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Scappaticcio L, Di Martino N, Caruso P, Ferrazzano P, Marino FZ, Clery E, Cioce A, Cozzolino G, Maiorino MI, Docimo G, Trimboli P, Franco R, Esposito K, Bellastella G. The value of ACR, European, Korean, and ATA ultrasound risk stratification systems combined with RAS mutations for detecting thyroid carcinoma in cytologically indeterminate and suspicious for malignancy thyroid nodules. Hormones (Athens) 2024:10.1007/s42000-024-00573-8. [PMID: 38884926 DOI: 10.1007/s42000-024-00573-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 06/05/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE The aim of this study was to evaluate the diagnostic value of four commonly utilized ultrasound (US) RSSs, namely, the American College of Radiology [ACR], European [EU], Korean [K] TI-RADSs and American Thyroid Association [ATA] US-based RSS criteria, in combination with activating point mutations of the RAS genes (NRAS, HRAS, and KRAS) for detection of thyroid carcinoma in cytologically indeterminate and suspicious for malignancy thyroid nodules. METHODS We retrospectively analyzed cytologically indeterminate and suspicious for malignancy thyroid nodules which underwent US, molecular testing and surgery between September 1, 2018, and December 31, 2023. Receiver operating characteristic (ROC) curves were generated, and the area under the curve (AUC, 95% confidence interval [CI]) was calculated. RESULTS A total of 100 cytologically indeterminate and 24 suspicious for malignancy thyroid nodules were analyzed. Compared to the four US-based RSSs alone, the diagnostic value of the four US-based RSSs combined with RAS mutations did not significantly improved (cytologically indeterminate, AUC [95% CI] 0.6 [0.5-0.7] and 0.6 [0.5-0.7], respectively, p = 0.70; cytologically suspicious for malignancy, AUC [95% CI] 0.7 [0.5-0.9] and 0.8 [0.6-0.9], respectively, p = 0.23). CONCLUSIONS The diagnostic value of the four main US-based RSSs (ACR, EU, K, and ATA) was not improved in conjunction with the evaluation of RAS mutations for preoperative risk stratification of cytologically indeterminate thyroid nodules. CLINICAL RELEVANCE STATEMENT In cytologically indeterminate nodules categorized according to US-based RSSs, isolated RAS positivity does not reliably distinguish between benignity and malignancy.
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Affiliation(s)
- Lorenzo Scappaticcio
- Unit of Endocrinology and Metabolic Diseases, AOU University of Campania "Luigi Vanvitelli", Naples, 80138, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nicole Di Martino
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Caruso
- Unit of Endocrinology and Metabolic Diseases, AOU University of Campania "Luigi Vanvitelli", Naples, 80138, Italy.
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Pamela Ferrazzano
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Eduardo Clery
- Pathology Unit, AOU University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro Cioce
- Pathology Unit, AOU University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giovanni Cozzolino
- Unit of Thyroid Surgery, AOU University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Ida Maiorino
- Unit of Endocrinology and Metabolic Diseases, AOU University of Campania "Luigi Vanvitelli", Naples, 80138, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giovanni Docimo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
- Unit of Thyroid Surgery, AOU University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pierpaolo Trimboli
- Clinic of Endocrinology and Diabetology, Lugano and Mendrisio Regional Hospital, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Renato Franco
- Pathology Unit, AOU University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Katherine Esposito
- Unit of Endocrinology and Metabolic Diseases, AOU University of Campania "Luigi Vanvitelli", Naples, 80138, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Bellastella
- Unit of Endocrinology and Metabolic Diseases, AOU University of Campania "Luigi Vanvitelli", Naples, 80138, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
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Gong Z, Xue L, Vlantis AC, van Hasselt CA, Chan JYK, Fang J, Wang R, Yang Y, Li D, Zeng X, Tong MCF, Chen GG. Brusatol attenuated proliferation and invasion induced by KRAS in differentiated thyroid cancer through inhibiting Nrf2. J Endocrinol Invest 2024; 47:1271-1280. [PMID: 38062319 DOI: 10.1007/s40618-023-02248-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/13/2023] [Indexed: 04/23/2024]
Abstract
BACKGROUND Poorly differentiated thyroid cancer (PDTC) and anaplastic thyroid cancer (ATC) can be developed from differentiated thyroid cancer, and this dedifferentiated transformation leads to poor prognosis and high mortality. The role of Nrf2 in the dedifferentiation of differentiated thyroid cancer (DTC) induced by KRAS remains unclear. METHODS AND MATERIALS In this study, two DTC cell lines, BCPAP and WRO, were used to evaluate the function of Nrf2 in the dedifferentiation caused by wild-type KRAS (KRAS-WT) and G12V point mutation KRAS (KRAS-G12V). RESULTS The overexpression of KRAS-WT and KRAS-G12V increased the proliferative and invasive ability of BCPAP and WRO cells. Aggressive morphology was observed in KRAS-WT and KRAS-G12V overexpressed WRO cells. These results suggested that overexpression of KRAS-WT or KRAS-G12V may induce dedifferentiation in DTC cells. The expression of Nrf2 was increased by KRAS-WT and KRAS-G12V in DTC cells. In addition, compared with normal thyroid tissues, the expression of Nrf2 protein was considerably higher in thyroid cancer tissues on immunohistochemistry (IHC) staining, and the increased expression of Nrf2 indicated a poor prognosis of thyroid cancer. These results indicated that Nrf2 is the KRAS downstream molecule in thyroid cancer. Functional studies showed that the Nrf2 inhibitor Brusatol counteracted the proliferative and invasive abilities induced by KRAS-WT and KRAS-G12V in BCPAP and WRO cells. In addition, the xenograft assay further confirmed that Brusatol inhibits tumor growth induced by KRAS-WT and KRAS-G12V. CONCLUSION Collectively, this study suggests that Nrf2 could be a promising therapeutic target in KRAS-mediated dedifferentiation of thyroid cancer.
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Affiliation(s)
- Z Gong
- Department of Otorhinolaryngology, Head and Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - L Xue
- Department of Otorhinolaryngology, Head and Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - A C Vlantis
- Department of Otorhinolaryngology, Head and Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - C A van Hasselt
- Department of Otorhinolaryngology, Head and Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - J Y K Chan
- Department of Otorhinolaryngology, Head and Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - J Fang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing Institute of Otolaryngology, Beijing, China
| | - R Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing Institute of Otolaryngology, Beijing, China
| | - Y Yang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing Institute of Otolaryngology, Beijing, China
| | - D Li
- Shenzhen Key Laboratory of ENT, Institute of ENT and Longgang ENT Hospital, Shenzhen, Guangdong, China
| | - X Zeng
- Shenzhen Key Laboratory of ENT, Institute of ENT and Longgang ENT Hospital, Shenzhen, Guangdong, China
| | - M C F Tong
- Department of Otorhinolaryngology, Head and Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, Guangdong, China.
| | - G G Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, Guangdong, China.
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Riccio IR, LaForteza AC, Hussein MH, Linhuber JP, Issa PP, Staav J, Fawzy MS, Toraih EA, Kandil E. Diagnostic utility of RAS mutation testing for refining cytologically indeterminate thyroid nodules. EXCLI JOURNAL 2024; 23:283-299. [PMID: 38487090 PMCID: PMC10938255 DOI: 10.17179/excli2024-6975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/08/2024] [Indexed: 03/17/2024]
Abstract
RAS mutations are prevalent in indeterminate thyroid nodules, but their association with malignancy risk and utility for diagnosis remains unclear. We performed a systematic review and meta-analysis to establish the clinical value of RAS mutation testing for cytologically indeterminate thyroid nodules. PubMed and Embase were systematically searched for relevant studies. Thirty studies comprising 13,328 nodules met the inclusion criteria. Random effects meta-analysis synthesized pooled estimates of RAS mutation rates, risk of malignancy with RAS positivity, and histologic subtype outcomes. The pooled mutation rate was 31 % (95 % CI 19-44 %) among 5,307 indeterminate nodules. NRAS mutations predominated at 67 % compared to HRAS (24 %) and KRAS (12 %). The malignancy rate with RAS mutations was 58 % (95 %CI=48-68 %). RAS positivity increased malignancy risk 1.7-fold (RR 1.68, 95 %CI=1.21-2.34, p=0.002), with significant between-study heterogeneity (I2=89 %). Excluding one outlier study increased the relative risk to 1.75 (95 %CI=1.54-1.98) and I2 to 14 %. Funnel plot asymmetry and Egger's test (p=0.03) indicated potential publication bias. Among RAS-positive malignant nodules, 38.6 % were follicular variant papillary carcinoma, 34.1 % classical variant, and 23.2 % follicular carcinoma. No statistically significant difference in the odds of harboring RAS mutation was found between subtypes. In conclusion, RAS mutation testing demonstrates clinical utility for refining the diagnosis of cytologically indeterminate thyroid nodules. Positivity confers a 1.7-fold increased malignancy risk, supporting use for personalized decision-making regarding surgery vs. monitoring. Follicular variant papillary carcinoma constitutes the most common RAS-positive malignant histological subtype. See also the graphical abstract(Fig. 1).
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Affiliation(s)
- Isabel R. Riccio
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Alexandra C. LaForteza
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Mohammad H. Hussein
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | | | - Peter P. Issa
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Jonathan Staav
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Manal S. Fawzy
- Department of Biochemistry, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
| | - Eman A. Toraih
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
- Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
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Harahap AS, Subekti I, Panigoro SS, Asmarinah, Lisnawati, Werdhani RA, Agustina H, Khoirunnisa D, Mutmainnah M, Salinah, Siswoyo AD, Ham MF. Profile of BRAFV600E, BRAFK601E, NRAS, HRAS, and KRAS Mutational Status, and Clinicopathological Characteristics of Papillary Thyroid Carcinoma in Indonesian National Referral Hospital. Appl Clin Genet 2023; 16:99-110. [PMID: 37255533 PMCID: PMC10226481 DOI: 10.2147/tacg.s412364] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/19/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION BRAFV600E and RAS mutations are the most common gene mutations in papillary thyroid carcinoma (PTC) that may be correlated with its biological behavior. There are still limited data about BRAFV600E and RAS mutations in Indonesia. This study aims to determine the prevalence of BRAFV600E and RAS mutations, and their association with clinicopathologic characteristics. METHODS Patients who had total thyroidectomy from 2019 to 2021 and those who met our study criteria underwent PCR and DNA sequencing analysis for BRAFV600E, BRAFK601E, exon 2 and 3 of NRAS, HRAS, and KRAS. Analyses were performed to determine the associations of BRAFV600E and RAS mutations with clinicopathologic characteristics. RESULTS Of 172 PTC patients, BRAFV600E mutation was observed in 37.8% of the patients and RAS mutations were found in 21.5%. One patient harbored BRAFK601E mutation. There was a significant association of BRAFV600E with a high-stage (p = 0.033, OR: 3.279; 95% CI: 1.048-10.259), tall-cell variants (p ≤0.001, OR: 41.143; 95% CI: 11.979-141.308), non-encapsulated (p = 0.001, OR: 4.176; 95% CI: 2.008-8.685), lymphovascular invasion (p = 0.043, OR: 1.912; 95% CI: 1.018-3.592), extrathyroidal extension (p = <0.001, OR: 3.983; 95% CI: 1.970-8.054), and lymph node metastasis (p = 0.009, OR: 2.301; 95% CI: 1.224-4.326). Follicular variant (p = 0.001, OR: 7.011; 95% CI: 2.690-18.268), encapsulated (p = 0.017, OR: 2.433; 95% CI: 1.161-5.100), and absent of extrathyroidal extension (p = 0.033, OR: 2.890; 95% CI: 1.052-7.940) were associated with RAS mutations. CONCLUSION A significant association between BRAFV600E mutation and high clinical stage, tall-cell variants, non-encapsulated morphology, lymphovascular invasion, extrathyroidal extension, and lymph node metastasis in PTC was observed. RAS mutations were associated with the follicular variant, encapsulated tumor, and no extrathyroidal extension. HRAS-mutated PTC frequently exhibited tumor multifocality.
