz-Junak
- 8 Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Institute and Centre of Oncology, Gliwice Branch, Gliwice, Poland
| | - Martha Hoffmann
- 9 Departments of Nuclear Medicine and Positron Emission Tomography/Computed Tomography, Radiology Center, Vienna, Austria
| | - Barbara Jarząb
- 8 Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Institute and Centre of Oncology, Gliwice Branch, Gliwice, Poland
| | - Laurence Leenhardt
- 10 Thyroid and Endocrine Tumor Unit, Pitié-Salpêtrière Sorbonne University Hospital, Paris, France
| | - Thomas J Musholt
- 11 Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medicine, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Kate Newbold
- 12 Thyroid Therapy Unit, The Royal Marsden Hospital, London, United Kingdom
| | - Iain J Nixon
- 13 Department of Ear, Nose, and Throat Surgery, NHS Lothian and University of Edinburgh, Edinburgh, United Kingdom
| | - Johannes Smit
- 14 Department of Medicine, Division of Endocrinology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Manuel Sobrinho-Simões
- 3 University Hospital of São João, Medical Faculty and Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Julie Ann Sosa
- 15 Department of Surgery, University of California at San Francisco-UCSF, San Francisco, California
| | - R Michael Tuttle
- 16 Department of Endocrinology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Frederik A Verburg
- 1 Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Leonard Wartofsky
- 17 Department of Medicine, Washington Hospital Center, Washington, DC
| | - Dagmar Führer
- 18 Department of Endocrinology and Metabolism, Endocrine Tumor Center at WTZ, Essen University Hospital, Essen, Germany
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1007
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Angell TE, Wirth LJ, Cabanillas ME, Shindo ML, Cibas ES, Babiarz JE, Hao Y, Kim SY, Walsh PS, Huang J, Kloos RT, Kennedy GC, Waguespack SG. Analytical and Clinical Validation of Expressed Variants and Fusions From the Whole Transcriptome of Thyroid FNA Samples. Front Endocrinol (Lausanne) 2019; 10:612. [PMID: 31572297 PMCID: PMC6749016 DOI: 10.3389/fendo.2019.00612] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/22/2019] [Indexed: 12/25/2022] Open
Abstract
Introduction: The Afirma® Xpression Atlas (XA) detects gene variants and fusions in thyroid nodule FNA samples from a curated panel of 511 genes using whole-transcriptome RNA-sequencing. Its intended use is among cytologically indeterminate nodules that are Afirma GSC suspicious, Bethesda V/VI nodules, or known thyroid metastases. Here we report its analytical and clinical validation. Methods: DNA and RNA were purified from the same sample across 943 blinded FNAs and compared by multiple methodologies, including whole-transcriptome RNA-seq, targeted RNA-seq, and targeted DNA-seq. An additional 695 blinded FNAs were used to define performance for fusions between whole-transcriptome RNA-seq and targeted RNA-seq. We quantified the reproducibility of the whole-transcriptome RNA-seq assay across laboratories and reagent lots. Finally, variants and fusions were compared to histopathology results. Results: Of variants detected in DNA at 5 or 20% variant allele frequency, 74 and 88% were also detected by XA, respectively. XA variant detection was 89% when compared to an alternative RNA-based detection method. Low levels of expression of the DNA allele carrying the variant, compared with the wild-type allele, was found in some variants not detected by XA. 82% of gene fusions detected in a targeted RNA fusion assay were detected by XA. Conversely, nearly all variants or fusions detected by XA were confirmed by an alternative method. Analytical validation studies demonstrated high intra-plate reproducibility (89%-94%), inter-plate reproducibility (86-91%), and inter-lab accuracy (90%). Multiple variants and fusions previously described across the spectrum of thyroid cancers were identified by XA, including some with approved or investigational targeted therapies. Among 190 Bethesda III/IV nodules, the sensitivity of XA as a standalone test was 49%. Conclusion: When the Afirma Genomic Sequencing Classifier (GSC) is used first among Bethesda III/IV nodules as a rule-out test, XA supplements genomic insight among those that are GSC suspicious. Our data clinically and analytically validate XA for use among GSC suspicious, or Bethesda V/VI nodules. Genomic information provided by XA may inform clinical decision-making with precision medicine insights across a broad range of FNA sample types encountered in the care of patients with thyroid nodules and thyroid cancer.
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Affiliation(s)
- Trevor E. Angell
- Division of Endocrinology, Diabetes and Metabolism, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- *Correspondence: Trevor E. Angell
| | - Lori J. Wirth
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Maria E. Cabanillas
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Maisie L. Shindo
- Otolaryngology–Head & Neck Surgery, Oregon Health & Science University, Portland, OR, United States
| | - Edmund S. Cibas
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Joshua E. Babiarz
- Research and Development, Veracyte, South San Francisco, CA, United States
| | - Yangyang Hao
- Research and Development, Veracyte, South San Francisco, CA, United States
| | - Su Yeon Kim
- Research and Development, Veracyte, South San Francisco, CA, United States
| | - P. Sean Walsh
- Research and Development, Veracyte, South San Francisco, CA, United States
| | - Jing Huang
- Research and Development, Veracyte, South San Francisco, CA, United States
| | - Richard T. Kloos
- Medical Affairs, Veracyte, South San Francisco, CA, United States
| | - Giulia C. Kennedy
- Research and Development, Medical Affairs, and Clinical Affairs, Veracyte, South San Francisco, CA, United States
| | - Steven G. Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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1008
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Kaya C, Bozkurt E, Türkyılmaz Mut D, Mihmanli M, Uludağ M. WHICH FACTORS ARE ASSOCIATED WITH MALIGNANCY IN THYROID NODULES CLASSIFIED AS BETHESDA CATEGORY 3 (AUS/FLUS) AND HOW DO THEY INFLUENCE THE PATIENT'S MANAGEMENT? ACTA ENDOCRINOLOGICA-BUCHAREST 2019; 15:491-496. [PMID: 32377247 DOI: 10.4183/aeb.2019.491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Thyroid nodules are a common pathology worldwide. Fine needle aspiration biopsy (FNAB) is an important diagnostic method for the investigation of malignancy in thyroid nodules. However, according to the Bethesda System used to classify the results, patients with atypia of undetermined significance/follicular lesion of undetermined significance (AUS / FLUS) may not be classified as benign or malignant. Therefore, it may be necessary to determine some clinical risk factors to apply the best treatment in these patients. Aim To determine the factors that increase the risk of malignancy in this patient group. Methods A retrospective study including 138 patients with an FNAB categorized as AUS/FLUS and operated between June 2015-September 2018. Demographical, Laboratory (TSH) and Ultrasound variables (number, size and characteristics of nodules) of the patients were compared among postoperative histopathological results. Results Hypo-echoic structure, microcalcification and irregular margin of the nodules were detected to be associated with malignancy in patients with FNAB results of AUS/FLUS (p <0.001). Conclusion We suggest that surgical treatment should be considered if the patients have nodules with the hypo-echoic structure, microcalcification and irregular margin with an FNAB histopathological result of AUS / FLUS.
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Affiliation(s)
- C Kaya
- University of Health Sciences, Hamidiye Etfal Medical Practice and Research Center - General Surgery - Istanbul, Turkey
| | - E Bozkurt
- University of Health Sciences, Hamidiye Etfal Medical Practice and Research Center - Kelkit State Hospital - General Surgery, Gümüşhane, Turkey
| | - D Türkyılmaz Mut
- University of Health Sciences, Hamidiye Etfal Medical Practice and Research Center - Radiology, Istanbul, Turkey
| | - M Mihmanli
- University of Health Sciences, Hamidiye Etfal Medical Practice and Research Center - General Surgery - Istanbul, Turkey
| | - M Uludağ
- University of Health Sciences, Hamidiye Etfal Medical Practice and Research Center - General Surgery - Istanbul, Turkey
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1009
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Hao Y, Choi Y, Babiarz JE, Kloos RT, Kennedy GC, Huang J, Walsh PS. Analytical Verification Performance of Afirma Genomic Sequencing Classifier in the Diagnosis of Cytologically Indeterminate Thyroid Nodules. Front Endocrinol (Lausanne) 2019; 10:438. [PMID: 31333584 PMCID: PMC6620518 DOI: 10.3389/fendo.2019.00438] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/18/2019] [Indexed: 01/21/2023] Open
Abstract
Background: Fine needle aspiration (FNA) cytology, a diagnostic test central to thyroid nodule management, may yield indeterminate results in up to 30% of cases. The Afirma® Genomic Sequencing Classifier (GSC) was developed and clinically validated to utilize genomic material obtained during the FNA to accurately identify benign nodules among those deemed cytologically indeterminate so that diagnostic surgery can be avoided. A key question for diagnostic tests is their robustness under different perturbations that may occur in the lab. Herein, we describe the analytical performance of the Afirma GSC. Results: We examined the analytical sensitivity of the Afirma GSC to varied input RNA amounts and the limit of detection of malignant signals with heterogenous samples mixed with adjacent normal or benign tissues. We also evaluated the analytical specificity from potential interfering substances such as blood and genomic DNA. Further, the inter-laboratory, intra-run, and inter-run reproducibility of the assay were examined. Analytical sensitivity analysis showed that Afirma GSC calls are tolerant to variation in RNA input amount (5-30 ng), and up to 75% dilution of malignant FNA material. Analytical specificity studies demonstrated Afirma GSC remains accurate in presence of up to 75% blood or 30% genomic DNA. The Afirma GSC results are highly reproducible across different operators, runs, reagent lots, and laboratories. Conclusion: The analytical robustness and reproducibility of the Afirma GSC test support its routine clinical use among thyroid nodules with indeterminant FNA cytology.
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Affiliation(s)
- Yangyang Hao
- Research and Development, Veracyte, South San Francisco, CA, United States
| | - Yoonha Choi
- Research and Development, Veracyte, South San Francisco, CA, United States
| | - Joshua E. Babiarz
- Research and Development, Veracyte, South San Francisco, CA, United States
| | - Richard T. Kloos
- Medical Affairs, Veracyte, South San Francisco, CA, United States
| | - Giulia C. Kennedy
- Research and Development, Veracyte, South San Francisco, CA, United States
- Medical Affairs, Veracyte, South San Francisco, CA, United States
- Department of Clinical Affairs, Veracyte, South San Francisco, CA, United States
| | - Jing Huang
- Research and Development, Veracyte, South San Francisco, CA, United States
| | - P. Sean Walsh
- Research and Development, Veracyte, South San Francisco, CA, United States
- *Correspondence: P. Sean Walsh
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1010
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Yu FX, Hu MX, Zhao HX, Niu LJ, Rong XY, Li WH, Zhu Q, Ying JM, Lyu N. Precise Detection of Gene Mutations in Fine-Needle Aspiration Specimens of the Papillary Thyroid Microcarcinoma Using Next-Generation Sequencing. Int J Endocrinol 2019; 2019:4723958. [PMID: 30915113 PMCID: PMC6399538 DOI: 10.1155/2019/4723958] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 12/18/2018] [Accepted: 01/09/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To assess the feasibility of next-generation sequencing (NGS) to detect mutations in BRAF, RAS, TERT promoter, and TP53 genes in ultrasound-guided fine-needle aspiration (FNA) biopsy samples of the papillary thyroid microcarcinoma (PTMC). METHODS A total of 135 FNA samples out of 135 patients with suspected PTMC were submitted for mutation testing using NGS. NGS was successfully performed in 114 specimens, while the remaining 21 samples were excluded due to insufficient amount/poor quality of DNA and sequencing failure. Of those 114 samples, 72 who were confirmed as having PTMC by postoperative histopathology were enrolled in our study, and the other 42 who had a follow-up with ultrasound were excluded. Mutations of genes including BRAF, NRAS, HRAS, KRAS, TERT promoter, and TP53 were evaluated using NGS. The associations of gene mutations and clinicopathological characteristics of PTMC were analyzed. RESULTS BRAF mutation was observed in 59 (81.94%) of 72 specimens. This mutation detected in BRAF was p.V600E (c.1799T>A) in exon 15 of all 59 specimens. NRAS mutation was identified in 1 (1.39%) specimen classified as Bethesda III and pathologically confirmed as a follicular variant PTMC. There were no mutations found in TERT promoter or TP53. The tumor with a maximum diameter (D max) larger than 5 mm was shown to be significantly correlated with the BRAF mutation in a multivariate analysis (OR 5.52, 95% CI 1.51-26.42, P = 0.033). But the BRAF mutation was not found to be significantly associated with the gender or age of patients with PTMC (P > 0.05). CONCLUSIONS This study demonstrated that gene mutations in FNA specimens of PTMC could be successfully analyzed with a higher sensitivity using NGS compared to conventional methods for mutation detection. BRAF mutation of p.V600E was statistically associated with PTMC with a D max larger than 5 mm.