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Affiliation(s)
- Agnes Stephanie Harahap
- Department of Anatomical Pathology, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Human Cancer Research Center-Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Doctoral Program in Medical Sciences, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Imam Subekti
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Sonar Soni Panigoro
- Department of Surgery, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Asmarinah
- Department of Medical Biology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Lisnawati
- Department of Anatomical Pathology, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Retno Asti Werdhani
- Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Hasrayati Agustina
- Department of Anatomical Pathology, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Dina Khoirunnisa
- Department of Anatomical Pathology, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Mutiah Mutmainnah
- Department of Anatomical Pathology, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Salinah
- Department of Anatomical Pathology, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Alvita Dewi Siswoyo
- Department of Radiology, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Maria Francisca Ham
- Department of Anatomical Pathology, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Human Cancer Research Center-Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Simoncini G, Orsatti A, Malvi D, Tardio ML, Maloberti T, de Biase D, D'Errico A, Vasuri F. NRAS-mutated oncocytic benign liver lesion in an organ donor: Pitfalls and troubles in frozen section diagnosis and risk assessment. Pathol Res Pract 2023; 246:154531. [PMID: 37182314 DOI: 10.1016/j.prp.2023.154531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND In the transplant setting, the definition of the risk of neoplastic transmission from donor to recipient often requires intraoperative pathological evaluation on frozen sections. Although most lesions can be easily classified into acceptable or unacceptable risk according to the Italian National Guidelines, there are cases in which unusual histologic features cannot be further investigated because of the lack of ancillary techniques on frozen sections. CASE PRESENTATION Here we present a case of a liver lesion in a 51-year-old male donor, subjected to histopathological on-call examination. The frozen sections showed a well-demarcated lesion consisting of epithelioid cells disposed in laminar structures and intermingled with a dense lymphocytic population: this led to organ discard with interruption of the donation process. The definitive histological analysis required an extensive immunohistochemical (IHC) investigation: the final diagnosis was "bile duct adenoma with oncocytic features", eventually confirmed by a strongly positive anti-mitochondrial IHC. Finally, an NGS panel analysis was performed, which revealed NRAS mutation. DISCUSSION To the best of our knowledge, this is the first case of oncocytic bile duct adenoma confirmed by anti-mitochondrial IHC and with NRAS mutation. The most challenging aspect of this case was represented by the transplant setting. In fact, the oncocytic features and the dense lymphocytic infiltrate represented concomitant unusual histological features that led to the halt of the organ donation procedures.
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Affiliation(s)
- Giulia Simoncini
- Pathology Unit, IRCCS Azienda-Ospedaliero Universitaria di Bologna, Italy
| | - Agnese Orsatti
- Pathology Unit, IRCCS Azienda-Ospedaliero Universitaria di Bologna, Italy
| | - Deborah Malvi
- Pathology Unit, IRCCS Azienda-Ospedaliero Universitaria di Bologna, Italy.
| | - Maria L Tardio
- Pathology Unit, IRCCS Azienda-Ospedaliero Universitaria di Bologna, Italy
| | - Thais Maloberti
- Department of Medicine, University of Bologna, Bologna, Italy
| | - Dario de Biase
- Department of Pharmacy and biotechnology (FaBiT), University of Bologna, Bologna, Italy
| | | | - Francesco Vasuri
- Pathology Unit, IRCCS Azienda-Ospedaliero Universitaria di Bologna, Italy
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Effect of Having Concurrent Mutations on the Degree of Aggressiveness in Patients with Thyroid Cancer Positive for TERT Promoter Mutations. Cancers (Basel) 2023; 15:cancers15020413. [PMID: 36672362 PMCID: PMC9856260 DOI: 10.3390/cancers15020413] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
This study aimed to examine whether concurrent mutations with a TERT promoter mutation are associated with a greater likelihood of more aggressive disease than a TERT promoter mutation alone. The medical records of 1477 patients who underwent thyroid surgery at two tertiary hospitals between 2017 and 2022 were reviewed. Twenty-four patients had TERT promoter mutations based on molecular profile testing. Clinicodemographic data, mutational profiles, and histopathological features were assessed. Descriptive analysis, Fisher's exact test, and binary logistic regression were performed. Seven patients had single-gene TERT promoter mutations, and 17 had concurrent mutations, including BRAF V600E, HRAS, NRAS, PIK3CA, and EIF1AX. The overall prevalence of malignancy was 95.8%, of which 78.3% were aggressive thyroid cancers. There was a statistically significant association between concurrent mutations and disease aggressiveness. The odds of having aggressive disease were 10 times higher in patients with a TERT promoter mutation and a concurrent molecular alteration than in those with a TERT promoter mutation alone. This is an important finding for thyroid specialists to consider when counseling patients concerning risk stratification and management options.
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McMurtry V, Canberk S, Deftereos G. Molecular testing in fine-needle aspiration of thyroid nodules. Diagn Cytopathol 2023; 51:36-50. [PMID: 36480743 DOI: 10.1002/dc.25035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Thyroid nodules are commonly faced by clinicians as palpable nodules or incidentally identified on imaging. Nodules that are found to be suspicious by imaging can be biopsied by fine needle aspiration, which can yield material for molecular testing to refine the diagnosis. METHODS The current literature concerning molecular testing in thyroid nodules including available commercial assays was reviewed and summarized. RESULTS/CONCLUSIONS Commonly encountered alterations include mutations in RAS, BRAF, TERT promoter, PTEN, and DICER1 as well as fusions of RET, ALK, PAX8-PPARγ, and NTRK. This article provides a summary of these molecular alterations, commercially available molecular assays, and general considerations for thyroid epithelial malignancies and benign thyroid nodules.
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Affiliation(s)
- Valarie McMurtry
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA.,ARUP Institute for Experimental Pathology, Salt Lake City, Utah, USA
| | - Sule Canberk
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup), Porto, Portugal.,Abel Salazar Biomedical Sciences Institute (ICBAS), University of Porto, Porto, Portugal
| | - Georgios Deftereos
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA.,ARUP Institute for Experimental Pathology, Salt Lake City, Utah, USA
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Heriyanto DS, Laiman V, Limantara NV, Anantawikrama WP, Yuliani FS, Cempaka R, Anwar SL. High frequency of KRAS and EGFR mutation profiles in BRAF-negative thyroid carcinomas in Indonesia. BMC Res Notes 2022; 15:369. [PMID: 36510281 PMCID: PMC9743704 DOI: 10.1186/s13104-022-06260-4] [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: 05/04/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Thyroid cancer incidence has steadily increased in Indonesia. However, data on Kirsten rat sarcoma virus (KRAS) and EGFR mutations in thyroid cancer in Indonesia remain unavailable, except for BRAF-V600E, the most common BRAF gene mutation. This study aimed to analyze KRAS and EGFR mutation profiles in BRAF-V600E negative thyroid cancer samples. RESULTS BRAF-V600E mutations were found in papillary thyroid carcinomas in 40.3% patients with mean age of 53 years old. In BRAF-V600E-negative samples, 41.3% had KRAS mutations with mean age of 55.5 years old. KRAS mutation was found in 52.6% of follicular carcinomas and 47.4% of papillary thyroid carcinomas. Additionally, 45.7% had EGFR mutations in patients with mean age of 50.5 years old. EGFR mutation was found in 71.4% of papillary thyroid carcinoma and 28.6% of follicular carcinoma. Nearly half of the BRAF-V600E negative thyroid carcinoma samples harbored either KRAS or EGFR mutations. This finding suggests that in BRAF-V600E negative thyroid carcinoma samples, testing for RAS and EGFR mutation may be warranted for further therapeutic consideration.
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Affiliation(s)
- Didik Setyo Heriyanto
- grid.8570.a0000 0001 2152 4506Department of Anatomical Pathology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada-Dr. Sardjito Hospital, Farmako Street, Yogyakarta, 55281 Indonesia
| | - Vincent Laiman
- grid.8570.a0000 0001 2152 4506Department of Anatomical Pathology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada-Dr. Sardjito Hospital, Farmako Street, Yogyakarta, 55281 Indonesia
| | - Nikko Vanda Limantara
- grid.8570.a0000 0001 2152 4506Department of Anatomical Pathology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada-Dr. Sardjito Hospital, Farmako Street, Yogyakarta, 55281 Indonesia
| | - Widyan Putra Anantawikrama
- grid.8570.a0000 0001 2152 4506Department of Anatomical Pathology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada-Dr. Sardjito Hospital, Farmako Street, Yogyakarta, 55281 Indonesia
| | - Fara Silvia Yuliani
- grid.8570.a0000 0001 2152 4506Department of Pharmacology and Therapy, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281 Indonesia
| | - Rita Cempaka
- grid.8570.a0000 0001 2152 4506Department of Anatomical Pathology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada-Dr. Sardjito Hospital, Farmako Street, Yogyakarta, 55281 Indonesia
| | - Sumadi Lukman Anwar
- grid.8570.a0000 0001 2152 4506Department of Surgery, Subdivision of Oncology Surgery; Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada-Dr. Sardjito Hospital, Yogyakarta, 55281 Indonesia
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Cipriani NA, Johnson DN, Sarne DH, Angelos P, Reeves W, Antic T. The Significance of RAS-Like Mutations and MicroRNA Profiling in Predicting Malignancy in Thyroid Biopsy Specimens. Endocr Pathol 2022; 33:446-456. [PMID: 36227454 DOI: 10.1007/s12022-022-09734-0] [Citation(s) in RCA: 6] [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] [Accepted: 10/07/2022] [Indexed: 11/03/2022]
Abstract
In cytologically indeterminate thyroid nodules undergoing molecular testing, estimated risk of malignancy is variable. Identification of a non-cancer-specific mutation (RAS-like) confirms a neoplastic process but does not differentiate between benign, malignant, and low-risk neoplasms. This study aims to retrospectively evaluate institutional experience of Interpace (ThyGeNEXT® and ThyraMIR®; Pittsburgh, PA) testing and to determine the rate of malignancy in resected nodules, stratified by mutational analysis and microRNA profile. Of 1917 fine need aspirations, 140 (7.3%) underwent Interpace testing: 47 (33.6%) were molecular-not-benign (harbored mutation, fusion, and/or positive miRNA) and 93 (66.4%) were molecular-benign (no mutations or fusions and negative microRNA). Surgery was spared in 79.6% of molecular-benign and 61.4% of all tested patients. Fifty-four (38.6%) underwent resection. Seventeen (89.5%) of the resected molecular-benign were benign and 2 were malignant. Thirteen (37.1%) of the resected molecular-not-benign were benign, 7 (20%) were noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), and 15 (42.9%) were malignant (p < 0.05, negative predictive value (NPV) 89.4-95.6%, positive predictive value (PPV) 22.3-42.8%). Most molecular-not-benign (72.3%) had RAS-like mutation. Twenty-three were resected: 3 were malignant and 7 were NIFTP. Nodules with non-RAS-like mutations (BRAF V600E-like, others) were more likely to be malignant than RAS-like (H/N/KRAS, BRAF K601E) (p < 0.05, NPV 86.9-96.5%, PPV 100%). Most nodules had RAS-like mutations and most were benign or low-risk neoplasms (NIFTP). This study supports the role of histologic examination in the distinction of malignancy in RAS-like thyroid neoplasms and underscores the role of molecular testing in risk stratification, patient counseling, and operative management.
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Affiliation(s)
- Nicole A Cipriani
- Department of Pathology, The University of Chicago, 5841 S. Maryland Ave., MC 6101, Chicago, IL, 60637, USA.
| | | | - David H Sarne
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, The University of Chicago, Chicago, IL, USA
| | - Peter Angelos
- Department of Surgery, Section of Endocrine Surgery, The University of Chicago, Chicago, IL, USA
| | - Ward Reeves
- Department of Pathology, The University of Chicago, 5841 S. Maryland Ave., MC 6101, Chicago, IL, 60637, USA
| | - Tatjana Antic
- Department of Pathology, The University of Chicago, 5841 S. Maryland Ave., MC 6101, Chicago, IL, 60637, USA
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10
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Thyroid and Molecular Testing. Advances in Thyroid Molecular Cytopathology. JOURNAL OF MOLECULAR PATHOLOGY 2021. [DOI: 10.3390/jmp2020008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Thyroid nodules are a common finding in the adult population including the fact that more than 50% of individuals, over the age of 60, have thyroid nodules. The majority have been mostly detected with ultrasonography and 10% by palpation. The majority of these nodules are benign, whereas 5–15% of them are malignant. The pre-operative diagnosis of cancer is a critical challenge in order to ensure that each patient can be treated with the best tailored management with a reduction of unnecessary surgery for benign lesions. Fine needle aspiration cytology (FNAC) represents the first and most important diagnostic tool for the evaluation of thyroid lesions. According to the literature, FNAC is able to render a conclusive diagnosis in up to 70–80% of all cases. For the remaining 20–30% of nodules, cytological diagnoses fall into the category of indeterminate lesions mostly due to the lack of specific morphological features. According to the Bethesda system for reporting thyroid cytopathology (TBSRTC), indeterminate lesions can be sub-stratified into three different subcategories including “atypia of undetermined significance/follicular lesion of undetermined significance-AUS/FLUS”; “follicular or Hürthle cell neoplasm/suspicious for follicular or Hürthle cell neoplasm-FN/SFN”; and “suspicious for malignancy-SFM”. Many of these indeterminate lesions undergo repetition or diagnostic lobectomy. Nonetheless, the majority of these cases will have a benign diagnosis due to the fact that the rate of cancer ranges between 6 and 30%. It stands to reason that the application of ancillary technique, mostly molecular testing, emerged as a critical additional tool for those thyroid indeterminate lesions. Since the early 1990s, material collected from cytological samples yields sufficient and adequate cells for the detection of point mutation or gene fusions. Nonetheless, the further availability of new sequencing technologies such as next-generation sequencing (NGS) has led to more comprehensive molecular applications adopted now in clinical use. The current review investigates the multiple advances in the field of molecular testing applied in thyroid cytology.
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11
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Hernandez-Prera JC, Valderrabano P, Creed JH, de la Iglesia JV, Slebos RJ, Centeno BA, Tarasova V, Hallanger-Johnson J, Veloski C, Otto KJ, Wenig BM, Yoder SJ, Lam CA, Park DS, Anderson AR, Raghunand N, Berglund A, Caudell J, Gerke TA, Chung CH. Molecular Determinants of Thyroid Nodules with Indeterminate Cytology and RAS Mutations. Thyroid 2021; 31:36-49. [PMID: 32689909 PMCID: PMC7864115 DOI: 10.1089/thy.2019.0650] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background:RAS gene family mutations are the most prevalent in thyroid nodules with indeterminate cytology and are present in a wide spectrum of histological diagnoses. We evaluated differentially expressed genes and signaling pathways across the histological/clinical spectrum of RAS-mutant nodules to determine key molecular determinants associated with a high risk of malignancy. Methods: Sixty-one thyroid nodules with RAS mutations were identified. Based on the histological diagnosis and biological behavior, the nodules were grouped into five categories indicating their degree of malignancy: non-neoplastic appearance, benign neoplasm, indeterminate malignant potential, low-risk cancer, or high-risk cancer. Gene expression profiles of these nodules were determined using the NanoString PanCancer Pathways and IO 360 Panels, and Angiopoietin-2 level was determined by immunohistochemical staining. Results: The analysis of differentially expressed genes using the five categories as supervising parameters unearthed a significant correlation between the degree of malignancy and genes involved in cell cycle and apoptosis (BAX, CCNE2, CDKN2A, CDKN2B, CHEK1, E2F1, GSK3B, NFKB1, and PRKAR2A), PI3K pathway (CCNE2, CSF3, GSKB3, NFKB1, PPP2R2C, and SGK2), and stromal factors (ANGPT2 and DLL4). The expression of Angiopoietin-2 by immunohistochemistry also showed the same trend of increasing expression from non-neoplastic appearance to high-risk cancer (p < 0.0001). Conclusions: The gene expression analysis of RAS-mutant thyroid nodules suggests increasing upregulation of key oncogenic pathways depending on their degree of malignancy and supports the concept of a stepwise progression. The utility of ANGPT2 expression as a potential diagnostic biomarker warrants further evaluation.
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Affiliation(s)
- Juan C. Hernandez-Prera
- Department of Pathology, Moffitt Cancer Center, Tampa, Florida, USA
- Juan C. Hernandez-Prera, MD, Department of Pathology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Pablo Valderrabano
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Jordan H. Creed
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Janis V. de la Iglesia
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Robbert J.C. Slebos
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | | | - Valentina Tarasova
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | | | - Colleen Veloski
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Kristen J. Otto
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Bruce M. Wenig
- Department of Pathology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Sean J. Yoder
- Molecular Genomics Core Facility, Moffitt Cancer Center, Tampa, Florida, USA
| | - Cesar A. Lam
- Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Derek S. Park
- Department of Integrated Mathematical Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Alexander R. Anderson
- Department of Integrated Mathematical Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | | | - Anders Berglund
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, USA
| | - Jimmy Caudell
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Travis A. Gerke
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Christine H. Chung
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida, USA
- Address correspondence to: Christine H. Chung, MD, Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
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12
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Abstract
Fine-needle aspiration (FNA) is among the first diagnostic tools used in the evaluation of thyroid nodules. It has the ability to triage patients with benign and malignant lesions, thus defining the optimum clinical and/or surgical management. The Bethesda System for Reporting Thyroid Cytopathology has found worldwide acceptance. Thyroid FNA offers high positive predictive value (97%-99%), with sensitivities and specificities of 65% to 99% and 72% to 100%, respectively. Nonetheless, many potential diagnostic pitfalls exist that can lead to false-positive and/or false-negative results. This article discusses several of the potential pitfalls in the cytologic evaluation of thyroid lesions.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, A. Gemelli Square, 1, Rome 20123, Italy
| | - Adebowale J Adeniran
- Department of Pathology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | - William C Faquin
- Department of Pathology, WRN 219, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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de Biase D, Acquaviva G, Visani M, Sanza V, Argento CM, De Leo A, Maloberti T, Pession A, Tallini G. Molecular Diagnostic of Solid Tumor Using a Next Generation Sequencing Custom-Designed Multi-Gene Panel. Diagnostics (Basel) 2020; 10:diagnostics10040250. [PMID: 32340363 PMCID: PMC7236002 DOI: 10.3390/diagnostics10040250] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 02/05/2023] Open
Abstract
Next generation sequencing (NGS) allows parallel sequencing of multiple genes at a very high depth of coverage. The need to analyze a variety of targets for diagnostic/prognostic/predictive purposes requires multi-gene characterization. Multi-gene panels are becoming standard approaches for the molecular analysis of solid lesions. We report a custom-designed 128 multi-gene panel engineered to cover the relevant targets in 22 oncogene/oncosuppressor genes for the analysis of the solid tumors most frequently subjected to routine genotyping. A total of 1695 solid tumors were analyzed for panel validation. The analytical sensitivity is 5%. Analytical validation: (i) Accuracy: sequencing results obtained using the multi-gene panel are concordant using two different NGS platforms and single-gene approach sequencing (100% of 83 cases); (ii) Precision: consistent results are obtained in the samples analyzed twice with the same platform (100% of 20 cases). Clinical validation: the frequency of mutations identified in different tumor types is consistent with the published literature. This custom-designed multi-gene panel allows to analyze with high sensitivity and throughput 22 oncogenes/oncosuppressor genes involved in diagnostic/prognostic/predictive characterization of central nervous system tumors, non-small-cell lung carcinomas, colorectal carcinomas, thyroid nodules, pancreatic lesions, melanoma, oral squamous carcinomas and gastrointestinal stromal tumors.
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Affiliation(s)
- Dario de Biase
- Department of Pharmacy and Biotechnology, Molecular Diagnostic Unit, University of Bologna, viale Ercolani 4/2, 40138 Bologna, Italy; (D.d.B.); (C.M.A.); (T.M.); (A.P.)
| | - Giorgia Acquaviva
- Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale), Molecular Diagnostic Unit, University of Bologna, Azienda USL di Bologna, viale Ercolani 4/2, 40138 Bologna, Italy; (G.A.); (V.S.); (A.D.L.); (G.T.)
| | - Michela Visani
- Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale), Molecular Diagnostic Unit, University of Bologna, Azienda USL di Bologna, viale Ercolani 4/2, 40138 Bologna, Italy; (G.A.); (V.S.); (A.D.L.); (G.T.)
- Correspondence: ; Tel.: +39-051-2144717; Fax: +39-051-6363689
| | - Viviana Sanza
- Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale), Molecular Diagnostic Unit, University of Bologna, Azienda USL di Bologna, viale Ercolani 4/2, 40138 Bologna, Italy; (G.A.); (V.S.); (A.D.L.); (G.T.)
| | - Chiara M. Argento
- Department of Pharmacy and Biotechnology, Molecular Diagnostic Unit, University of Bologna, viale Ercolani 4/2, 40138 Bologna, Italy; (D.d.B.); (C.M.A.); (T.M.); (A.P.)
| | - Antonio De Leo
- Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale), Molecular Diagnostic Unit, University of Bologna, Azienda USL di Bologna, viale Ercolani 4/2, 40138 Bologna, Italy; (G.A.); (V.S.); (A.D.L.); (G.T.)
| | - Thais Maloberti
- Department of Pharmacy and Biotechnology, Molecular Diagnostic Unit, University of Bologna, viale Ercolani 4/2, 40138 Bologna, Italy; (D.d.B.); (C.M.A.); (T.M.); (A.P.)
| | - Annalisa Pession
- Department of Pharmacy and Biotechnology, Molecular Diagnostic Unit, University of Bologna, viale Ercolani 4/2, 40138 Bologna, Italy; (D.d.B.); (C.M.A.); (T.M.); (A.P.)
| | - Giovanni Tallini
- Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale), Molecular Diagnostic Unit, University of Bologna, Azienda USL di Bologna, viale Ercolani 4/2, 40138 Bologna, Italy; (G.A.); (V.S.); (A.D.L.); (G.T.)