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Affiliation(s)
- Feng-xia Yu
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Min-xia Hu
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Han-xue Zhao
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Li-juan Niu
- Department of Diagnostic Ultrasound, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xue-yu Rong
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Wei-hua Li
- Department of Pathology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Qiang Zhu
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Jian-ming Ying
- Department of Pathology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ning Lyu
- Department of Pathology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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1011
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Lin YH, Tsai YC, Lin KJ, Der Lin J, Wang CC, Chen ST. Computer-Aided Diagnostic Technique in 2-Deoxy-2-[ 18F]fluoro-D-glucose-Positive Thyroid Nodule: Clinical Experience of 74 Non-thyroid Cancer Patients. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:108-121. [PMID: 30336966 DOI: 10.1016/j.ultrasmedbio.2018.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/01/2018] [Accepted: 09/03/2018] [Indexed: 06/08/2023]
Abstract
This study verified the value of a computer-aided diagnosis (CAD) technique assisting in ultrasonography (US) diagnosis of 2-deoxy-2-[18F]fluoro-D-glucose (18FDG)-avid thyroid incidentalomas on positron emission tomography. A total of 82 18FDG-avid thyroid incidentalomas from 74 non-thyroid cancer patients were retrospectively analyzed with respect to US and CAD parameters (anechoic area, hyper-echoic foci, hypo-echogenicity, heterogeneity, margin, taller-than-wide shape, eccentric area) and were compared with 38 other non-18FDG-avid nodules found in the same patient group. Fine-needle aspiration cytology or surgical intervention pathology was performed for diagnosis. No significant differences in nodule size or CAD parameters were found in 18FDG-avid nodules reported as benign, indeterminate or malignant. Significantly more taller-than-wide nodules were thyroid originating than metastatic (0.30 vs. 0.16, p < 0.05). Nevertheless, combined CAD and positron emission tomography/computed tomography scores and a discrimination point of 4 resulted in a sensitivity of 75% and a specificity of 80% in prediction of incidentaloma benignity.
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Affiliation(s)
- Yi-Hsuan Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | | | - Kun Ju Lin
- Departments of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jen- Der Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Chih-Ching Wang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Szu-Tah Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
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1012
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Grani G, Lamartina L, Ascoli V, Bosco D, Biffoni M, Giacomelli L, Maranghi M, Falcone R, Ramundo V, Cantisani V, Filetti S, Durante C. Reducing the Number of Unnecessary Thyroid Biopsies While Improving Diagnostic Accuracy: Toward the "Right" TIRADS. J Clin Endocrinol Metab 2019; 104:95-102. [PMID: 30299457 DOI: 10.1210/jc.2018-01674] [Citation(s) in RCA: 181] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 10/03/2018] [Indexed: 12/20/2022]
Abstract
CONTEXT The prevalence of thyroid nodules in the general population is increasingly high, and at least half of those biopsied prove to be benign. Sonographic risk-stratification systems are being proposed as "rule-out" tests that can identify nodules that do not require fine-needle aspiration (FNA) cytology. OBJECTIVE To comparatively assess the performances of five internationally endorsed sonographic classification systems [those of the American Thyroid Association, the American Association of Clinical Endocrinologists, the American College of Radiology (ACR), the European Thyroid Association, and the Korean Society of Thyroid Radiology] in identifying nodules whose FNAs can be safely deferred and to estimate their negative predictive values (NPVs). DESIGN Prospective study of thyroid nodules referred for FNA. SETTING Single academic referral center. PATIENTS Four hundred seventy-seven patients (358 females, 75.2%); mean (SD) age, 55.9 (13.9) years. MAIN OUTCOME MEASURES Number of biopsies classified as unnecessary, false-negative rate (FNR), sensitivity, specificity, predictive values, and diagnostic ORs for each system. RESULTS Application of the systems' FNA criteria would have reduced the number of biopsies performed by 17.1% to 53.4%. The ACR Thyroid Imaging Reporting and Data System (TIRADS) allowed the largest reduction (268 of 502) with the lowest FNR (NPV, 97.8%; 95% CI, 95.2% to 99.2%). Except for the Korean Society of Thyroid Radiology TIRADS, all other systems exhibited significant discriminatory performance but produced significantly smaller reductions in the number of procedures. CONCLUSIONS Internationally endorsed sonographic risk stratification systems vary widely in their ability to reduce the number of unnecessary thyroid nodule FNAs. The ACR TIRADS outperformed the others, classifying more than half the biopsies as unnecessary with a FNR of 2.2%.
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Affiliation(s)
- Giorgio Grani
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma "Sapienza," Rome, Italy
| | - Livia Lamartina
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma "Sapienza," Rome, Italy
| | - Valeria Ascoli
- Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomo Patologiche, Università di Roma "Sapienza," Rome, Italy
| | - Daniela Bosco
- Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomo Patologiche, Università di Roma "Sapienza," Rome, Italy
| | - Marco Biffoni
- Dipartimento di Scienze Chirurgiche, Università di Roma "Sapienza," Rome, Italy
| | - Laura Giacomelli
- Dipartimento di Scienze Chirurgiche, Università di Roma "Sapienza," Rome, Italy
| | - Marianna Maranghi
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma "Sapienza," Rome, Italy
| | - Rosa Falcone
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma "Sapienza," Rome, Italy
| | - Valeria Ramundo
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma "Sapienza," Rome, Italy
| | - Vito Cantisani
- UOS Innovazioni Diagnostiche e Ultrasonografiche, Azienda Ospedaliera Universitaria Policlinico Umberto I, Università di Roma "Sapienza," Rome, Italy
| | - Sebastiano Filetti
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma "Sapienza," Rome, Italy
| | - Cosimo Durante
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma "Sapienza," Rome, Italy
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1013
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Abstract
Genomic, clinical, and pathologic studies have prompted a more risk-stratified approach to the management of patients with thyroid nodules. The recent nomenclature change concerning noninvasive follicular thyroid neoplasm with papillary-like nuclear features reflects the clinical trend toward conservative treatment choices for carefully selected low-risk thyroid neoplasms. These developments have occurred in parallel with a growing array of molecular tests intended to improve clinical triage for patients with indeterminate fine needle aspiration diagnoses. This review discusses the implications of the nomenclature revision on the interpretation of thyroid fine needle aspiration and updates available ancillary molecular tests for thyroid fine needle aspirations.
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Affiliation(s)
- Michiya Nishino
- Department of Pathology, Harvard Medical School and Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
| | - Jeffrey F Krane
- Department of Pathology, Harvard Medical School and Brigham and Women's Hospital, 75 Francis Street, Amory 3, Boston, MA 02115, USA
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1014
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Kuo JH, McManus C, Graves CE, Madani A, Khokhar MT, Huang B, Lee JA. Updates in the management of thyroid nodules. Curr Probl Surg 2018; 56:103-127. [PMID: 30798796 DOI: 10.1067/j.cpsurg.2018.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/18/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Jennifer H Kuo
- Division of Endocrine Surgery, Columbia University, New York, NY.
| | | | - Claire E Graves
- Division of Endocrine Surgery, Columbia University, New York, NY
| | - Amin Madani
- Division of Endocrine Surgery, Columbia University, New York, NY
| | - Mamoona T Khokhar
- Division of Endocrine Surgery, Banner University Medical Center, Phoenix, AZ
| | - Bernice Huang
- Division of Endocrine Surgery, Columbia University, New York, NY
| | - James A Lee
- Division of Endocrine Surgery, Columbia University, New York, NY
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1015
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Meltzer CJ, Irish J, Angelos P, Busaidy NL, Davies L, Dwojak S, Ferris RL, Haugen BR, Harrell RM, Haymart MR, McIver B, Mechanick JI, Monteiro E, Morris JC, Morris LGT, Odell M, Scharpf J, Shaha A, Shin JJ, Shonka DC, Thompson GB, Tuttle RM, Urken ML, Wiseman SM, Wong RJ, Randolph G. American Head and Neck Society Endocrine Section clinical consensus statement: North American quality statements and evidence-based multidisciplinary workflow algorithms for the evaluation and management of thyroid nodules. Head Neck 2018; 41:843-856. [PMID: 30561068 DOI: 10.1002/hed.25526] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/28/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Care for patients with thyroid nodules is complex and multidisciplinary, and research demonstrates variation in care. The objective was to develop clinical guidelines and quality metrics to reduce unwarranted variation and improve quality. METHODS Multidisciplinary expert consensus and modified Delphi approach. Source documents were workflow algorithms from Kaiser Permanente Northern California and Cancer Care of Ontario based on the 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. RESULTS A consensus-based, unified preoperative, perioperative, and postoperative workflow was developed for North American use. Twenty-one panelists achieved consensus on 16 statements about workflow-embedded process and outcomes metrics addressing safety, access, appropriateness, efficiency, effectiveness, and patient centeredness of care. CONCLUSION A panel of Canadian and United States experts achieved consensus on workflows and quality metric statements to help reduce unwarranted variation in care, improving overall quality of care for patients diagnosed with thyroid nodules.