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14
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Guan H, Toraldo G, Cerda S, Godley FA, Rao SR, McAneny D, Doherty G, Braverman L, Lee SL. Utilities of RAS Mutations in Preoperative Fine Needle Biopsies for Decision Making for Thyroid Nodule Management: Results from a Single-Center Prospective Cohort. Thyroid 2020; 30:536-547. [PMID: 31996097 DOI: 10.1089/thy.2019.0116] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: It has been advocated to apply individualized strategies to evaluate thyroid nodules due to the growing awareness that the pathogenesis of thyroid cancer is not uniform. Molecular markers in fine needle biopsies (FNBs) may be helpful for the diagnosis and management decisions. Unlike the detection of BRAF mutations, the clinical utility of rat sarcoma viral oncogene homolog (RAS) mutations has not been fully elucidated. This study aimed at presenting a real-world performance of RAS mutations in identifying thyroid malignancies, at investigating the nature of thyroid tumors carrying RAS mutations, and at providing an additional reference for interpreting how to utilize the presence of RAS mutations in the decision-making process of thyroid nodule management. Methods: Between February 2015 and December 2017, 1400 sequential thyroid biopsies were performed at Boston Medical Center. Of these, 546 FNBs were evaluated for RAS mutations by using a ThyroSeq next-generation sequencing panel. Nodules carrying RAS mutations were prospectively followed, and medical records were collected. Results: ThyroSeq successfully provided molecular information in 504 nodules; 173 with molecular alteration(s); and 80 positive for mutations in the Kirsten-, Neuroblastoma-, or Harvey-RAS genes. RAS gene mutations constituted up to 46.2% of the total molecular alterations found in the study. Fifty-six of the 80 RAS-positive nodules underwent surgery, 33 (58.9%) were confirmed to be benign, 7 (12.5%) were noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP), and 16 (28.6%) were thyroid carcinomas. The positive predictive value, negative predictive value, and accuracy of RAS mutations for identifying malignancies among cytologically indeterminate nodules were 25.5%, 89.7%, and 54.0% when NIFTP was not counted as cancer. A combination of RAS and other mutations increased the risk of malignancy. Twelve histopathologically proved RAS-only-positive malignant nodules all showed low-risk features and favorable prognosis. RAS isoforms added little assistance for predicting a malignancy and the response to therapy in our series. Conclusions:RAS mutations represent the most frequently detected genetic alterations in our series. RAS mutations, when occurring alone, are not helpful markers to identify malignancy among Bethesda III/IV cytologies, but may predict favorable behavior, and hence should be considered to guide initial management.
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Affiliation(s)
- Haixia Guan
- Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Shenyang, China
- Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston, Massachusetts
| | - Gianluca Toraldo
- Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston, Massachusetts
| | - Sandra Cerda
- Department of Pathology, Boston Medical Center, Boston, Massachusetts
| | - Frederick A Godley
- Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston, Massachusetts
| | - Sowmya R Rao
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - David McAneny
- Department of Surgery, Boston Medical Center, Boston, Massachusetts
| | - Gerard Doherty
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lewis Braverman
- Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston, Massachusetts
| | - Stephanie L Lee
- Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston, Massachusetts
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15
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Yildirim Simsir I, Cetinkalp S, Kabalak T. Review of Factors Contributing to Nodular Goiter and Thyroid Carcinoma. Med Princ Pract 2020; 29:1-5. [PMID: 31542786 PMCID: PMC7024874 DOI: 10.1159/000503575] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 09/22/2019] [Indexed: 01/07/2023] Open
Abstract
There is an increased incidence of thyroid nodules and cancer. In this article, the reasons for this increase are evaluated and discussed. The factors causing increases in the incidence of nodules are the same as those causing increases in thyroid cancer. There are publications from all over the world regarding the rising incidence of thyroid cancer; it is especially associated with papillary cancer. The literature was reviewed and evaluated with regard to this significant phenomenon. Thyroid-stimulating hormone (TSH) is the main mitotic factor. Any agent that elevates TSH will stimulate nodule formation. Therefore, the incidence of thyroid nodules is high in endemic goiter regions due to iodine deficiency. This paper has described many of the factors causing this higher incidence. Of note, metabolic syndrome and insulin resistance are important factors associated with the increased incidence of nodular goiter and papillary thyroid cancer today. However, these data must be confirmed by other studies in the future.
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Affiliation(s)
- Ilgin Yildirim Simsir
- Division of Endocrinology and Metabolism Disorders, Department of Internal Medicine, Ege University Medical Faculty, Izmir, Turkey,
| | - Sevki Cetinkalp
- Division of Endocrinology and Metabolism Disorders, Department of Internal Medicine, Ege University Medical Faculty, Izmir, Turkey
| | - Taylan Kabalak
- Division of Endocrinology and Metabolism Disorders, Department of Internal Medicine, Ege University Medical Faculty, Izmir, Turkey
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16
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Goldner WS, Angell TE, McAdoo SL, Babiarz J, Sadow PM, Nabhan FA, Nasr C, Kloos RT. Molecular Variants and Their Risks for Malignancy in Cytologically Indeterminate Thyroid Nodules. Thyroid 2019; 29:1594-1605. [PMID: 31469053 PMCID: PMC6864764 DOI: 10.1089/thy.2019.0278] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Gene panels are routinely used to assess predisposition to hereditary cancers by simultaneously testing multiple susceptibility genes and/or variants. More recently, genetic panels have been implemented as part of solid tumor malignancy testing assessing somatic alterations. One example is targeted variant panels for thyroid nodules that are not conclusively malignant or benign upon fine-needle aspiration (FNA). We systematically reviewed published studies from 2009 to 2018 that contained genetic data from preoperative FNA specimens on cytologically indeterminate thyroid nodules (ITNs) that subsequently underwent surgical resection. Pooled prevalence estimates per gene and variant, along with their respective positive predictive values (PPVs) for malignancy, were calculated. Summary: Our systematic search identified 540 studies that were supplemented by 18 studies from bibliographies or personal files. Sixty-one studies met all inclusion criteria and included >4600 ITNs. Overall, 26% of nodules contained at least 1 variant or fusion. However, half of them did not include details on the specific gene, variant, and/or complete fusion pair reported for inclusion toward PPV calculations. The PPVs of genomic alterations reported at least 10 times were limited to BRAFV600E (98%, 95% confidence interval [CI 96-99%]), PAX8/PPARG (55% [CI 34-78%]), HRASQ61R (45% [CI 22-72%]), BRAFK601E (42% [CI 19-68%]), and NRASQ61R (38% [CI 23-55%]). Excluding BRAFV600E, the pooled PPV for all other specified variants and fusions was 47%. Multiple variants within the same nodule were identified in ∼1% of ITN and carried a cumulative PPV of 77%. Conclusions: The chance that a genomic alteration predicts malignancy depends on the individual variant or fusion detected. Only five alterations were reported at least 10 times; BRAFV600E had a PPV of 98%, while the remaining four had individual PPVs ranging from 38% to 55%. The small sample size of most variants and fusion pairs found among ITNs, however, limits confidence in their individual PPV point estimates. Better specific reporting of genomic alterations with cytological category, histological subtype, and cancer staging would facilitate better understanding of cancer prediction, and the independent contribution of the genomic profile to prognosis.
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Affiliation(s)
- Whitney S. Goldner
- Division of Diabetes, Endocrinology, and Metabolism, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
- Address correspondence to: Whitney S. Goldner, MD, Division of Diabetes, Endocrinology, and Metabolism, Department of Internal Medicine, University of Nebraska Medical Center, 984120 Nebraska Medical Center, Omaha, NE 68198-4120
| | - Trevor E. Angell
- Division of Endocrinology, Diabetes and Metabolism, Keck School of Medicine, University of Southern California, Los Angles, California
| | | | | | - Peter M. Sadow
- Pathology Service, Massachusetts General Hospital, Boston, Massachusetts
- Department of Pathology, Harvard Medical School, Boston, Massachusetts
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Fadi A. Nabhan
- Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University Wexner Medical Center and Arthur G. James Cancer Center, Columbus, Ohio
| | - Christian Nasr
- Endocrinology and Metabolism Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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17
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Paniza ACDJ, Mendes TB, Viana MDB, Thomaz DMD, Chiappini PBO, Colozza-Gama GA, Lindsey SC, de Carvalho MB, Alves VAF, Curioni O, Bastos AU, Cerutti JM. Revised criteria for diagnosis of NIFTP reveals a better correlation with tumor biological behavior. Endocr Connect 2019; 8:1529-1538. [PMID: 31671409 PMCID: PMC6893310 DOI: 10.1530/ec-19-0459] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 10/31/2019] [Indexed: 12/20/2022]
Abstract
The recent reclassification of a follicular variant of papillary thyroid carcinoma (FVPTC), subset as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), aims to avoid overtreatment of patients with an indolent lesion. The diagnosis of NIFTP has recently been revisited using more rigid criteria. This study presents histological and molecular findings and a long clinical follow-up of 94 FVPTC, 40 cases of follicular adenoma (FTA) and 22 cases of follicular carcinoma (FTC) that were classified before the advent of the NIFTP reclassification. All slides were reviewed using these rigid criteria and analysis of numerous sections of paraffin blocks and reclassified as 7 NIFTPs, 2 EFVPTCs, 29 infiltrative FVPTC (IFVPTCs), 57 invasive EFVPTC (I-EFVPTCs), 39 FTAs and 22 FTCs. Remarkably, EFVPTC and NIFTP patients were all free of disease at the end of follow-up and showed no BRAF mutation. Only one NIFTP sample harbored mutations, an NRAS Q61R. PAX8/PPARG fusion was found in I-EFVPTCs and FTC. Although additional studies are needed to identify a specific molecular profile to aid in the diagnosis of lesions with borderline morphological characteristics, we confirmed that the BRAF V600E mutation is an important tool to exclude the diagnosis of NIFTP. We also show that rigorous histopathological criteria should be strongly followed to avoid missing lesions in which more aggressive behavior is present, mainly via the analysis of capsule or vascular invasion and the presence of papillary structures.
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Affiliation(s)
- Ana Carolina de Jesus Paniza
- Division of Genetics, Department of Morphology and Genetics, Genetic Bases of Thyroid Tumors Laboratory, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Thais Biude Mendes
- Division of Genetics, Department of Morphology and Genetics, Genetic Bases of Thyroid Tumors Laboratory, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Matheus Duarte Borges Viana
- Division of Genetics, Department of Morphology and Genetics, Genetic Bases of Thyroid Tumors Laboratory, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Débora Mota Dias Thomaz
- Division of Genetics, Department of Morphology and Genetics, Genetic Bases of Thyroid Tumors Laboratory, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Gabriel A Colozza-Gama
- Division of Genetics, Department of Morphology and Genetics, Genetic Bases of Thyroid Tumors Laboratory, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Susan Chow Lindsey
- Division of Endocrinology, Department of Medicine, Laboratory of Molecular and Translational Endocrinology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Otavio Curioni
- Department of Head and Neck Surgery and Otorhinolaryngology, Hospital Heliópolis, São Paulo, Brazil
| | - André Uchimura Bastos
- Division of Genetics, Department of Morphology and Genetics, Genetic Bases of Thyroid Tumors Laboratory, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Microbiology, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Janete Maria Cerutti
- Division of Genetics, Department of Morphology and Genetics, Genetic Bases of Thyroid Tumors Laboratory, Universidade Federal de São Paulo, São Paulo, Brazil
- Correspondence should be addressed to J M Cerutti:
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18
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Rossi ED, Larocca LM, Pantanowitz L. Ancillary molecular testing of indeterminate thyroid nodules. Cancer Cytopathol 2019; 126 Suppl 8:654-671. [PMID: 30156775 DOI: 10.1002/cncy.22012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/11/2018] [Accepted: 04/11/2018] [Indexed: 12/11/2022]
Abstract
Cytological specimens from thyroid nodules are increasingly being adopted as the first available material for cost effectively managing patients in the era of personalized medicine. Cytology aspirates not only play a central role in providing accurate diagnoses, but are also being collected for ancillary molecular testing. Molecular analysis, including the evaluation of somatic mutations and other genomic alterations, has accordingly become well integrated in the cytological workup of thyroid lesions. Appropriately handled thyroid cytology preparations provide well-preserved and adequately cellular material with improved DNA/RNA quantity. The recent publication of the 2nd edition of The Bethesda System for Reporting Thyroid Cytopathology and the American Thyroid Association guidelines confirm the relevant role of molecular testing in the management of the different subcategories of indeterminate thyroid lesions. This review discusses the role of molecular testing for indeterminate thyroid nodules, including the recent introduction of the noninvasive, encapsulated follicular variant of papillary thyroid carcinoma (FVPTC), known also as noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP).
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Affiliation(s)
- Esther Diana Rossi
- Istituto di Anatomia Patologica, Fondazione Policlinico Universitario, "Agostino Gemelli" Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Maria Larocca
- Istituto di Anatomia Patologica, Fondazione Policlinico Universitario, "Agostino Gemelli" Università Cattolica del Sacro Cuore, Rome, Italy
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh
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19
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Valderrabano P, Khazai L, Thompson ZJ, Otto KJ, Hallanger-Johnson JE, Chung CH, Centeno BA, McIver B. Association of Tumor Size With Histologic and Clinical Outcomes Among Patients With Cytologically Indeterminate Thyroid Nodules. JAMA Otolaryngol Head Neck Surg 2019; 144:788-795. [PMID: 30027226 DOI: 10.1001/jamaoto.2018.1070] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Tens of thousands of unnecessary operations are performed each year for diagnostic purposes among patients with cytologically indeterminate thyroid nodules. Whereas a diagnostic lobectomy is recommended for most patients with solitary indeterminate thyroid nodules, a total thyroidectomy is preferred for nodules larger than 4 cm. Objective To determine whether histologic or clinical outcomes of indeterminate thyroid nodules 4 cm or larger are worse than those for nodules smaller than 4 cm, thus justifying a more aggressive initial surgical approach. Design, Setting, and Participants In this retrospective cohort study, 652 indeterminate thyroid nodules (546 nodules <4 cm and 106 nodules ≥4 cm) with surgical follow-up were consecutively evaluated at an academic cancer center from October 1, 2008, through April 30, 2016. Exposure Tumor size. Main Outcomes and Measures Differences in cancer rates, rates of invasive features, cancer aggressiveness, and response to therapy between indeterminate thyroid nodules smaller than 4 cm and 4 cm or larger. Results A total of 652 indeterminate thyroid nodules (546 nodules <4 cm and 106 nodules ≥4 cm) from 589 patients (mean [SD] age, 53.1 [13.8] years; 453 [76.9%] female) were studied. No differences were found in the baseline characteristics of patients or nodules between the 2 size groups. Tumor size was not associated with the cancer rate as a categorical (140 of 546 [25.6%] for nodules <4 cm and 33 of 106 [31.1%] for nodules ≥4 cm; effect size, 0.05; 95% CI, 0.002-0.12) or continuous (odds ratio [OR], 1.03; 95% CI, 0.92-1.15) variable. No association was found between nodule size and prevalence of extrathyroidal extension, positive margins, lymphovascular invasion, lymph node metastasis, or distant metastasis. Most malignant tumors were low risk in both size groups (70% in the nodules <4 cm and 72% in the nodules ≥4 cm), and tumor size was not associated with tumor aggressiveness as a categorical (effect size, 0.10; 95% CI, 0.03-0.31) or continuous variable (OR for intermediate-risk cancer, 0.91; 95% CI, 0.72-1.14; OR for high-risk cancer, 1.43; 95% CI, 0.96-2.15). At the last follow-up visit, 88 of 105 patients (83.8%) with malignant tumors in the smaller than 4 cm group and 21 of 25 (84.0%) in the 4 cm or greater group had no evidence of disease, and tumor size was not associated with response to therapy (effect size, 0.13; 95% CI, 0.07-0.33). Conclusions and Relevance Most indeterminate thyroid nodules are benign or low-risk malignant tumors regardless of tumor size. In the absence of other indications for total thyroidectomy, this study suggests that a thyroid lobectomy is sufficient initial treatment for most solitary cytologically indeterminate thyroid nodules independent of the tumor size.
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Affiliation(s)
- Pablo Valderrabano
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Laila Khazai
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Zachary J Thompson
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kristen J Otto
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Julie E Hallanger-Johnson
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - 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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20
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Rossi ED, Pantanowitz L, Faquin WC. The Role of Molecular Testing for the Indeterminate Thyroid FNA. Genes (Basel) 2019; 10:genes10100736. [PMID: 31547603 PMCID: PMC6826845 DOI: 10.3390/genes10100736] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/13/2019] [Accepted: 09/18/2019] [Indexed: 01/21/2023] Open
Abstract
Thyroid nodules are common in the adult population where a majority are benign and only 4.0% to 6.5% are malignant. Fine needle aspiration (FNA) is a key method used in the early stages to evaluate and triage patients with thyroid nodules. While a definitive cytological diagnosis is provided in more than 70–75% of all thyroid FNA cases, the group of indeterminate lesions offers a challenge in terms of interpretation and clinical management. Molecular testing platforms have been developed, are recognized as an option by the 2015 American Thyroid Association Guidelines, and are frequently used in conjunction with FNA as an integral part of the cytologic evaluation. In this review, the utility of molecular testing options for nodules assigned to the group of indeterminate thyroid FNAs is described.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, 00168 Rome, Italy.
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15232, USA.
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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21
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Duan H, Liu X, Ren X, Zhang H, Wu H, Liang Z. Mutation profiles of follicular thyroid tumors by targeted sequencing. Diagn Pathol 2019; 14:39. [PMID: 31077238 PMCID: PMC6511182 DOI: 10.1186/s13000-019-0817-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/18/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND One of the major challenges remaining in the classification of thyroid tumor is the determination of whether a nodule is benign or malignant. We aimed to characterize the mutational profiles of follicular thyroid tumor and to identify markers with potential diagnostic and prognostic implications. METHODS Targeted sequencing with a panel of 18 thyroid cancer-related genes was performed on 48 tissue samples from follicular thyroid adenoma (FTA), 32 follicular tumors of uncertain malignant potential (FT-UMP), 17 well-differentiated tumors of uncertain malignant potential (WDT-UMP) and 53 samples from follicular thyroid carcinoma (FTC). The correlation of mutation profiles and clinicopathological features and prognosis were also analyzed. RESULTS We identified 95 nonsilent mutations spanning 14 genes. Specifically, TERT promoter (TERTp) mutations were exclusively detected in FTC. A total of 80% EIF1AX exon 2 mutations (4/5) and 75% TSHR mutations (3/4) occurred in FTA, whereas the rest of them occurred in FT-UMP. KRAS mutations and TP53 mutations were only presented in borderline or malignant tumors. H/N-RAS mutations were detected in all four subtypes, but were most commonly found in WDT-UMP (p = 0.031). All N-RAS mutations were located at codon 61. BRAF V600E and RET fusion were absent in the entire cohort. In FTC cases, EIF1AX mutations were all located at intron 5/exon 6 and correlated with advanced disease (p = 0.032). Both EIF1AX and TERTp mutations predicted shorter disease-free survival (p = 0.007, p = 0.024, respectively). Further analysis revealed that TERTp mutations were correlated with shorter disease-free survival in patients with minimally invasive /encapsulated angioinvasive FTC (p = 0.017), but not in those with widely invasive FTC (p = 0.297). CONCLUSION TERTp, EIF1AX, TSHR, H/N/K-RAS and TP53 mutations may have diagnostic or prognostic potential in follicular thyroid tumors. TERTp mutations may predict a poor outcome in patients with minimally invasive/encapsulated angioinvasive FTC.
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Affiliation(s)
- Huanli Duan
- Molecular Pathology Research Center, Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, 100730 China
| | - Xiaoding Liu
- Molecular Pathology Research Center, Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, 100730 China
| | - Xinyu Ren
- Molecular Pathology Research Center, Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, 100730 China
| | - Hui Zhang
- Molecular Pathology Research Center, Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, 100730 China
| | - Huanwen Wu
- Molecular Pathology Research Center, Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, 100730 China
| | - Zhiyong Liang
- Molecular Pathology Research Center, Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, 100730 China
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22
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Mitchell J, Yip L. Decision Making in Indeterminate Thyroid Nodules and the Role of Molecular Testing. Surg Clin North Am 2019; 99:587-598. [PMID: 31255193 DOI: 10.1016/j.suc.2019.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Cytologically indeterminate thyroid nodules are associated with a broad range (5%-75%) of malignant risk and accurately informing definitive management poses a challenge. Advancements in molecular testing of fine-needle aspiration biopsies have improved preoperative diagnostic accuracy and prognostication. For indeterminate nodules, such testing ideally will reduce the need for surgery for benign nodules and potentially guide appropriate extent of initial surgery for malignancy.
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Affiliation(s)
- Janeil Mitchell
- Fox Valley Surgical Associates, Endocrine Surgery, 1818 North Meade Street, Appleton, WI 54911, USA
| | - Linwah Yip
- Department of Surgery, Division of Endocrine Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, 3471 Fifth Avenue, Suite 101, Pittsburgh, PA 15213, USA.
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23
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Cohen DS, Tongson-Ignacio JE, Lolachi CM, Ghaderi VS, Jahan-Parwar B, Thompson LDR. Rethinking Malignancy Risk in Indeterminate Thyroid Nodules with Positive Molecular Studies: Southern California Permanente Experience. Otolaryngol Head Neck Surg 2019; 161:419-423. [DOI: 10.1177/0194599819842859] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To recognize that thyroid nodules with atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS; Bethesda III) have different risks of malignancy based on genetic mutation and to consider molecular testing of nodules with AUS/FLUS to help avoid unnecessary morbidity or cost. Study Design Retrospective cohort study. Setting Multiple locations within Southern California Permanente Medical Group. Subjects and Methods Patients included those with indeterminate thyroid nodules and AUS/FLUS on 2 separate fine-needle aspirations with positive ThyGenX testing from 2014 to 2017 who underwent thyroid surgery. Patients were classified as having benign or malignant disease. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features was considered benign. Results A total of 231 patients had repeat AUS/FLUS with positive molecular testing and surgery. The most frequent type of malignancy was papillary carcinoma, followed by follicular carcinoma. The overall prevalence of malignancy in nodules with mutations was 74.0%, although there was considerable variation: BRAF = 100%, RET = 100%, PAX8-PPARγ = 84.6%, HRAS = 70.7%, NRAS = 63.4%, and KRAS = 33%—a statistically significant finding ( P < .001). Conclusions Not all molecular mutations in thyroid nodules with AUS/FLUS have a high risk of malignancy. Of note, patients with BRAF and RET mutations in our population had a 100% risk of malignancy. Patients with PAX, HRAS, or NRAS mutations had a high risk of malignancy, while patients with KRAS mutations had a lower risk of malignancy. Further studies are needed to determine if the presence of certain molecular mutations can help personalize care and aid in the decision for thyroid surgery.