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Affiliation(s)
- Charles J Meltzer
- The Permanente Medical Group, Kaiser Permanente, Santa Rosa, California
| | - Jonathan Irish
- Department of Otolaryngology, Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network/University of Toronto, Toronto, Ontario, Canada
| | - Peter Angelos
- Department of Surgery, MacLean Center for Clinical Ethics, The University of Chicago Medicine, Chicago, Illinois
| | - Naifa L Busaidy
- Department of Endocrine Neoplasia & Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Louise Davies
- The VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vermont.,Section of Otolaryngology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.,The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
| | - Sunshine Dwojak
- Northwest Permanente Medicine, Kaiser Permanente, Portland, Oregon
| | - Robert L Ferris
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Bryan R Haugen
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado
| | - Richard M Harrell
- Departments of Integrative Endocrine Surgery and Pathology, Memorial Healthcare System, Hollywood, Florida
| | - Megan R Haymart
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Bryan McIver
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jeffrey I Mechanick
- Divisions of Cardiology and Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, Mount Sinai School of Medicine, New York, New York
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - John C Morris
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Luc G T Morris
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Odell
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Joseph Scharpf
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ashok Shaha
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jennifer J Shin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - David C Shonka
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia
| | | | - R Michael Tuttle
- Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark L Urken
- Department of Otolaryngology Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York.,Icahn School of Medicine, Mount Sinai, New York, New York.,Thyroid, Head and Neck Cancer Foundation, New York, New York
| | - Sam M Wiseman
- Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard J Wong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gregory Randolph
- Department of Otolaryngology, Massachusetts General Hospital, Boston, Massachusetts
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1016
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Hosokawa S, Takebayashi S, Sasaki Y, Nakamura Y, Shinmura K, Takahashi G, Mineta H. Clinical analysis of false-negative fine needle aspiration cytology of head and neck cancers. Postgrad Med 2018; 131:151-155. [DOI: 10.1080/00325481.2019.1559431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Seiji Hosokawa
- Department of Otorhinolaryngology/Head & Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Satoru Takebayashi
- Department of Otorhinolaryngology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Yutaka Sasaki
- Department of Otorhinolaryngology, Numazu City Hospital, Numazu, Japan
| | - Yuuki Nakamura
- Department of Otorhinolaryngology, Numazu City Hospital, Numazu, Japan
| | - Kazuya Shinmura
- Department of Tumor Pathology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Goro Takahashi
- Department of Otorhinolaryngology/Head & Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Yamahoshi ENT Clinic, Hamamatsu, Japan
| | - Hiroyuki Mineta
- Department of Otorhinolaryngology/Head & Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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1017
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Incidence and malignancy rates classified by The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) - An 8-year tertiary center experience in Thailand. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2018; 16:100175. [PMID: 30815363 PMCID: PMC6378904 DOI: 10.1016/j.jcte.2018.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 12/05/2018] [Accepted: 12/10/2018] [Indexed: 12/21/2022]
Abstract
Incidence and Malignancy Rates Classified by The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) – An 8-year Tertiary Center experience in Thailand. Background Fine-needle aspiration (FNA) of the thyroid is considered the best diagnostic tool for preoperative evaluation of thyroid nodules. The introduction of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) in 2010 provided the opportunity to establish worldwide standard for reporting and terminology guidelines for diagnostic categories. It is recommended that every institution evaluates the risk of malignancy (ROM) in each category for quality improvement process. Aim To assess the effectiveness of TBSRTC method at our institution using cyto-histological correlation. Method A retrospective 8-year (2010–2017) audit of thyroid FNA done by thyroid specialists at Theptarin hospital. The FNA results were classified according to TBSRTC. Histopathology reports for operated cases were used to correlate cytology and final histopathology. Results A total of 2735 thyroid FNA from 2115 patients (mean age 45.7 ± 13.1 years, female 89.8%) were examined. The rates of non-diagnostic, benign, atypia of undetermined significance (AUS), follicular neoplasm, suspected for malignancy, and malignant cases were 21.1%, 66.6%, 4.7%, 2.4%, 1.8%, and 3.3% respectively. There were 188 patients (9%) who underwent surgical resection with available histopathology. Malignancy rates in operated thyroid nodules were 20.0%, 4.2%, 9.4%, 23.5%, 57.1%, and 90.3% for categories 1 to 6, respectively. The sensitivity, specificity, negative predictive value, and positive predictive value were 96.6%, 88.5%, 95.8%, and 90.3, respectively. Conclusions Preoperative diagnosis of thyroid nodules using TBSRTC in our hospital was comparable with other studies. The uniform diagnostic criteria of the Bethesda System help avoid misinterpretation while sharing local experience with international benchmarks.
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1018
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Oh HS, Ha J, Kim HI, Kim TH, Kim WG, Lim DJ, Kim TY, Kim SW, Kim WB, Shong YK, Chung JH, Baek JH. Active Surveillance of Low-Risk Papillary Thyroid Microcarcinoma: A Multi-Center Cohort Study in Korea. Thyroid 2018; 28:1587-1594. [PMID: 30226447 DOI: 10.1089/thy.2018.0263] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Active surveillance has been introduced as a management option for low-risk papillary thyroid microcarcinoma (PTMC) due to its mostly indolent course. METHODS This was a multicenter study of 370 PTMC patients who underwent active surveillance more than one year. The changes in volume and maximum diameter between initial and last ultrasonography were evaluated to identify the natural course of PTMC during active surveillance. RESULTS Patients' age at diagnosis was 51 ± 12 years, and 110 (30%) patients were <45 years of age. The initial maximum diameter and volume of PTMCs were 5.9 ± 1.7 mm and 81.0 ± 77.7 mm3, respectively. During the median 32.5 months of follow-up, 86 (23.2%) patients were found to have an increase in tumor volume, and 13 (3.5%) patients showed an increase in the maximal diameter of the tumor. The cumulative incidence of volume increase gradually rose with time (6.9%, 17.3%, 28.2%, and 36.2% after two, three, four, and five years, respectively). The risk of volume increase in patients <45 years of age was twice as high as in older patients (p = 0.002). There was no significant difference in tumor size change according to sex, levothyroxine treatment, or presence of Hashimoto's thyroiditis. During the period, 58 (15.7%) patients underwent delayed thyroid surgery due to anxiety (37.9%), tumor size increase (32.8%), or appearance of cervical lymph node metastasis (8.6%). Lymph node metastasis was found in 29.3% of patients on pathological examination. CONCLUSIONS A significant number of PTMCs grow during active surveillance, and tumor volume change is a more sensitive means of evaluating tumor growth. Active surveillance can be carefully applied for selected patients. Although it is not contraindicated, it should be applied more cautiously for younger patients.
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Affiliation(s)
- Hye-Seon Oh
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeonghoon Ha
- 2 Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hye In Kim
- 3 Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- 4 Division of Endocrinology and Metabolism, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Tae Hyuk Kim
- 3 Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Gu Kim
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong-Jun Lim
- 2 Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae Yong Kim
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sun Wook Kim
- 3 Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Bae Kim
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Kee Shong
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Hoon Chung
- 3 Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Hwan Baek
- 5 Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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1019
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Cipriani NA, White MG, Angelos P, Grogan RH. Large Cytologically Benign Thyroid Nodules Do Not Have High Rates of Malignancy or False-Negative Rates and Clinical Observation Should be Considered: A Meta-Analysis. Thyroid 2018; 28:1595-1608. [PMID: 30280990 DOI: 10.1089/thy.2018.0221] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background: Management of large thyroid nodules is controversial, as data are conflicting regarding overall rates of malignancy (ROM) in all nodules and frequency of false-negative fine-needle aspiration results (FNR) in cytologically benign nodules. This meta-analysis aimed to evaluate and compare ROM and FNR in small versus large nodules published in the literature. Methods: Articles indexed in PubMed, written in English, published electronically or in print on or prior to December 8 2017 were searched for "false negative thyroid size or cm" and "malignancy rates benign thyroid nodules." Three hundred fifty-two unique citations were identified. Multiple reviewers selected a final set of 35 articles that contained nodules stratified by size (3, 4, or 5 cm), with benign or all cytologic diagnoses, and with postsurgical histologic diagnoses. Multiple observers extracted data, including numbers of total, cytologically benign, and histologically malignant nodules. Size cutoffs of 3, 4, and/or 5 cm were analyzed in 14, 24, and 1 article, respectively. Results: ROM in all nodules ≥3 cm (13.1%) and ≥4 cm (20.9%) was lower than those <3 cm (19.6%) and <4 cm (19.9%; odds ratio [OR] = 0.72 [confidence interval (CI) 0.64-0.81] and OR = 0.85 [CI 0.77-0.95]). FNR in nodules ≥3 cm (7.2%) was not different from smaller nodules (5.7%; OR = 1.47 [CI 0.80-2.69]). FNR in nodules ≥4 cm (6.7%) was slightly higher than those <4 cm (4.5%; OR = 1.38 [CI 1.06-1.80]). The most frequently reported false-negative diagnosis was papillary thyroid carcinoma. Conclusions: Rates of malignancy and false-negative FNA results vary but, in most studies, are not higher in larger nodules. Patients with large, cytologically benign thyroid nodules need not undergo immediate surgical resection, as false-negative FNA rates are low and are expected to decrease in light of nomenclature revision of a subset of follicular variants of papillary thyroid carcinoma.
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Affiliation(s)
- Nicole A Cipriani
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Michael G White
- Endocrine Surgery Research Program Department of Surgery, The University of Chicago, Chicago, Illinois
| | - Peter Angelos
- Endocrine Surgery Research Program Department of Surgery, The University of Chicago, Chicago, Illinois
| | - Raymon H Grogan
- Department of Endocrine Surgery, Baylor St. Luke's Medical Center, Houston, Texas
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1020
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Kim BH, Kim SJ, Kim M, Lee SW, Jeong SY, Pak K, Kim K, Kim IJ. Diagnostic performance of HMGA2 gene expression for differentiation of malignant thyroid nodules: A systematic review and meta-analysis. Clin Endocrinol (Oxf) 2018; 89:856-862. [PMID: 30223300 DOI: 10.1111/cen.13853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/22/2018] [Accepted: 09/10/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of the current study was to investigate the diagnostic performance of high mobility group A2 (HMGA2) gene expression for differentiation of malignant thyroid nodules through a systematic review and meta-analysis. DESIGN The MEDLINE/PubMed and EMBASE database, from the earliest available date of indexing through 10 April 2018, were searched for studies evaluating the diagnostic performance of HMGA2 expression for differentiation of thyroid nodules. METHODS We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR-), and constructed summary receiver operating characteristic (ROC) curves. RESULTS Across 7 studies, the pooled sensitivity for HMGA2 expression was 0.78 (95% CI; 0.67-0.86) with heterogeneity (I2 = 86.6) and a pooled specificity of 0.94 (95% CI: 0.85-0.98) with heterogeneity (I2 = 94.7). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 12.6 (95% CI: 5.1-31.3) and negative likelihood ratio (LR-) of 0.24 (95% CI: 0.15-0.36). The pooled diagnostic odds ratio (DOR) was 53 (95% CI: 18-159). Hierarchical summary ROC curve indicates that the areas under the curve were 0.92 (95% CI: 0.89-0.94). In meta-regression analysis, no definite variable was the source of the study heterogeneity. CONCLUSION The current meta-analysis showed the moderate sensitivity and high specificity of HMGA2 expression for differentiation of malignant thyroid nodules. The likelihood ratio scatter-gram suggested that HMGA2 expression analysis could be useful for confirmation of the presence of malignant thyroid nodules. Considering the heterogeneity of included studies, further large prospective studies are necessary to confirm these results.
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Affiliation(s)
- Bo Hyun Kim
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Seong Jang Kim
- Department of Nuclear Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Nuclear Medicine, College of Medicine, Pusan National University, Yangsan, Korea
| | - Mijin Kim
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sang-Woo Lee
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University Medical Center, Daegu, Korea
| | - Shin Young Jeong
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University Medical Center, Daegu, Korea
| | - Kyoungjune Pak
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Keunyoung Kim
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - In Joo Kim
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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1021
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Trabzonlu L, Paksoy N. Cytomorphological Analysis of Thyroid Nodules Diagnosed as Follicular Variant of Papillary Thyroid Carcinoma: a Fine Needle Aspiration Study of Diagnostic Clues in 42 Cases and the Impact of Using Bethesda System in Reporting-an Institutional Experience. Endocr Pathol 2018; 29:351-356. [PMID: 30315491 DOI: 10.1007/s12022-018-9550-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Follicular variant of papillary thyroid carcinoma (FVPTC) is the second most common subtype of papillary thyroid carcinoma (PTC) after classical PTC (cPTC). Follicular thyroid lesions such as follicular adenomas/carcinomas, FVPTC, and noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) pose some diagnostic challenges for FNAC. In this study, we aimed to explore whether FNAC can demonstrate diagnostic clues by re-evaluating cytology slides from histopathologically diagnosed FVPTC cases. A total of 42 patients were enrolled in this study: patients were diagnosed with FVPTC via surgical resection between 2006 and 2016, and all patients were subjected to preoperative FNAC, which was conducted at either a private center or at the teaching hospital of Kocaeli University and reported by the same cytopathologist (NP). Clinical and cytomorphological characteristics were reviewed by both authors .Most cases (76.2%) are diagnosed either Bethesda IV or V. The majority of cases had a high cellularity (38/42; 90.5%), and the most frequent observations were monolayer and large syncytial groups of cells (95.2%). While microfollicular structures were observed in 30 (71.4%) cases, nuclear crowding and large naked nuclei were observed in all cases. Nuclear grooves were sparsely detected in 23 (54.8%) cases, and nuclear pseudoinclusions were detected in only six (14.3%) cases. Because thyrocytes often have a mixed architecture in FVPTC, despite a distinct follicular morphology, we believe that nuclear overcrowding, enlargement, and hyperchromasia in cases presenting with increased cellularity are notable clues for the cytodiagnosis of FVPTC. We believe that the primary aim of FNAC in such cases is to give preoperative diagnosis as either category IV or V. Nuclear crowding, monolayered clusters with large syncytial formations, nuclear enlargement, and hyperchromasia are notable cytomorphologic clues for the diagnosis of FVPTC on FNAC.
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Affiliation(s)
- Levent Trabzonlu
- Department of Pathology, Faculty of Medicine, Kocaeli University, Izmit, Kocaeli, Turkey
- Pathology Department, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nadir Paksoy
- Department of Pathology, Faculty of Medicine, Kocaeli University, Izmit, Kocaeli, Turkey.
- Dr Paksoy's Private Cytopathology/FNA Practice, Hurriyet Cad. Safak Apt. 125/17, 41300, Izmit, Kocaeli, Turkey.
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1022
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dos Santos MT, Buzolin AL, Gama RR, da Silva ECA, Dufloth RM, Figueiredo DLA, Carvalho AL. Molecular Classification of Thyroid Nodules with Indeterminate Cytology: Development and Validation of a Highly Sensitive and Specific New miRNA-Based Classifier Test Using Fine-Needle Aspiration Smear Slides. Thyroid 2018; 28:1618-1626. [PMID: 30319072 PMCID: PMC6308280 DOI: 10.1089/thy.2018.0254] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Thyroid nodules can be identified in up to 68% of the population. Fine-needle aspiration (FNA) cytopathology classifies 20%-30% of nodules as indeterminate, and these are often referred for surgery due to the risk of malignancy. However, histological postsurgical reports indicate that up to 84% of cases are benign, highlighting a high rate of unnecessary surgeries. We sought to develop and validate a microRNA (miRNA)-based thyroid molecular classifier for precision endocrinology (mir-THYpe) with both high sensitivity and high specificity, to be performed on the FNA cytology smear slide with no additional FNA. Methods: The expression of 96 miRNA candidates from 39 benign/39 malignant thyroid samples, (indeterminate on FNA) was analyzed to develop and train the mir-THYpe algorithm. For validation, an independent set of 58 benign/37 malignant FNA smear slides (also classified as indeterminate) was used. Results: In the training set, with a 10-fold cross-validation using only 11 miRNAs, the mir-THYpe test reached 89.7% sensitivity, 92.3% specificity, 90.0% negative predictive value and 92.1% positive predictive value. In the FNA smear slide validation set, the mir-THYpe test reached 94.6% sensitivity, 81.0% specificity, 95.9% negative predictive value, and 76.1% positive predictive value. Bayes' theorem shows that the mir-THYpe test performs satisfactorily in a wide range of cancer prevalences. Conclusions: The presented data and comparison with other commercially available tests suggest that the mir-THYpe test can be considered for use in clinical practice to support a more informed clinical decision for patients with indeterminate thyroid nodules and potentially reduce the rates of unnecessary thyroid surgeries.
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Affiliation(s)
- Marcos Tadeu dos Santos
- Department of Research and Development, Onkos Molecular Diagnostics, Ribeirão Preto/SP, Brazil
- Department of Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos/SP, Brazil
- Address correspondence to: Marcos Tadeu dos Santos, PhD, Department of Research and Development, Onkos Molecular Diagnostics, (Startups incubator), 1805 Avenida Doutora Nadir Aguiar, SUPERA Innovation and Technology Park, Ribeirão Preto/SP 14056-680, Brazil
| | - Ana Lígia Buzolin
- Department of Research and Development, Onkos Molecular Diagnostics, Ribeirão Preto/SP, Brazil
| | - Ricardo Ribeiro Gama
- Department of Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos/SP, Brazil
- Department of Head and Neck Surgery, Barretos Cancer Hospital, Barretos/SP, Brazil
| | | | | | | | - André Lopes Carvalho
- Department of Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos/SP, Brazil
- Department of Head and Neck Surgery, Barretos Cancer Hospital, Barretos/SP, Brazil
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1023
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Rammeh S, Romdhane E, Sassi A, Belhajkacem L, Blel A, Ksentini M, Lahiani R, Farah F, Salah MB, Ferjaoui M. Accuracy of fine-needle aspiration cytology of head and neck masses. Diagn Cytopathol 2018; 47:394-399. [PMID: 30488579 DOI: 10.1002/dc.24120] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/21/2018] [Accepted: 10/24/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Head and neck masses are a common presentation in daily practice and can be challenging to both clinicians and cytopathologists. Fine needle aspiration cytology (FNAC) is a widely used method for the diagnosis of head and neck masses. The aim of the study was to assess our institutional experience of the accuracy of FNAC in the diagnosis of head and neck masses. METHODS A total of 1262 FNACs were conducted from January 2013 to December 2016 and subdivided into benign and malignant categories. The thyroid and salivary glands FNACs were classified according to the Bethesda System for Reporting Thyroid cytopathology and to the Milan System for Reporting Salivary Gland Cytopathology respectively. The measures of diagnostic accuracy of FNAC were determined taking histology as a gold standard. RESULTS A total of 7 false negative (FN) and 6 false positive (FP) FNACs were identified. Overall sensitivity and specificity of FNAC for a malignant diagnosis were 92% and 94.4%, respectively. Accuracy of FNACs of head and neck masses was 93.5% for all sites. The salivary gland group had the highest rate of FN (2.8%). All FP were reported in the thyroid group. These cases were cytologically classified suspicious for malignancy (n = 3) and papillary carcinoma (n = 3) and proved to be lymphocytic thyroiditis on final histology. Among the most common locations, cytology of lymph nodes provided the best sensitivity (98.2%). Salivary glands as well as lymph nodes had the best specificity (100%). CONCLUSION FNAC of head and neck masses has a high accuracy allowing a correct therapeutic management. However, this accuracy depends on the anatomic location of the mass.
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Affiliation(s)
- Soumaya Rammeh
- Department of Pathology, Charles Nicolle Hospital, Tunis, Tunisia.,Faculté de Médecine de Tunis, Université de Tunis El Manar, UR17ES15, Tunis, Tunisie
| | - Emna Romdhane
- Department of Pathology, Charles Nicolle Hospital, Tunis, Tunisia.,Faculté des Sciences de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Asma Sassi
- Department of Pathology, Charles Nicolle Hospital, Tunis, Tunisia.,Faculté de Médecine de Tunis, Université de Tunis El Manar, UR17ES15, Tunis, Tunisie
| | - Linda Belhajkacem
- Department of Pathology, Charles Nicolle Hospital, Tunis, Tunisia.,Faculté de Médecine de Tunis, Université de Tunis El Manar, UR17ES15, Tunis, Tunisie
| | - Ahlem Blel
- Department of Pathology, Charles Nicolle Hospital, Tunis, Tunisia.,Faculté de Médecine de Tunis, Université de Tunis El Manar, UR17ES15, Tunis, Tunisie
| | - Meriem Ksentini
- Department of Pathology, Charles Nicolle Hospital, Tunis, Tunisia.,Faculté de Médecine de Tunis, Université de Tunis El Manar, UR17ES15, Tunis, Tunisie
| | - Rim Lahiani
- Faculté de Médecine de Tunis, Université de Tunis El Manar, UR17ES15, Tunis, Tunisie.,Department of Otorhinolaryngology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Faten Farah
- Department of Pathology, Charles Nicolle Hospital, Tunis, Tunisia.,Faculté de Médecine de Tunis, Université de Tunis El Manar, UR17ES15, Tunis, Tunisie
| | - Mamia Ben Salah
- Faculté de Médecine de Tunis, Université de Tunis El Manar, UR17ES15, Tunis, Tunisie.,Department of Otorhinolaryngology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mohamed Ferjaoui
- Faculté de Médecine de Tunis, Université de Tunis El Manar, UR17ES15, Tunis, Tunisie.,Department of Otorhinolaryngology, Charles Nicolle Hospital, Tunis, Tunisia
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1024
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Jiang D, Zang Y, Jiang D, Zhang X, Zhao C. Value of rapid on-site evaluation for ultrasound-guided thyroid fine needle aspiration. J Int Med Res 2018; 47:626-634. [PMID: 30463462 PMCID: PMC6381502 DOI: 10.1177/0300060518807060] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Objective Application of rapid on-site evaluation (ROSE) for thyroid fine needle aspiration (FNA) is controversial. Therefore, ROSE has not been universally applied. This study aimed to evaluate the value of ROSE for ultrasound-guided thyroid FNA. Methods A total of 997 patients with 1103 suspicious thyroid nodules had ultrasound-guided FNA performed from January 2016 to February 2018. There were 513 nodules with ROSE and 590 nodules without ROSE. The cytological nondiagnostic rate, needle passes, and procedural times of thyroid FNA with or without ROSE were compared. The nondiagnostic rates of subsets of suspicious thyroid nodules were further compared. Results There was no significant effect of ROSE on the nondiagnostic rate of FNA. However, FNA with ROSE significantly reduced the numbers of sub-centimeter, mixed solid-cystic, macrocalcified, and hypervascular nodules. There was a significantly smaller number of needle passes and less procedural times with ROSE than without ROSE. There was no significant difference in the complication rate of FNA with and without ROSE. Conclusion ROSE for thyroid FNA reduces the number of needle passes and procedural times. ROSE has a higher clinical application value in subsets of thyroid nodules, which tend to be difficult to diagnose with FNA.
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Affiliation(s)
- Danni Jiang
- 1 Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yichen Zang
- 1 Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Dandan Jiang
- 2 Department of Breast Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaojuan Zhang
- 1 Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Cheng Zhao
- 1 Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
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1025
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Ahn D, Lee GJ, Sohn JH, Jeong JY. Fine‐needle aspiration cytology versus core‐needle biopsy for the diagnosis of extracranial head and neck schwannoma. Head Neck 2018; 40:2695-2700. [DOI: 10.1002/hed.25520] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 08/12/2018] [Accepted: 10/09/2018] [Indexed: 11/08/2022] Open
Affiliation(s)
- Dongbin Ahn
- Department of Otolaryngology‐Head and Neck Surgery, School of MedicineKyungpook National University Daegu Republic of Korea
| | - Gil Joon Lee
- Department of Otolaryngology‐Head and Neck Surgery, School of MedicineKyungpook National University Daegu Republic of Korea
| | - Jin Ho Sohn
- Department of Otolaryngology‐Head and Neck Surgery, School of MedicineKyungpook National University Daegu Republic of Korea
| | - Ji Yun Jeong
- Department of Pathology, School of MedicineKyungpook National University Daegu Republic of Korea
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1026
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Pastorello RG, Saieg MA. Metastases to the Thyroid: Potential Cytologic Mimics of Primary Thyroid Neoplasms. Arch Pathol Lab Med 2018; 143:394-399. [PMID: 30444438 DOI: 10.5858/arpa.2017-0570-rs] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Secondary tumors of the thyroid gland, although uncommon, can sometimes pose as diagnostic dilemmas on fine-needle aspiration cytology, frequently mimicking primary thyroid neoplasms. An accurate diagnosis of such lesions, however, is critical for patient management and prognosis. The present study reviews the cytologic aspects of secondary involvement of the thyroid, listing the most common primary malignancies that metastasize to this gland. Knowledge of such morphologic aspects, combined with prompt clinical correlation, is essential for the cytopathologist to achieve a proper, definite diagnosis.