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Affiliation(s)
- David S. Cohen
- Department of Head and Neck Surgery, Southern California Permanente Medical Group, Harbor City, California, USA
| | - Jane E. Tongson-Ignacio
- Department of Cytopathology, Southern California Permanente Medical Group, North Hollywood, California, USA
| | - Christopher M. Lolachi
- Department of Head and Neck Surgery, Southern California Permanente Medical Group, Harbor City, California, USA
| | - Vanessa S. Ghaderi
- Department of Endocrinology, Southern California Permanente Medical Group, Harbor City, California, USA
| | - Babak Jahan-Parwar
- Department of Head and Neck Surgery, Southern California Permanente Medical Group, Baldwin Park, California, USA
| | - Lester D. R. Thompson
- Department of Pathology, Southern California Permanente Medical Group, Woodland Hills, California, USA
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24
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Depciuch J, Stanek-Widera A, Skrzypiec D, Lange D, Biskup-Frużyńska M, Kiper K, Stanek-Tarkowska J, Kula M, Cebulski J. Spectroscopic identification of benign (follicular adenoma) and cancerous lesions (follicular thyroid carcinoma) in thyroid tissues. J Pharm Biomed Anal 2019; 170:321-326. [PMID: 30954022 DOI: 10.1016/j.jpba.2019.03.061] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 01/03/2023]
Abstract
Thyroid follicular nodules are quite common in the population, however only a small proportion is malignant. Thyroid cancer differs from adenoma by features of cellular atypia, angioinvasiveness and possibility of metastasis via blood vessels mainly in the lungs and bones. Pathomorphological examination of the postoperative material plays a significant role in the diagnosis of cystic thyroid lesions. De facto, there is no possibility to determine with certainty whether the lesion is benign or malignant before surgery, therefore new methods are being sought to meet clinical needs. The study aimed to investigate if Fourier-transform infrared spectroscopy (FTIR) spectroscopy and Raman spectroscopy combined with multidimensional analysis can be a useful tool in distinguishing between thyroid adenomas and carcinomas. The obtained results indicate quantitative and qualitative alterations within proteins and fats derived from patients' tissues samples. Raman spectroscopy additionally shows significant changes in the amount of tissue collagen due to the pathogenic process. In the spectra of the second FTIR derivative, shifts of vibrations corresponding to the β-sheet and α-helix structure are observed towards the lower rates of wave numbers in the case of neoplastic tissues. Using the leave-one-out cross-validation, sensitivity and specificity calculated with Principal Component Analysis-Linear Discriminant Analysis (PCA-LDA) clearly shows the possibility to distinguish between pathologically changed and normal thyroid tissue as well as differentiate follicular thyroid adenoma (FTA) from widely invasive follicular thyroid carcinoma (WI-FTC) tissues.
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Affiliation(s)
- Joanna Depciuch
- Institute of Nuclear Physics Polish Academy of Sciences, PL-31342, Krakow, Poland.
| | - Agata Stanek-Widera
- Department of Tumor Pathology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, PL-44101, Gliwice, Poland
| | - Dominika Skrzypiec
- Center for Innovation and Transfer of Natural Sciences and Engineering Knowledge, University of Rzeszow, PL-35959, Rzeszow, Poland
| | - Dariusz Lange
- Department of Tumor Pathology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, PL-44101, Gliwice, Poland
| | - Magdalena Biskup-Frużyńska
- Department of Tumor Pathology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, PL-44101, Gliwice, Poland
| | - Krzysztof Kiper
- Faculty of Medicine, University of Rzeszow, PL-35959, Rzeszow, Poland
| | | | - Monika Kula
- Polish Academy of Sciences, The Franciszek Górski Institute of Plant Physiology, Niezapominajek 21, 30239, Krakow, Poland
| | - Jozef Cebulski
- Center for Innovation and Transfer of Natural Sciences and Engineering Knowledge, University of Rzeszow, PL-35959, Rzeszow, Poland
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25
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Abstract
Fine needle aspiration biopsy (FNAB) and ultrasonography are the most common modalities for the diagnosis and follow up of thyroid nodules. FNAB is able to distinguish benign from malignant nodules with high sensitivity and specificity; however, 20% to 30% of nodules are diagnosed as indeterminate with a risk of malignancy varying from 10% to 75% based on the 2017 revision of the Bethesda System for Reporting Thyroid Cytopathology. Molecular tests are being increasingly used to triage this group of nodules. Several molecular tests are commercially available and newer upgrades are being developed to either "rule in" or "rule out" malignancy with greater accuracy. The Afirma gene expression classifier and its recent upgrade (the Afirma gene sequencing classifier), Thryoseq v2, a next generation sequencing test and its recent upgrade (the v3), RosettaGX Reveal based on microRNA alterations, and ThyGenX/ThyraMIR, a combination test, are currently on the market. Familiarity with these tests, their performance, and postvalidation publications will enable appropriate test selection and improve triage of patients for appropriate therapy. The underlying rate of malignancy at different institutions and the interobserver variability in cytologic and histologic diagnosis of thyroid lesions are important factors that impact the performance of the various molecular tests.
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26
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Martini M, Capodimonti S, Cenci T, Bilotta M, Fadda G, Larocca LM, Rossi ED. To Obtain More With Less: Cytologic Samples With Ancillary Molecular Techniques-The Useful Role of Liquid-Based Cytology. Arch Pathol Lab Med 2019; 142:299-307. [PMID: 29494225 DOI: 10.5858/arpa.2017-0148-ra] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - Fine-needle aspiration cytology has been increasingly used as the first tool in the evaluation of several diseases. Although cytology has a relevant role in the discrimination between benign and malignant lesions, conventional slides cannot lead to 100% conclusive results. It was hoped that the introduction of liquid-based cytology (LBC) would improve the efficacy of cytology through standardization, quality improvement, and the possibility of carrying out ancillary techniques on the residual stored material. In recent decades, the application of genomic alterations has been studied on cytologic samples with feasible and reliable results. The molecular analysis offers a powerful aid to define the best clinical or surgical approaches and follow-up for patients. In recent years, the application of different ancillary techniques has been carried out on conventional slides even though LBC represents a useful additional and alternative method for molecular testing. OBJECTIVE - To demonstrate the relevance of LBC as a valid aid to overcoming the difficulties encountered in the application of ancillary techniques on conventional slides. DATA SOURCES - We examined and reviewed our experience with the application of ancillary techniques on LBC performed on different body sites. CONCLUSIONS - We emphasize that LBC achieves significant and accurate results. It represents a valid method for cytologic evaluation and it provides highly reproducible and informative molecular yields.
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Affiliation(s)
| | | | | | | | | | | | - Esther Diana Rossi
- From the Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
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27
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Ohba K, Mitsutake N, Matsuse M, Rogounovitch T, Nishino N, Oki Y, Goto Y, Kakudo K. Encapsulated Papillary Thyroid Tumor with Delicate Nuclear Changes and a KRAS Mutation as a Possible Novel Subtype of Borderline Tumor. J Pathol Transl Med 2019; 53:136-141. [PMID: 30636389 PMCID: PMC6435983 DOI: 10.4132/jptm.2018.12.07] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 12/07/2018] [Indexed: 12/11/2022] Open
Abstract
Although papillary thyroid carcinoma (PTC)–type nuclear changes are the most reliable morphological feature in the diagnosis of PTC, the nuclear assessment used to identify these changes is highly subjective. Here, we report a noninvasive encapsulated thyroid tumor with a papillary growth pattern measuring 23 mm at its largest diameter with a nuclear score of 2 in a 26-year-old man. After undergoing left lobectomy, the patient was diagnosed with an encapsulated PTC. However, a second opinion consultation suggested an alternative diagnosis of follicular adenoma with papillary hyperplasia. When providing a third opinion, we identified a low MIB-1 labeling index and a heterozygous point mutation in the KRAS gene but not the BRAF gene. We speculated that this case is an example of a novel borderline tumor with a papillary structure. Introduction of the new terminology “noninvasive encapsulated papillary RAS-like thyroid tumor (NEPRAS)” without the word “cancer” might relieve the psychological burden of patients in a way similar to the phrase “noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP).”
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Affiliation(s)
- Kenji Ohba
- Department of Internal Medicine, Enshu Hospital, Shizuoka, Japan.,Department of Family and Community Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Norisato Mitsutake
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Michiko Matsuse
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Tatiana Rogounovitch
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | | | - Yutaka Oki
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Yoshie Goto
- Department of Internal Medicine, Enshu Hospital, Shizuoka, Japan
| | - Kennichi Kakudo
- Department of Pathology, Nara Hospital, Kindai University Faculty of Medicine, Nara, Japan
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28
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Saini S, Maker AV, Burman KD, Prabhakar BS. Molecular aberrations and signaling cascades implicated in the pathogenesis of anaplastic thyroid cancer. Biochim Biophys Acta Rev Cancer 2018; 1872:188262. [PMID: 30605717 DOI: 10.1016/j.bbcan.2018.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 01/16/2023]
Abstract
Anaplastic Thyroid Cancer (ATC) accounts for >40% thyroid cancer-related deaths and has a dismal prognosis. In the past decade, significant efforts have been made towards understanding the pathogenesis of this disease and developing novel therapeutics. Unfortunately, effective treatment is still lacking and a more thorough understanding of ATC pathogenesis may provide new opportunities to improve ATC therapeutics. This review provides insights into ATC clinical presentation and pathology, and the putative role of genetic aberrations and alterations in molecular signaling pathways in ATC pathogenesis. We reviewed prevalent mutations, chromosomal abnormalities and fusions, epigenetic alterations and dysregulations in ATC, and highlighted several signaling cascades which appeared to be integral to ATC pathogenesis. Moreover, these features offer insights into de-differentiated, aggressive and drug-resistant phenotype of ATC, and thus may help in exploring potential new molecular targets for developing novel therapeutics.
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Affiliation(s)
- Shikha Saini
- Department of Microbiology and Immunology, University of Illinois-College of Medicine, Chicago, IL, United States
| | - Ajay V Maker
- Department of Surgery, Division of Surgical Oncology, University of Illinois-College of Medicine, Chicago, IL, United States
| | - Kenneth D Burman
- Medstar Washington Hospital Medical Center, Washington, DC, United States
| | - Bellur S Prabhakar
- Department of Microbiology and Immunology, University of Illinois-College of Medicine, Chicago, IL, United States; Jesse Brown VA Medical Center, Chicago, IL, United States.
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29
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Maerki J, Klein M, Chau K, Gimenez C, Fishbein J, Khutti S, Das K. Determining the molecular test for indeterminate thyroid nodules best suited for our practice: A quality assurance study. Diagn Cytopathol 2018; 47:259-267. [PMID: 30488606 DOI: 10.1002/dc.24091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/12/2018] [Accepted: 09/20/2018] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Currently, molecular studies are widely used as a guiding tool in further management of cytologically indeterminate thyroid nodules. At our institution, clinicians have recently expressed concern over receiving "less positive molecular results" upon switching from an extended 14 gene mutation panel (EGMP) to a 7 gene mutation panel (GMP). Our goal is to compare outcomes of these two tests in regards to the performance characteristics and clinical impact. MATERIALS AND METHODS All thyroid fine-needle aspiration (FNA) biopsy specimens sent for molecular studies from 2016 to 2017 were retrospectively studied. Cytopathology diagnosis, pertinent clinical findings, molecular results, and follow-up (F/U) surgical and cytology diagnoses were recorded. RESULTS Of the total 165 cases sent for molecular tests 86 (52%) were GMP and 79 (47%) EGMP. There were 21 (24%) and 40 (50%) cases with positive GMP and EGMP results, respectively. Within these positive cases (n = 61), there were a total of 33 (54%) patients who underwent surgical resection and 28 (45%) patients had no follow-up. The molecular findings and surgical pathologic diagnoses obtained are illustrated in Figures 1 through 4 for GMP and EGMP, respectively. CONCLUSIONS The selection of molecular testing should be directed toward optimizing patient care and facilitate clinical management. This quality assurance study helped in understanding the complexities associated with test selection best suited for our institution and in educating clinicians.