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Affiliation(s)
- Ricardo Garcia Pastorello
- From the Department of Pathology, A.C. Camargo Cancer Center, Sao Paulo, Brazil (Drs Pastorello and Saieg); and the Department of Pathology, Santa Casa Medical School, Sao Paulo, Brazil (Dr Saieg)
| | - Mauro Ajaj Saieg
- From the Department of Pathology, A.C. Camargo Cancer Center, Sao Paulo, Brazil (Drs Pastorello and Saieg); and the Department of Pathology, Santa Casa Medical School, Sao Paulo, Brazil (Dr Saieg)
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1027
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Abstract
Population-based studies have demonstrated that an increasing number of incidental thyroid nodules are being identified. The corresponding increase in thyroid-based diagnostic procedures, such as fine-needle aspiration biopsy, has in part led to an increase in the diagnoses of thyroid cancers and to more thyroid surgeries being performed. Small papillary thyroid cancers account for most of this increase in diagnoses. These cancers are considered to be low risk because of the excellent patient outcomes, with a 5-year disease-specific survival of >98%. As a result, controversy remains regarding the optimal management of newly diagnosed differentiated thyroid cancer, as the complications related to thyroidectomy (primarily recurrent laryngeal nerve injury and hypoparathyroidism) have considerable effects on patient quality of life. This Review highlights current debates, including undertaking active surveillance versus thyroid surgery for papillary thyroid microcarcinoma, the extent of thyroid surgery and lymphadenectomy for low-risk differentiated thyroid cancer, and the use of molecular testing to guide decision-making about whether surgery is required and the extent of the initial operation. This Review includes a discussion of current consensus guideline recommendations regarding these topics in patients with differentiated thyroid cancer. Additionally, innovative thyroidectomy techniques (including robotic and transoral approaches) are discussed, with an emphasis on patient preferences around decision-making and outcomes following thyroidectomy.
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Affiliation(s)
- Tracy S Wang
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Julie Ann Sosa
- Department of Surgery, University of California at San Francisco, San Francisco, CA, USA
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1028
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Zhang F, Oluwo O, Castillo FB, Gangula P, Castillo M, Farag F, Zakaria S, Zahedi T. THYROID NODULE LOCATION ON ULTRASONOGRAPHY AS A PREDICTOR OF MALIGNANCY. Endocr Pract 2018; 25:131-137. [PMID: 30383496 DOI: 10.4158/ep-2018-0361] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The diagnostic capacity of ultrasonography (US) for differentiating between malignant and benign thyroid nodules is crucial in preventing unnecessary invasive procedures. This is the first study to evaluate whether thyroid nodule location on US has predictive value for malignancy. METHODS We retrospectively reviewed data from 219 patients with thyroid nodules who underwent fine-needle aspiration biopsy in 1 year. Patients' demographics as well as nodule's laterality, polarity, morphology, and multinodularity were analyzed. All malignant lesions were confirmed by surgical pathology. RESULTS The majority of the patients were female (86.2%). Nodules were evenly distributed between the right lobe (46.3%) and left lobe (49.5%). Eight nodules (4.2%) were located in the isthmus. Most nodules (79.3%) were located in the lower pole, while 9.6% were located in the upper pole and 6.9% in the middle pole. Seventy-five patients (39.9%) had multiple nodules. Fourteen nodules were malignant, representing a prevalence of 7.4%. A significantly higher frequency of malignancy was observed in upper pole (22.2%) compared to lower pole (4.7%) and middle pole (15.4%). A multiple logistic regression model confirmed such association after adjusting for age, body mass index, multinodularity, and laterality. The odds of malignancy in the upper pole were 4 times higher than other locations (odds ratio, 4.6; P = .03). CONCLUSION Our study is the first showing that thyroid nodules located in the upper pole can be considered as having higher risk for malignancy. It may enhance the predictive value of malignancy if it is included in thyroid nodule ultrasound classification guidelines. ABBREVIATIONS AACE = American Association of Clinical Endocrinologists; ATA = American Thyroid Association; BMI = body mass index; FNA = fine-needle aspiration; TMS = total malignancy score; TTW = taller than wide; US = ultrasonography.
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1029
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Christopher MM, Ku CK. Likelihood of Neoplasia for Diagnoses Modified by Probability Terms in Canine and Feline Lymph Node Cytology: How Probable Is Probable? Front Vet Sci 2018; 5:246. [PMID: 30356759 PMCID: PMC6189517 DOI: 10.3389/fvets.2018.00246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/17/2018] [Indexed: 01/21/2023] Open
Abstract
Background: Descriptive probability modifiers are used often to convey the uncertainty of a pathology diagnosis, but they also contribute to ambiguity in communication between pathologists and clinicians. Objectives: Our goal was to determine the frequency and use of probability modifiers in canine and feline lymph node cytology diagnoses, and to determine the actual likelihood of neoplasia for diagnoses with and without modifiers, based on the histologic outcome. Methods: Canine and feline lymph node cytology and histology reports over an 11-year period (2001–2011; n = 367) were evaluated retrospectively. Diagnoses were categorized as neoplastic/malignant (lymphoma, metastatic) or non-neoplastic/benign. The frequency and type of modifier, and the sensitivity, specificity, and predictive values for neoplasia were determined for modified and unmodified diagnoses using histology as the gold standard. Results: Ninety-one of 367 (24.8%) cytology diagnoses were modified by probability terms, including 25/204 (12.2%) diagnoses of non-neoplastic lesions and 66/163 (40.5%) diagnoses of neoplasia. In addition, 26 unmodified diagnoses of neoplasia were followed by a probability phrase indicating specific tumor type. Based on the histologic outcome, modified diagnoses had higher sensitivity (87.3%, confidence interval [CI] 75.5, 94.7%) but lower specificity (50.0%, CI 32.9, 67.1%) for neoplasia than did unmodified diagnoses (60.6 and 100%, respectively; P < 0.0001, Chi square). Modified phrases indicating the probability of a specific tumor type were accurate in 22/26 (84.6%) cases. Positive predictive values for neoplasia were 100% (CI 96.2, 100%) for unmodified and 72.7% (CI 60.4, 83.0%) for modified diagnoses. Negative predictive values were 65.9% (CI 58.5, 72.8%) for unmodified and 72.0% (CI 60.4, 83.0%) for modified diagnoses. No significant difference was found in the likelihood of neoplasia for individual terms used to modify a cytologic diagnosis except for “cannot rule out” (P = 0.0368). Conclusions: Most modified diagnoses of cancer in canine and feline lymph node cytology have a 60–83% likelihood of neoplasia based on histologic outcome, compared with 96–100% for unmodified diagnoses. Non-neoplastic lesions, regardless of modifiers, have a 12–49% likelihood of neoplasia. A limited number of risk categories based on these likelihoods may be a more effective and accurate way to communicate the risk of malignancy in lymph node cytology.
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Affiliation(s)
- Mary M Christopher
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Chieh-Ko Ku
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
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1030
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Marcadis AR, Valderrabano P, Ho AS, Tepe J, Swartzwelder CE, Byrd S, Sacks WL, Untch BR, Shaha AR, Xu B, Lin O, Ghossein RA, Wong RJ, Marti JL, Morris LGT. Interinstitutional variation in predictive value of the ThyroSeq v2 genomic classifier for cytologically indeterminate thyroid nodules. Surgery 2018; 165:17-24. [PMID: 30360906 DOI: 10.1016/j.surg.2018.04.062] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND The ThyroSeq v2 next-generation sequencing assay estimates the probability of malignancy in indeterminate thyroid nodules. Its diagnostic accuracy in different practice settings and patient populations is not well understood. METHODS We analyzed 273 Bethesda III/IV indeterminate thyroid nodules evaluated with ThyroSeq at 4 institutions: 2 comprehensive cancer centers (n = 98 and 102), a multicenter health care system (n = 60), and an academic medical center (n = 13). The positive and negative predictive values of ThyroSeq and distribution of final pathologic diagnoses were analyzed and compared with values predicted by Bayes theorem. RESULTS Across 4 institutions, the positive predictive value was 35% (22%-43%) and negative predictive value was 93% (88%-100%). Predictive values correlated closely with Bayes theorem estimates (r2 = 0.84), although positive predictive values were lower than expected. RAS mutations were the most common molecular alteration. Among 84 RAS-mutated nodules, malignancy risk was variable (25%, range 10%-37%) and distribution of benign diagnoses differed across institutions (adenoma/hyperplasia 12%-85%, noninvasive follicular thyroid neoplasm with papillary-like nuclear features 5%-46%). CONCLUSION In a multi-institutional analysis, ThyroSeq positive predictive values were variable and lower than expected. This is attributable to differences in the prevalence of malignancy and variability in pathologist interpretations of noninvasive tumors. It is important that clinicians understand ThyroSeq performance in their practice setting when evaluating these results.
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Affiliation(s)
- Andrea R Marcadis
- Department of Surgery (Head and Neck Service), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Pablo Valderrabano
- Department of Head and Neck Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Allen S Ho
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Justin Tepe
- Department of Surgery (Head and Neck Service), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Christina E Swartzwelder
- Department of Surgery (Head and Neck Service), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Serena Byrd
- Department of Surgery (Head and Neck Service), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Wendy L Sacks
- Department of Endocrinology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Brian R Untch
- Department of Surgery (Head and Neck Service), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ashok R Shaha
- Department of Surgery (Head and Neck Service), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ronald A Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Richard J Wong
- Department of Surgery (Head and Neck Service), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jennifer L Marti
- Department of Surgery, New York Presbyterian/Weill Cornell Medical Center, New York, NY
| | - Luc G T Morris
- Department of Surgery (Head and Neck Service), Memorial Sloan Kettering Cancer Center, New York, NY.