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Affiliation(s)
- Jennifer Maerki
- Northwell Health Laboratories, Division of Cytopathology, Department of Pathology and Laboratory Medicine, New York, New York
| | - Melissa Klein
- Northwell Health Laboratories, Division of Cytopathology, Department of Pathology and Laboratory Medicine, New York, New York
| | - Karen Chau
- Northwell Health Laboratories, Division of Cytopathology, Department of Pathology and Laboratory Medicine, New York, New York
| | - Cecilia Gimenez
- Department of Pathology and Laboratory Medicine, Hofstra Northwell Health School of Medicine, New York, New York
| | - Joanna Fishbein
- Biostatistics Unit, Feinstein Institute for Medical Research, Northwell Health, New York, New York
| | - Seema Khutti
- Department of Pathology and Laboratory Medicine, Hofstra Northwell Health School of Medicine, New York, New York
| | - Kasturi Das
- Department of Pathology and Laboratory Medicine, Hofstra Northwell Health School of Medicine, New York, New York
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30
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Nabhan F, Porter K, Lupo MA, Randolph GW, Patel KN, Kloos RT. Heterogeneity in Positive Predictive Value of RAS Mutations in Cytologically Indeterminate Thyroid Nodules. Thyroid 2018; 28:729-738. [PMID: 29665745 DOI: 10.1089/thy.2017.0635] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND RAS mutations are common in the available mutational analysis of cytologically indeterminate (Cyto-I) thyroid nodules. However, their reported positive predictive value (PPV) for cancer is widely variable. The reason for this variability is unknown, and it causes clinical management uncertainty. A systematic review was performed, evaluating the PPV for cancer in RAS mutation positive Cyto-I nodules, and variables that might affect residual heterogeneity across the different studies were considered. METHODS PubMed was searched through February 22, 2017, including studies that evaluated at least one type of RAS mutation in Cyto-I nodules, including any (or all) of the Bethesda III/IV/V categories or their equivalents and where the histological diagnosis was available. The PPV residual heterogeneity was investigated after accounting for Bethesda classification, blindedness of the histopathologist to the RAS mutational status, Bethesda category-specific cancer prevalence for each study, and which RAS genes and codons were tested. This was studied using five meta-regression models fit to different sets of Bethesda classification categories: Bethesda III, IV, or V (III/IV/V); Bethesda III or IV (III/IV); Bethesda III only; Bethesda IV only; and Bethesda V only. RESULTS Of 1831 studies, 23 were eligible for data inclusion. Wide ranges of PPV were found at 0-100%, 28-100%, and 0-100% in Bethesda III, IV, and V, respectively. Residual heterogeneity remained moderately high for PPV after accounting for the above moderators for Bethesda III/IV/V (21 studies; I2 = 59.5%) and Bethesda III/IV (19 studies; I2 = 66.0%), with significant Cochran's Q-test for residual heterogeneity (p < 0.001). Among individual Bethesda categories, residual heterogeneity was: Bethesda III (eight studies; I2 = 89.0%), IV (12 studies; I2 = 53.5%), and V (10 studies; I2 = 34.4%), with significant Cochran's Q-test for Bethesda III (p < 0.001) and IV (p = 0.04). CONCLUSION The PPV of RAS mutations in Bethesda III and IV categories is quite heterogeneous across different studies, creating low confidence in the accuracy of a single estimate of PPV. Clinicians must appreciate this wide variability when managing a RAS-mutated Cyto-I nodule. Future studies should seek to resolve this unexplained variability.
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Affiliation(s)
- Fadi Nabhan
- 1 Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - Kyle Porter
- 2 Center for Biostatistics, Division of Human Genetics, The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - Mark A Lupo
- 3 Thyroid and Endocrine Center of Florida , Sarasota, Florida
| | - Gregory W Randolph
- 4 Department of Otolaryngology Harvard Medical School Boston, Massachusetts
| | - Kepal N Patel
- 5 Division of Endocrine Surgery, NYU Langone Medical Center , New York, New York
| | - Richard T Kloos
- 6 Department of Medical Affairs, Veracyte, Inc. , South San Francisco, California
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Valderrabano P, McIver B. Evaluation and Management of Indeterminate Thyroid Nodules: The Revolution of Risk Stratification Beyond Cytological Diagnosis. Cancer Control 2018; 24:1073274817729231. [PMID: 28975825 PMCID: PMC5937245 DOI: 10.1177/1073274817729231] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
In accordance with National Guidelines, we currently follow a linear approach to the diagnosis of thyroid nodules, with management decision based primarily on a cytological diagnosis following fine-needle aspiration biopsy. However, 25% of these biopsies render an indeterminate cytology, leaving uncertainty regarding appropriate management. Individualizing the risk of malignancy of these nodules could improve their management significantly. We summarize the current evidence on the relevance of clinical information, radiological features, cytological features, and molecular markers tests results and describe how these can be integrated to personalize the management of thyroid nodules with indeterminate cytology. Several factors can be used to stratify the risk of malignancy in thyroid nodules with indeterminate cytology. Male gender, large tumors (>4 cm), suspicious sonographic patterns, and the presence of nuclear atypia on the cytology are all associated with an increased cancer prevalence. The added value of current molecular markers in the risk stratification process needs further study because their performance seems compromised in some clinical settings and remains to be validated in others. Risk stratification is possible in thyroid nodules with indeterminate cytology using data that are often underused by current guidelines. Future guidelines should integrate these factors and personalize the recommended diagnostic and therapeutic approaches accordingly.
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Affiliation(s)
- Pablo Valderrabano
- 1 Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Bryan McIver
- 1 Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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32
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de Koster EJ, de Geus-Oei LF, Dekkers OM, van Engen-van Grunsven I, Hamming J, Corssmit EPM, Morreau H, Schepers A, Smit J, Oyen WJG, Vriens D. Diagnostic Utility of Molecular and Imaging Biomarkers in Cytological Indeterminate Thyroid Nodules. Endocr Rev 2018; 39:154-191. [PMID: 29300866 DOI: 10.1210/er.2017-00133] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 12/27/2017] [Indexed: 12/21/2022]
Abstract
Indeterminate thyroid cytology (Bethesda III and IV) corresponds to follicular-patterned benign and malignant lesions, which are particularly difficult to differentiate on cytology alone. As ~25% of these nodules harbor malignancy, diagnostic hemithyroidectomy is still custom. However, advanced preoperative diagnostics are rapidly evolving.This review provides an overview of additional molecular and imaging diagnostics for indeterminate thyroid nodules in a preoperative clinical setting, including considerations regarding cost-effectiveness, availability, and feasibility of combining techniques. Addressed diagnostics include gene mutation analysis, microRNA, immunocytochemistry, ultrasonography, elastosonography, computed tomography, sestamibi scintigraphy, [18F]-2-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET), and diffusion-weighted magnetic resonance imaging.The best rule-out tests for malignancy were the Afirma® gene expression classifier and FDG-PET. The most accurate rule-in test was sole BRAF mutation analysis. No diagnostic had both near-perfect sensitivity and specificity, and estimated cost-effectiveness. Molecular techniques are rapidly advancing. However, given the currently available techniques, a multimodality stepwise approach likely offers the most accurate diagnosis, sequentially applying one sensitive rule-out test and one specific rule-in test. Geographical variations in cytology (e.g., Hürthle cell neoplasms) and tumor genetics strongly influence local test performance and clinical utility. Multidisciplinary collaboration and implementation studies can aid the local decision for one or more eligible diagnostics.
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Affiliation(s)
- Elizabeth J de Koster
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Olaf M Dekkers
- Department of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Jaap Hamming
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Eleonora P M Corssmit
- Department of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Abbey Schepers
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan Smit
- Department of Endocrinology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wim J G Oyen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.,Division of Radiotherapy and Imaging, Institute of Cancer Research, and Department of Nuclear Medicine, Royal Marsden Hospital, London, United Kingdom
| | - Dennis Vriens
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
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Cantisani MC, Parascandolo A, Perälä M, Allocca C, Fey V, Sahlberg N, Merolla F, Basolo F, Laukkanen MO, Kallioniemi OP, Santoro M, Castellone MD. A loss-of-function genetic screening identifies novel mediators of thyroid cancer cell viability. Oncotarget 2017; 7:28510-22. [PMID: 27058903 PMCID: PMC5053742 DOI: 10.18632/oncotarget.8577] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 03/02/2016] [Indexed: 12/31/2022] Open
Abstract
RET, BRAF and other protein kinases have been identified as major molecular players in thyroid cancer. To identify novel kinases required for the viability of thyroid carcinoma cells, we performed a RNA interference screening in the RET/PTC1(CCDC6-RET)-positive papillary thyroid cancer cell line TPC1 using a library of synthetic small interfering RNAs (siRNAs) targeting the human kinome and related proteins. We identified 14 hits whose silencing was able to significantly reduce the viability and the proliferation of TPC1 cells; most of them were active also in BRAF-mutant BCPAP (papillary thyroid cancer) and 8505C (anaplastic thyroid cancer) and in RAS-mutant CAL62 (anaplastic thyroid cancer) cells. These included members of EPH receptor tyrosine kinase family as well as SRC and MAPK (mitogen activated protein kinases) families. Importantly, silencing of the identified hits did not affect significantly the viability of Nthy-ori 3-1 (hereafter referred to as NTHY) cells derived from normal thyroid tissue, suggesting cancer cell specificity. The identified proteins are worth exploring as potential novel druggable thyroid cancer targets.
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Affiliation(s)
| | - Alessia Parascandolo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Universita' Federico II, Naples, Italy
| | - Merja Perälä
- Medical Biotechnology, VTT Technical Research Centre of Finland, Turku, Finland.,Center for Biotechnology, University of Turku, Turku, Finland
| | - Chiara Allocca
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Universita' Federico II, Naples, Italy
| | - Vidal Fey
- Medical Biotechnology, VTT Technical Research Centre of Finland, Turku, Finland.,Center for Biotechnology, University of Turku, Turku, Finland
| | - Niko Sahlberg
- Medical Biotechnology, VTT Technical Research Centre of Finland, Turku, Finland.,Center for Biotechnology, University of Turku, Turku, Finland
| | - Francesco Merolla
- Dipartimento di Scienze Biomediche Avanzate, Università Federico II, Naples, Italy
| | - Fulvio Basolo
- Division of Pathology, Department of Surgery, University of Pisa, Pisa, Italy
| | | | - Olli Pekka Kallioniemi
- FIMM-Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Massimo Santoro
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Universita' Federico II, Naples, Italy.,Istituto di Endocrinologia ed Oncologia Sperimentale "G. Salvatore" (IEOS), C.N.R., Naples, Italy
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34
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Valderrabano P, Khazai L, Leon ME, Thompson ZJ, Ma Z, Chung CH, Hallanger-Johnson JE, Otto KJ, Rogers KD, Centeno BA, McIver B. Evaluation of ThyroSeq v2 performance in thyroid nodules with indeterminate cytology. Endocr Relat Cancer 2017; 24:127-136. [PMID: 28104680 PMCID: PMC7771306 DOI: 10.1530/erc-16-0512] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/19/2017] [Indexed: 01/03/2023]
Abstract
ThyroSeq v2 claims high positive (PPV) and negative (NPV) predictive values in a wide range of pretest risks of malignancy in indeterminate thyroid nodules (ITNs) (categories B-III and B-IV of the Bethesda system). We evaluated ThyroSeq v2 performance in a cohort of patients with ITNs seen at our Academic Cancer Center from September 2014 to April 2016, in light of the new diagnostic criteria for non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Our study included 182 patients (76% female) with 190 ITNs consecutively tested with ThyroSeq v2. Patient treatment followed our institutional thyroid nodule clinical pathway. Histologies of nodules with follicular variant papillary thyroid carcinoma or NIFTP diagnoses were reviewed, with reviewers blinded to molecular results. ThyroSeq v2 performance was calculated in nodules with histological confirmation. We identified a mutation in 24% (n = 45) of the nodules. Mutations in RAS were the most prevalent (n = 21), but the positive predictive value of this mutation was much lower (31%) than that in prior reports. In 102 resected ITNs, ThyroSeq v2 performance was as follows: sensitivity 70% (46-88), specificity 77% (66-85), PPV 42% (25-61) and NPV 91% (82-97). The performance in B-IV nodules was significantly better than that in B-III nodules (area under the curve 0.84 vs 0.57, respectively; P = 0.03), where it was uninformative. Further studies evaluating ThyroSeq v2 performance are needed, particularly in B-III.