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1031
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Fradet L, Temmar R, Couture F, Belzile M, Fortier PH, Day R. Evaluation of PACE4 isoforms as biomarkers in thyroid cancer. J Otolaryngol Head Neck Surg 2018; 47:63. [PMID: 30340539 PMCID: PMC6194618 DOI: 10.1186/s40463-018-0311-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 10/01/2018] [Indexed: 01/10/2023] Open
Abstract
Background To date, no single molecular marker has been demonstrated as clinically useful in differentiating malignant from benign thyroid nodules when a fine needle aspiration falls in the “unknown significance” categories of the Bethesda Classification. PACE4, a member of the proprotein convertase family of enzymes, has been shown to play a major role in the pathogenesis of prostate cancer, through the formation of an oncogenic isoform named PACE4-altCT. PACE4 isoforms have also been suggested to play a role in other cancers, including thyroid cancer, but have never been investigated in a detailed manner. Our objective is to compare the histochemical distribution of the two major PACE4 isoforms in benign and malignant thyroid nodules, in order to determine their potential usefulness as discriminatory biomarkers. Methods Thyroid tissues of patients who underwent thyroidectomy were classified according to final pathology. Corresponding tissue sections were immunostained, using two previously validated antibodies raised against the C-terminal end of the two PACE4 isoforms, namely the full-length PACE4 protein (PACE4-FL) and its alternative isoform (PACE4-altCT). Nodules were compared with adjacent normal parenchyma and immunostaining was rated as “low” or “high” by a head and neck pathologist. Results Non-lesional thyroid parenchyma did not express PACE4-FL (p = 0.002). As a group, malignant (n = 17) nodules expressed PACE4-FL significantly more than benign (n = 24) nodules (percentage of high immunostaining: 52.9% vs 4.2%; p = 0.001). Reciprocally, there was a statistically lower expression of PACE4-altCT in malignant nodules than in adjacent non-lesional parenchyma (p = 0.014). The specificity of a high PACE4-FL immunostaining in determining malignancy was 95.8% (95% CI, 78.9% to 99.9%). Conclusion This study supports the previously described relationship between PACE4-FL and PACE4-altCT through alternative splicing. It also suggests that PACE4-FL is a promising biomarker for thyroid malignancy. Its high specific expression for malignancy could make it an interesting “rule in” test for thyroid cancer. Further prospective, quantitative studies are currently being designed to address how measurements of PACE4 isoforms could be used in a clinical setting. Trial registration This study does not report the results of a health care intervention on human participants. It was nonetheless registered on ClinicalTrials.gov under reference number NCT03160482. Electronic supplementary material The online version of this article (10.1186/s40463-018-0311-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laurent Fradet
- Division of Otolaryngology, Department of Surgery, Faculty of Medicine, Université de Sherbrooke, CIUSSS de l'Estrie - CHUS, Hôpital Hôtel-Dieu de Sherbrooke, 580 Bowen S, Sherbrooke, QC, J1G 2E8, Canada.
| | - Rabia Temmar
- Department of Pathology, Faculty of Medicine, Université de Sherbrooke, CIUSSS de l'Estrie - CHUS, Hôpital Hôtel-Dieu de Sherbrooke, 580 Bowen S, Sherbrooke, QC, J1G 2E8, Canada
| | - Frédéric Couture
- Divison of Urology, Departemnt of Surgery, Faculty of Medicine, Université de Sherbrooke, Institut de pharmacologie de Sherbrooke, 3001 12th Ave N, Sherbrooke, QC, J1H 5N4, Canada
| | - Mathieu Belzile
- Division of Otolaryngology, Department of Surgery, Faculty of Medicine, Université de Sherbrooke, CIUSSS de l'Estrie - CHUS, Hôpital Hôtel-Dieu de Sherbrooke, 580 Bowen S, Sherbrooke, QC, J1G 2E8, Canada
| | - Pierre-Hugues Fortier
- Division of Otolaryngology, Department of Surgery, Faculty of Medicine, Université de Sherbrooke, CIUSSS de l'Estrie - CHUS, Hôpital Hôtel-Dieu de Sherbrooke, 580 Bowen S, Sherbrooke, QC, J1G 2E8, Canada
| | - Robert Day
- Divison of Urology, Departemnt of Surgery, Faculty of Medicine, Université de Sherbrooke, Institut de pharmacologie de Sherbrooke, 3001 12th Ave N, Sherbrooke, QC, J1H 5N4, Canada
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1032
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Lindeman BM, Nehs MA, Angell TE, Alexander EK, Gawande AA, Moore FD, Doherty GM, Cho NL. Effect of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP) on Malignancy Rates in Thyroid Nodules: How to Counsel Patients on Extent of Surgery. Ann Surg Oncol 2018; 26:93-97. [DOI: 10.1245/s10434-018-6932-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Indexed: 02/06/2023]
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1033
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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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1034
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Cha H, Pyo JY, Hong SW. The Usefulness of Immunocytochemistry of CD56 in Determining Malignancy from Indeterminate Thyroid Fine-Needle Aspiration Cytology. J Pathol Transl Med 2018; 52:404-410. [PMID: 30317844 PMCID: PMC6250936 DOI: 10.4132/jptm.2018.09.20] [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: 07/06/2018] [Accepted: 09/18/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Fine-needle aspiration cytology serves as a safe, economical tool in evaluating thyroid nodules. However, about 30% of the samples are categorized as indeterminate. Hence, many immunocytochemistry markers have been studied, but there has not been a single outstanding marker. We studied the efficacy of CD56 with human bone marrow endothelial cell marker-1 (HBME-1) in diagnosis in the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) category III. METHODS We reviewed ThinPrep liquid-based cytology (LBC) samples with Papanicolaou stain from July 1 to December 31, 2016 (2,195 cases) and selected TBSRTC category III cases (n = 363). Twenty-six cases were histologically confirmed as benign (six cases, 23%) or malignant (20 cases, 77%); we stained 26 LBC slides with HBME-1 and CD56 through the cell transfer method. For evaluation of reactivity of immunocytochemistry, we chose atypical follicular cell clusters. RESULTS CD56 was not reactive in 18 of 20 cases (90%) of malignant nodules and showed cytoplasmic positivity in five of six cases (83%) of benign nodules. CD56 showed high sensitivity (90.0%) and relatively low specificity (83.3%) in detecting malignancy (p = .004). HBME-1 was reactive in 17 of 20 cases (85%) of malignant nodules and was not reactive in five of six cases (83%) of benign nodules. HBME-1 showed slightly lower sensitivity (85.0%) than CD56. The specificity in detecting malignancy by HBME-1 was similar to that of CD56 (83.3%, p = .008). CD56 and HBME-1 tests combined showed lower sensitivity (75.0% vs 90%) and higher specificity (93.8% vs 83.3%) in detecting malignancy compared to using CD56 alone. CONCLUSIONS Using CD56 alone showed relatively low specificity despite high sensitivity for detecting malignancy. Combining CD56 with HBME-1 could increase the specificity. Thus, we suggest that CD56 could be a useful preoperative marker for differential diagnosis of TBSRTC category III samples.
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Affiliation(s)
- Hyunseo Cha
- Department of Pathology, Gangnam Severance Hospital, Seoul, Korea
| | - Ju Yeon Pyo
- Department of Pathology, Gangnam Severance Hospital, Seoul, Korea
| | - Soon Won Hong
- Department of Pathology, Gangnam Severance Hospital, Seoul, Korea
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1035
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Pastorello RG, Destefani C, Pinto PH, Credidio CH, Reis RX, Rodrigues TDA, Toledo MCD, De Brot L, Costa FDA, Nascimento AG, Pinto CAL, Saieg MA. The impact of rapid on‐site evaluation on thyroid fine‐needle aspiration biopsy: A 2‐year cancer center institutional experience. Cancer Cytopathol 2018; 126:846-852. [DOI: 10.1002/cncy.22051] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 12/17/2022]
Affiliation(s)
| | - Camila Destefani
- Department of Pathology A.C. Camargo Cancer Center Sao Paulo Brazil
| | - Pedro H. Pinto
- Department of Pathology A.C. Camargo Cancer Center Sao Paulo Brazil
- Department of Pathology Base Hospital Federal District Brazil
| | | | - Rafael X. Reis
- Department of Pathology A.C. Camargo Cancer Center Sao Paulo Brazil
| | | | | | - Louise De Brot
- Department of Pathology A.C. Camargo Cancer Center Sao Paulo Brazil
| | | | | | | | - Mauro A. Saieg
- Department of Pathology A.C. Camargo Cancer Center Sao Paulo Brazil
- Department of Pathology Santa Casa Medical School Sao Paulo Brazil
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1036
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Eisa N, Khan A, Akhter M, Fensterwald M, Saleem S, Fananapazir G, Campbell MJ. Both Ultrasound Features and Nuclear Atypia are Associated with Malignancy in Thyroid Nodules with Atypia of Undetermined Significance. Ann Surg Oncol 2018; 25:3913-3918. [PMID: 30302643 DOI: 10.1245/s10434-018-6826-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND The optimal management of thyroid nodules that undergo fine-needle aspiration (FNA) with findings of atypia of undetermined significance (AUS) is unclear. Categorizing nodules by AUS subtype and ultrasound characteristics may improve risk stratification. Therefore, the purpose of this study is to evaluate the association between AUS subtype and ultrasound features on risk of malignancy (ROM). METHODS We performed a review of all patients with a thyroid nodule who underwent an FNA at our institution between January 2010 and November 2015. Patients with AUS were divided into groups with (1) nuclear atypia, (2) architectural atypia, or (3) Hurthle cell atypia. Their ultrasound features were assessed using the American Thyroid Association (ATA) thyroid nodule sonographic patterns. We conducted a univariate and multivariable analysis to determine the association between AUS subtype and other variables of interest with ROM. RESULTS Of the 3428 thyroid nodules that underwent FNA, 237 (6.9%) had AUS. Of the 97 surgically resected nodules, 67 (69%) were benign and 30 (31%) were malignant. On univariate analysis nuclear atypia (p < 0.01) was associated with a thyroid malignancy. On multivariable analysis, both ATA high-risk ultrasound features (p = 0.04, odds ratio [OR] 3.68) and nuclear atypia (p < 0.01, OR 11.8) were independently associated with a final diagnosis of thyroid carcinoma. CONCLUSIONS Nuclear atypia and ATA high-risk ultrasound features are useful in identifying patients with AUS that are at a higher risk of thyroid malignancy. Surgeons should take these factors into consideration when evaluating patients with AUS.
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Affiliation(s)
- Naseem Eisa
- Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Ahsan Khan
- School of Medicine, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Mutaal Akhter
- School of Medicine, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Molly Fensterwald
- School of Medicine, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Saba Saleem
- School of Medicine, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Ghaneh Fananapazir
- Department of Radiology, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Michael J Campbell
- Department of Surgery, University of California, Davis Medical Center, Sacramento, CA, USA. .,University of California, Davis, Comprehensive Cancer Center, Sacramento, CA, USA.
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1037
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Affiliation(s)
- Gilbert H Daniels
- 1 Thyroid Unit, Cancer Center and Department of Medicine , Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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1038
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Rago T, Scutari M, Loiacono V, Tonacchera M, Scuotri G, Romani R, Proietti A, Piaggi P, Elisei R, Basolo F, Latrofa F, Vitti P. Patients with Indeterminate Thyroid Nodules at Cytology and Cancer at Histology Have a More Favorable Outcome Compared with Patients with Suspicious or Malignant Cytology. Thyroid 2018; 28:1318-1324. [PMID: 30132418 DOI: 10.1089/thy.2017.0522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The outcomes of patients with thyroid cancer proven by histology in patients in whom cytology was Thy 3 (indeterminate; Thy 3 patients in this study) based on the Italian consensus classification compared with those in whom cytology was Thy 4 (suspicious for malignancy) or Thy 5 (indicative for malignancy) (Thy 4-5 patients here) remains unclear. OBJECTIVE To analyze the outcome of 371 Thy 3 patients versus 269 Thy 4-5 patients homogeneously treated with total thyroidectomy and 131I activity. RESULTS T1 stage was observed in 46.0% of Thy 3 and in 38.8% of Thy 4-5 patients (p = 0.02), N0 in 95.9% of Thy 3 and in 75.5% of Thy 4-5 patients (p < 0.0001). 35/261 (9.6%) Thy 3 and 85/269 (31.5%) Thy 4-5 patients required >30 mCi of 131I (p < 0.0001). 359/371 (96.8%) Thy 3 and 232/269 (86.2%) Thy 4-5 patients were free of disease at the end of follow-up (p < 0.001). The time required to obtain 50% of patients in remission was 2 years in Thy 3 and 4 years in Thy 4-5 patients (p < 0.001). The most common histological type was the follicular variant of papillary thyroid carcinoma (FV-PTC) in Thy 3 patients (239/371, 64.4%) and the classic variant in Thy 4-5 patients (185/269; 68.8%). The FV-PTC had better prognostic features compared with the other PTC variants: T1 stage was observed in 133/277 (48.0%) FV-PTC patients and in 146/363 (40.0%) patients with the other variants (p < 0.001), N0 was present in 265/277 (96.0%) FV-PTC and in 290/363 (79.8%) patients with the other variants (p < 0.001). Overall, 267/277 FV-PTC patients (96.4%) and 324/363 patients (89.0%) with the other variants were free of disease (p < 0.0008) at the end of follow-up, and the time required to obtain 50% of patients in remission was 2 years in FV-PTC and 4.0 years in the other variants (p < 0.001). CONCLUSION Patients with Thy 3 cytology have better outcomes of thyroid cancer compared with patients with Thy 4 or Thy 5 cytology, and indeterminate cytology is commonly associated with the less aggressive FV-PTC.
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Affiliation(s)
- Teresa Rago
- 1 Endocrinology Unit, Department of Clinical and Experimental Medicine, and Section of Histo-Cytopathology, Pathology, University of Pisa , Italy
| | - Maria Scutari
- 1 Endocrinology Unit, Department of Clinical and Experimental Medicine, and Section of Histo-Cytopathology, Pathology, University of Pisa , Italy
| | - Valeria Loiacono
- 1 Endocrinology Unit, Department of Clinical and Experimental Medicine, and Section of Histo-Cytopathology, Pathology, University of Pisa , Italy
| | - Massimo Tonacchera
- 1 Endocrinology Unit, Department of Clinical and Experimental Medicine, and Section of Histo-Cytopathology, Pathology, University of Pisa , Italy
| | - Giuditta Scuotri
- 2 Department of Laboratory Medicine, Section of Histo-Cytopathology, Pathology, University of Pisa , Italy
| | - Rossana Romani
- 2 Department of Laboratory Medicine, Section of Histo-Cytopathology, Pathology, University of Pisa , Italy
| | - Agnese Proietti
- 2 Department of Laboratory Medicine, Section of Histo-Cytopathology, Pathology, University of Pisa , Italy
| | - Paolo Piaggi
- 3 National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health , Phoenix, Arizona
| | - Rossella Elisei
- 1 Endocrinology Unit, Department of Clinical and Experimental Medicine, and Section of Histo-Cytopathology, Pathology, University of Pisa , Italy
| | - Fulvio Basolo
- 2 Department of Laboratory Medicine, Section of Histo-Cytopathology, Pathology, University of Pisa , Italy
| | - Francesco Latrofa
- 1 Endocrinology Unit, Department of Clinical and Experimental Medicine, and Section of Histo-Cytopathology, Pathology, University of Pisa , Italy
| | - Paolo Vitti
- 1 Endocrinology Unit, Department of Clinical and Experimental Medicine, and Section of Histo-Cytopathology, Pathology, University of Pisa , Italy
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1039
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García Pascual L, Surralles ML, Morlius X, Garcia Cano L, González Mínguez C. Prevalence and associated malignancy of Bethesda category III cytologies of thyroid nodules assigned to the "cytological atypia" or "architectural atypia" groups. ACTA ACUST UNITED AC 2018; 65:577-583. [PMID: 30262240 DOI: 10.1016/j.endinu.2018.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/24/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To ascertain the prevalence of Bethesda category III cytologies and their malignancy rate, and to analyze differences in the second cytology, malignancy rate, type of carcinoma, and TNM stage between the cytological atypia (CA) and architectural atypia (AA) groups. PATIENTS AND METHOD A retrospective study of 973 biopsies. Bethesda category III cytologies were classified as CA when nuclear atypia was seen but they were not diagnostic or suspicious of malignancy, and as AA when smears had few cells but had a predominantly microfollicular pattern and minimal or absent colloid. The cytological and pathological results were correlated. RESULTS There were 87 (8.9%) Bethesda category III cytologies (34 CC, 53 AA). Second cytologies were performed in 23 patients (16 with CA, 7 with AA), and a benign result was found in 68.7% of CA and 71.4% of the AA group. Sixty-four patients (23 CA, 41 AA) underwent surgery and 15 of these (23.4%) had a malignant disease: 39.1% CA vs 14.6% AA (P=.029). There was a false negative result in the CA group. The follicular variant of papillary thyroid carcinoma was the most common malignancy (60%). There were no differences in type of carcinoma or TNM stage between CA and AA patients. CONCLUSIONS The reported prevalence of Bethesda category III cytologies was as expected. The malignancy rate was significantly higher in the CA group, but there were no differences in the result of the second cytology, type of carcinoma found, or TNM stage. The division of Bethesda category III cytologies is useful to provide a better stratification of the risk of malignancy.
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Affiliation(s)
- Luis García Pascual
- Servicio de Endocrinología, Hospital Universitari Mútua de Terrassa, Terrassa, España.
| | - Maria Lluïsa Surralles
- Servicio de Anatomía Patológica, Hospital Universitari Mútua de Terrassa, Terrassa, España
| | - Xavier Morlius
- Servicio de Anatomía Patológica, Hospital Universitari Mútua de Terrassa, Terrassa, España
| | - Laia Garcia Cano
- Servicio de Anatomía Patológica, Hospital Universitari Mútua de Terrassa, Terrassa, España
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1040
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Guleria P, Phulware R, Agarwal S, Jain D, Mathur SR, Iyer VK, Ballal S, Bal CS. Cytopathology of Solid Variant of Papillary Thyroid Carcinoma: Differential Diagnoses with other Thyroid Tumors. Acta Cytol 2018; 62:371-379. [PMID: 30253413 DOI: 10.1159/000493081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 08/20/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Solid variant of papillary thyroid carcinoma (SVPTC) is rare, differing from classical PTC (cPTC) in architecture and outcome. We evaluated the cytomorphology of SVPTC cases to assess the feasibility of a preoperative diagnosis. STUDY DESIGN SVPTC cases were evaluated for architecture, nuclear features, and Bethesda category and were compared with noninvasive follicular thyroid neoplasm with papillary-like nuclear features/follicular variant of PTC (NIFTP/FVPTC), cPTC, and poorly differentiated thyroid carcinoma (PDTC). RESULTS Nine SVPTCs, 29 NIFTP/FVPTCs, 12 cPTCs, and 4 PDTCs were included. The predominant architecture in most SVPTCs was solid fragment, which is helpful in differentiating them from NIFTP/FVPTC (p < 0.001) and cPTC (p = 0.006) but not from PDTC. The presence of microfollicles led to misinterpretation as NIFTP/FVPTC/follicular neoplasm in 4 patients. All but 1 SVPTC showed diffuse nuclear features. Intranuclear pseudoinclusions (INIs) were seen in 67% of SVPTCs as compared to 83% of cPTCs, 14% of NIFTP/FVPTCs (p = 0.005), and none of PDTCs. SVPTC cases were commonly (78%) categorized as intermediate/suspicious. CONCLUSIONS The presence of solid fragments and lack of true papillae are helpful in differentiating SVPTC from cPTC. Solid fragments, trabeculae, the extent of nuclear features, and INIs should be looked for in cases with prominent microfollicles for distinguishing SVPTC from NIFTP/FVPTC. None of the features were helpful in differentiating SVPTC from PDTC.
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Affiliation(s)
- Prerna Guleria
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Ravi Phulware
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Shipra Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi,
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep R Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Venkateswaran K Iyer
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjana Ballal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrasekhar S Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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1041
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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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1042
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Costa C, Pastorello RG, Mendonça A, Tamaro C, Morais C, Barbosa B, Ribeiro KB, Caivano A, Saieg MA. Use of a low-cost telecytopathology method for remote assessment of thyroid FNAs. Cancer Cytopathol 2018; 126:767-772. [DOI: 10.1002/cncy.22026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/26/2018] [Accepted: 05/17/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Camilla Costa
- Department of Pathology; Santa Casa Medical School; Sao Paulo Brazil
| | | | - André Mendonça
- Department of Pathology; Santa Casa Medical School; Sao Paulo Brazil
| | - Caroline Tamaro
- Department of Pathology; Santa Casa Medical School; Sao Paulo Brazil
| | - Caroline Morais
- Department of Pathology; Santa Casa Medical School; Sao Paulo Brazil
| | - Barbara Barbosa
- Department of Pathology; Santa Casa Medical School; Sao Paulo Brazil
| | | | | | - Mauro Ajaj Saieg
- Department of Pathology; Santa Casa Medical School; Sao Paulo Brazil
- Department of Pathology; AC Camargo Cancer Center; Sao Paulo Brazil
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1043
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Modified Bethesda system informing cytopathologic adequacy improves malignancy risk stratification in nodules considered benign or atypia(follicular lesion) of undetermined significance. Sci Rep 2018; 8:13503. [PMID: 30202035 PMCID: PMC6131141 DOI: 10.1038/s41598-018-31955-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/30/2018] [Indexed: 01/26/2023] Open
Abstract
We modified the nondiagnostic/unsatisfactory category of the Bethesda system for reporting thyroid cytopathology to inform cytopathologic adequacy to better stratify the malignancy risk. Malignancy rates from 1,450 cytopathologic specimens not satisfying adequacy criteria from April 2011 to March 2016 were calculated based on sub-classification of the nondiagnostic/unsatisfactory category and sonographic patterns using matched surgical pathology. Rates were compared with those of 1,446 corresponding adequate specimens from July to December 2013. Upon resection, 63.2% of nondiagnostic, 36.7% of unsatisfactory + benign, 72.5% of unsatisfactory + atypia (follicular lesion) of undetermined significance, 98.1% of unsatisfactory + suspicious for malignancy, and 100.0% of unsatisfactory + malignant cases were confirmed to be malignant on surgical pathology. In nodules with inadequate specimens, those with high suspicion sonographic patterns had a malignancy rate (93.2%) higher than the others (45.5%) (p < 0.001). Nodules with unsatisfactory + benign specimens had a higher malignancy rate (36.7%) than satisfactory benign specimens (14.3%) (p = 0.020). For atypia (follicular lesion) of undetermined significance, the malignancy rate of inadequate specimens (72.5%) was higher than that of adequate specimens (51.3%) (p = 0.027). Sparse cellular samples with a few groups of benign follicular cells should not represent a benign lesion. There might be value in qualifying atypia (follicular lesion) of undetermined significance cases less than optimal.
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1044
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Gay S, Schiaffino S, Santamorena G, Massa B, Ansaldo G, Turtulici G, Giusti M, At The Policlinico San Martino Genoa TT. Role of Strain Elastography and Shear-Wave Elastography in a Multiparametric Clinical Approach to Indeterminate Cytology Thyroid Nodules. Med Sci Monit 2018; 24:6273-6279. [PMID: 30194820 PMCID: PMC6140375 DOI: 10.12659/msm.909870] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background In thyroid nodules with indeterminate cytology, further clinical assessment aimed at ruling out malignancy is often mandatory. Ancillary imaging techniques and genetic mutation analysis can improve the risk stratification of such lesions, thereby facilitating the clinician’s decision to undertaken surgery or simple follow-up. The aim of this study was to evaluate the diagnostic performance of shear-wave elastography (SW), strain elastography (ELX 2/1), conventional ultrasound (US), contrast-enhanced ultrasound (CEUS), and BRAF V600E mutation analysis in the aforementioned lesions. Material/Methods We enrolled 81 patients, each with 1 indeterminate-cytology thyroid nodule. Thyroid function, thyroperoxidase antibodies and calcitonin were known in each case. SW, ELX 2/1, US, CEUS, and BRAF mutation analysis were subsequently performed, followed by a second FNAB. If the lesion was not downgraded to benign, surgery was recommended and histological reports collected. Results There were 28 nodules (34%) that proved benign on the second FNAB; 38 nodules (47%) underwent surgery (17 benign, 21 malignant), and 15 nodules (19%) refused surgery. The only techniques related to histological outcome were US (AUC=0,766), ELX 2/1 (AUC=0.701), and BRAF analysis (AUC=0.762). ELX 2/1 and SW reports were not correlated with each other (P=0.45). A scoring system taking into account all the variables considered performed better than the single variables alone (AUC=0.831). Conclusions In indeterminate-cytology thyroid lesions, repeating FNAB can avoid unnecessary surgery. ELX 2/1 seems to perform better than SW in distinguishing malignancy; these techniques could, however, be complementary in describing such lesions. A multiparametric approach appears the most accurate in predicting nodule histology.
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Affiliation(s)
- Stefano Gay
- Endocrine Unit, Policlinico San Martino, Genoa, Italy
| | | | | | - Barbara Massa
- Cyto-Histopathological Unit, Policlinico San Martino, Genova, Italy
| | | | - Giovanni Turtulici
- Interventional Radiology Unit, Ospedale Evangelico Internazionale, Genoa, Italy
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1045
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Pandya A, Caoili EM, Jawad-Makki F, Wasnik AP, Shankar PR, Bude R, Haymart MR, Davenport MS. Limitations of the 2015 ATA Guidelines for Prediction of Thyroid Cancer: A Review of 1947 Consecutive Aspirations. J Clin Endocrinol Metab 2018; 103:3496-3502. [PMID: 29982716 DOI: 10.1210/jc.2018-00792] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/27/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND The 2015 American Thyroid Association (ATA) guidelines have been proposed to aid in the management of thyroid nodules by determining whether fine needle aspiration is indicated. OBJECTIVE To determine whether the ATA guidelines contribute to the overdiagnosis of thyroid cancer. PATIENTS AND METHODS This was a retrospective cohort study of ultrasound-imaged thyroid nodules (n = 1947) consecutively aspirated at a tertiary care center from 1 October 2009 to 22 February 2016. Nodules were retrospectively reviewed, assigned a 2015 ATA morphology, and placed into one of five 2015 ATA categories of risk (ATA-1, <1% risk of malignancy; ATA-2, <3% risk; ATA-3, 5% to 10% risk, ATA-4: 10% to 20% risk; ATA-5, >70% to 90% risk) by a reader who was blinded to cytology. ATA category was compared with cytopathology. The positive predictive value (PPV) of each ATA category was calculated with respect to cancer. Numbers needed to aspirate and Pearson correlations were calculated. Interrater agreement for ATA category across five readers was assessed. RESULTS The PPV for cancer increased by ATA category [category 1 to 5, respectively: 0% (0/14), 2% (4/249), 5% (36/733), 12% (104/850), 28% (28/101)]. The number needed to sample to detect one papillary cancer was 125 (ATA-2), 49 (ATA-3), 13 (ATA-4), and 5 (ATA-5). The overall interrater agreement for ATA score across all five readers was fair (intraclass correlation coefficient 0.460). CONCLUSIONS The 2015 ATA guidelines stratify risk for thyroid cancer; however, the stratification system is overly optimistic regarding cancer detection rates for the higher-risk nodules, and there is only fair interrater agreement.
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Affiliation(s)
- Amit Pandya
- Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Elaine M Caoili
- Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Farah Jawad-Makki
- Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Ashish P Wasnik
- Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Prasad R Shankar
- Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Ron Bude
- Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Megan R Haymart
- Department of Internal Medicine, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Matthew S Davenport
- Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan
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1046
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Rivera GR, Segura S, Suhrland M. Educational Case: Thyroid Neoplasms: Pathogenesis, Diagnosis, and Treatment. Acad Pathol 2018; 5:2374289518777471. [PMID: 30140734 PMCID: PMC6096672 DOI: 10.1177/2374289518777471] [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: 01/16/2018] [Revised: 03/29/2018] [Accepted: 04/05/2018] [Indexed: 11/29/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040.
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Affiliation(s)
| | - Sheila Segura
- Montefiore Hospital and Medical Center, Bronx, NY, USA
| | - Mark Suhrland
- Montefiore Hospital and Medical Center, Bronx, NY, USA
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1047
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Decaussin-Petrucci M, Descotes F, Lifante JC, Borson-Chazot F, Lopez J. Reply to Dr Ozden et al. Cytopathology 2018; 29:599. [PMID: 30084521 DOI: 10.1111/cyt.12620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/16/2018] [Indexed: 11/26/2022]
Affiliation(s)
| | - Françoise Descotes
- Service de Biochimie et Biologie moléculaire, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Jean-Christophe Lifante
- Service de Chirurgie endocrinienne, Hospices Civils de Lyon, Pierre-Bénite, France.,Faculté de Médecine Lyon Sud, Universite Claude Bernard Lyon 1, Oullins, France
| | - Françoise Borson-Chazot
- Hospices Civils de Lyon, Fédération d'Endocrinologie Est, Bron, France.,Faculté de Médecine Lyon Est, Universite Claude Bernard Lyon 1, Lyon, France
| | - Jonathan Lopez
- Service de Biochimie et Biologie moléculaire, Hospices Civils de Lyon, Pierre-Bénite, France
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1048
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Valderrabano P, McGettigan MJ, Lam CA, Khazai L, Thompson ZJ, Chung CH, Centeno BA, McIver B. Thyroid Nodules with Indeterminate Cytology: Utility of the American Thyroid Association Sonographic Patterns for Cancer Risk Stratification. Thyroid 2018; 28:1004-1012. [PMID: 29848195 PMCID: PMC6916126 DOI: 10.1089/thy.2018.0085] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The 2015 American Thyroid Association (ATA) guidelines recommend using a classification based on sonographic patterns to set the size threshold for biopsies. Each pattern is associated with a distinct estimated rate of malignancy that it was hypothesized should stratify the risk of malignancy of cytologically indeterminate thyroid nodules (ITNs). METHODS Ultrasound images of 463 ITNs (38% atypia/follicular lesions of undetermined significance; 62% follicular neoplasms) with histological follow-up consecutively evaluated between October 2008 and June 2015 at the authors' academic cancer center were independently evaluated by three observers and classified into one of the five sonographic patterns proposed by the ATA. Nodules with sonographic patterns not defined in the classification were grouped into a non-ATA pattern category. Differences in clinical and histological findings between the sonographic patterns were assessed. The prevalence of malignancy and odds ratio for malignancy were calculated for each sonographic pattern (low and intermediate patterns were collapsed for the analysis). RESULTS The distribution of size and cytological diagnosis was significantly different between sonographic patterns (p < 0.001). The overall rate of malignancy was 27%. The rate of malignancy for the very low, low/intermediate, high, and non-ATA patterns were 0%, 19%, 56%, and 36%, respectively, and were all significantly different. Compared to the low/intermediate suspicion patterns, the odds ratios for malignancy were 2.35 for the non-ATA and 5.18 for the high suspicion patterns (p < 0.001). The odds ratio of the non-ATA pattern was 0.45 over the high suspicion pattern (p = 0.04). Results were similar in both cytological categories and for each observer separately. Sonographic patterns were associated with distinct histopathological profiles (p < 0.001). CONCLUSIONS ATA sonographic patterns are associated with distinct clinical features and pathological outcomes, and effectively stratify the cancer risk in ITNs. Thus, the ATA sonographic patterns should be used not only to set the size threshold for biopsy, but also to personalize management after the biopsy.
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Affiliation(s)
- Pablo Valderrabano
- Department of Head and Neck—Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
- Address correspondence to:Pablo Valderrabano, MD, PhDDepartment of Head and Neck-Endocrine OncologyH. Lee Moffitt Cancer Center and Research Institute12902 Magnolia DriveTampa, FL 33612
| | - Melissa J. McGettigan
- Department of Diagnostic Imaging, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Cesar A. Lam
- Department of Diagnostic Imaging, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Laila Khazai
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Zachary J. Thompson
- Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Christine H. Chung
- Department of Head and Neck—Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Barbara A. Centeno
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Bryan McIver
- Department of Head and Neck—Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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1049
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Deaver KE, Haugen BR, Pozdeyev N, Marshall CB. Outcomes of Bethesda categories III and IV thyroid nodules over 5 years and performance of the Afirma gene expression classifier: A single-institution study. Clin Endocrinol (Oxf) 2018; 89:226-232. [PMID: 29791966 DOI: 10.1111/cen.13747] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/09/2018] [Accepted: 05/14/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The second edition Bethesda System for Reporting Thyroid Cytology estimates 6%-18% malignancy rate of category III (B3) and 10%-40% for category IV (B4) nodules; however, reported malignancy rates have considerable variability among institutions. Use of molecular classifiers (including Afirma Gene Expression Classifier, GEC) can be utilized in management of thyroid nodules. Our objective was to analyse malignancy rates of B3 and B4 nodules and determine clinical outcomes of GEC Benign nodules. METHODS A retrospective analysis of 2019 thyroid FNAs was performed at the University of Colorado from 2011 to 2015, including molecular, surgical and clinical follow-up. RESULTS Of 2019 FNAs analysed, 231 (11.4%) were diagnosed as B3 and 80 (4.0%) as B4. GEC was obtained in 54.1% of B3 cases, with nearly half (48.8%) having a Benign result. Surgery was performed in 40.7% B3 cases with a 24.5% malignancy rate, ranging 8%-38% by year. In the B4 group, 52.5% underwent molecular testing with 28.6% as GEC Benign. About 68.8% of B4 cases underwent surgery with a 20% malignancy rate, ranging 0%-42% by year. Seventy-three GEC Benign cases were reviewed: 5 (6.8%) underwent surgery, with none demonstrating malignancy in the target nodule. Size remained stable for most GEC Benign nodules: 75.9% (B3) and 71.4% (B4) with no malignancy on repeat FNA. CONCLUSIONS Our 5-year review demonstrated that malignancy rates of B3 and B4 nodules showed year-to-year variability. We suggest that clinicians use a multi-year average of their institution's malignancy rates to optimally manage patients. Follow-up for GEC Benign cases thus far supports their indolent nature.
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Affiliation(s)
- Kelsi E Deaver
- Division of Endocrinology, Metabolism & Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - Bryan R Haugen
- Division of Endocrinology, Metabolism & Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
- University of Colorado Cancer Center, Aurora, CO, USA
| | - Nikita Pozdeyev
- Division of Endocrinology, Metabolism & Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - Carrie B Marshall
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO, USA
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1050
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The new guidelines of Papanicolaou Society of Cytopathology for respiratory specimens: Assessment of risk of malignancy and diagnostic yield in different cytological modalities. Diagn Cytopathol 2018; 46:725-729. [DOI: 10.1002/dc.24036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/18/2018] [Accepted: 06/29/2018] [Indexed: 12/19/2022]
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