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Affiliation(s)
- Pablo Valderrabano
- Department of Head and Neck-Endocrine OncologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Laila Khazai
- Department of Anatomic PathologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Marino E Leon
- Department of Anatomic PathologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Zachary J Thompson
- Department of Biostatistics and BioinformaticsH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Zhenjun Ma
- Department of Biostatistics and BioinformaticsH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Christine H Chung
- Department of Head and Neck-Endocrine OncologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Julie E Hallanger-Johnson
- Department of Head and Neck-Endocrine OncologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Kristen J Otto
- Department of Head and Neck-Endocrine OncologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Kara D Rogers
- Department of Head and Neck-Endocrine OncologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Barbara A Centeno
- Department of Anatomic PathologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Bryan McIver
- Department of Head and Neck-Endocrine OncologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
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35
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Clinkscales W, Ong A, Nguyen S, Harruff EE, Gillespie MB. Diagnostic Value of RAS Mutations in Indeterminate Thyroid Nodules. Otolaryngol Head Neck Surg 2017; 156:472-479. [PMID: 28116986 DOI: 10.1177/0194599816685697] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objectives To determine the diagnostic value of HRAS, KRAS, and NRAS mutations in fine-needle aspiration biopsies of thyroid nodules that are nondiagnostic on cytology. Data Sources PubMed, Scopus, Embase, CINAHL. Review Methods Two authors independently searched the data sources. To be included, studies reported the RAS mutational status and postoperative histopathologic diagnosis of nodules that exhibited indeterminate cytology after fine-needle aspiration biopsy. Data were extracted to calculate sensitivity, specificity, and positive/negative predictive values of any HRAS, KRAS, or NRAS mutation. A meta-analysis was performed to generate pooled values for each parameter. Results A total of 7 studies with a combined 1025 patients met inclusion criteria. The pooled sensitivity of a RAS mutation for detecting cancer was 0.343 (95% confidence interval [95% CI], 0.198-0.506), while the pooled specificity was 0.935 (95% CI, 0.882-0.973). The weighted averages for positive predictive value and negative predictive value were 78.0% and 64.0%, respectively, with 68.0% accuracy. The positive likelihood ratio was 4.235 (95% CI, 1.506-11.910), and the negative likelihood ratio was 0.775 (95% CI, 0.630-0.953). Conclusion Our data suggest that testing for any RAS mutation is unlikely to change the clinical management of thyroid nodules that have indeterminate cytology. While a RAS mutation may rule in malignancy, the sensitivity of testing is low enough to merit further mutational analysis, repeat fine-needle aspiration, or surgical excision, even in the presence of a negative test.
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Affiliation(s)
- William Clinkscales
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Adrian Ong
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun Nguyen
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Elizabeth Emily Harruff
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Marion Boyd Gillespie
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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36
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Rossi ED, Martini M, Capodimonti S, Cenci T, Larocca LM. The role of miRNAs in the evaluation of follicular thyroid neoplasms: an overview of literature. J Am Soc Cytopathol 2017; 6:96-104. [PMID: 31043264 DOI: 10.1016/j.jasc.2017.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/07/2017] [Accepted: 02/07/2017] [Indexed: 01/21/2023]
Abstract
MicroRNA (miRNA) deregulation has been frequently associated with different human cancers. Not only have miRNAs been involved in almost every cellular function but they have also been linked with a significant number of cancers including thyroid carcinomas. Specifically, thyroid tumors encompass several different miRNA profiles based on the histotypes. Furthermore, thyroid lesions with their broad spectrum of neoplasms (from benign to malignant entities) offer the possibility of studying and recognizing specific subsets of different up-and downregulated miRNAs in each different entity. To date, the majority of authors completed their evaluation mostly by including histologic samples of thyroid tumors. Nonetheless, in the last years, a few studies are focusing on the role of miRNA expression in thyroid fine-needle aspiration cytology (FNAC) regardless of the cytologic preparation, including liquid-based cytology. This growing interest is driven by the possible role of miRNAs in the malignant risk stratification, especially for the indeterminate categories of follicular neoplasms (FNs). In this review we overview the reliability of analyzing miRNAs on thyroid lesions, including those diagnosed as FNs, to identify whether their profiles are likely to distinguish benign from malignant lesions, providing a predictive molecular diagnosis on FNAC.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Department of Pathology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy.
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology, Department of Pathology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Sara Capodimonti
- Division of Anatomic Pathology and Histology, Department of Pathology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Tonia Cenci
- Division of Anatomic Pathology and Histology, Department of Pathology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology, Department of Pathology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
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Abstract
The detection of thyroid nodules, consisting of different diseases, represents a common finding in population. Their evaluation and diagnosis are mostly achieved with fine-needle aspiration cytology (FNAC). Even though the majority of thyroid nodules are correctly diagnosed, a total of 25% to 30% of them are classified "indeterminate" comprising lesions with varying risk of malignancy and different types of management. Although the number of thyroid FNACs, including small lesions, is increasing due to the reliance upon sonographic and cytologic interpretations, there are issues concerning cytomorphologic interpretation and interobserver reproducibility. Different classification systems have tried to better define the criteria for inclusion in specific categories and to therefore reduce the rate of indeterminate diagnoses such as atypia of undetermined significance, follicular neoplasms, and suspicious for malignancy. However, the support of ancillary techniques (eg, immunocytochemistry and molecular analysis) are reshaping morphologic diagnoses made on materials obtained from FNAC.
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38
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Patel SG, Carty SE, McCoy KL, Ohori NP, LeBeau SO, Seethala RR, Nikiforova MN, Nikiforov YE, Yip L. Preoperative detection of RAS mutation may guide extent of thyroidectomy. Surgery 2016; 161:168-175. [PMID: 27863786 DOI: 10.1016/j.surg.2016.04.054] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/25/2016] [Accepted: 04/30/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Preoperative detection of RAS mutations can contribute to cancer risk assessment in indeterminate thyroid nodules, although RAS is not always associated with malignancy. METHODS Fine-needle aspiration samples classified in 1 of 3 indeterminate cytology categories were prospectively tested for N-, H-, and K-RAS mutations using next-generation sequencing assay. RESULTS In the study, 93 patients with 94 nodules had preoperative RAS detected, of whom 86 patients had an operation (69% total thyroidectomy, 29% lobectomy). In total, 76% of RAS-positive nodules were malignant and follicular variant papillary thyroid cancer was the most common cancer type (83%). HRAS mutations had the greatest risk of cancer (92%) followed by NRAS (74%) and KRAS (64%; P = .05). No preoperative variables were associated with malignancy including age (P = .07), sex (P = .49), RAS isoform (P = .05), mutational allelic frequency (P = .49), nodule size (P = .14), cytology category (P = .63), or ultrasound bilaterality (P = .24), multifocality (P = .23), or presence of ≥1 suspicious feature (P = .86). Only 60% of patients with a unifocal nodule on ultrasound had single focus low-risk encapsulated follicular variant papillary thyroid cancer or benign disease. CONCLUSION Preoperative RAS mutation detection in thyroid nodules carries a substantial risk of cancer with a greater risk associated with HRAS and NRAS. Most RAS malignancies are follicular variant papillary thyroid cancer, which may inform the extent of operation.
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Affiliation(s)
- Snehal G Patel
- Department of Surgery, Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Sally E Carty
- Department of Surgery, Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Kelly L McCoy
- Department of Surgery, Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, PA
| | - N Paul Ohori
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA
| | - Shane O LeBeau
- Department of Medicine, Division of Endocrinology, University of Pittsburgh, Pittsburgh, PA
| | - Raja R Seethala
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA
| | | | - Yuri E Nikiforov
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA
| | - Linwah Yip
- Department of Surgery, Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, PA.
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39
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Ting S, Synoracki S, Bockisch A, Führer D, Schmid KW. [Clinical importance of thyroid gland cytology]. DER PATHOLOGE 2016; 36:543-52. [PMID: 26462485 DOI: 10.1007/s00292-015-0093-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The cytological evaluation of fine needle biopsies (FNB) of the thyroid gland crucially depends on a close cooperation between clinicians and cytopathologists. Scintigraphy, sonography as well as clinical data and patient history are necessary for a correct interpretation of the indications for FNB; moreover, these data are of outstanding importance for cytopathologists for the correct interpretation of the cytomorphological findings. This overview describes the present standards in the acquisition, technical workup and cytopathological interpretation of thyroid gland tissue obtained by FNB, particularly focusing on the rapidly growing relevance of additional molecular pathological investigations to increase the diagnostic accuracy of thyroid FNB.
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40
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Udager AM, McHugh JB, Betz BL, Montone KT, Livolsi VA, Seethala RR, Yakirevich E, Iwenofu OH, Perez-Ordonez B, DuRoss KE, Weigelin HC, Lim MS, Elenitoba-Johnson KSJ, Brown NA. ActivatingKRASmutations are characteristic of oncocytic sinonasal papilloma and associated sinonasal squamous cell carcinoma. J Pathol 2016; 239:394-8. [DOI: 10.1002/path.4750] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/19/2016] [Accepted: 05/23/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Aaron M Udager
- Department of Pathology; University of Michigan Health System; Ann Arbor MI USA
| | - Jonathan B McHugh
- Department of Pathology; University of Michigan Health System; Ann Arbor MI USA
| | - Bryan L Betz
- Department of Pathology; University of Michigan Health System; Ann Arbor MI USA
| | - Kathleen T Montone
- Department of Pathology; Perelman School of Medicine at University of Pennsylvania; Philadelphia PA USA
| | - Virginia A Livolsi
- Department of Pathology; Perelman School of Medicine at University of Pennsylvania; Philadelphia PA USA
| | - Raja R Seethala
- Department of Pathology; University of Pittsburgh Medical Center; Pittsburgh PA USA
| | | | - O Hans Iwenofu
- Department of Pathology; Ohio State University; Columbus OH USA
| | | | - Kathleen E DuRoss
- Department of Pathology; University of Michigan Health System; Ann Arbor MI USA
| | - Helmut C Weigelin
- Department of Pathology; University of Michigan Health System; Ann Arbor MI USA
| | - Megan S Lim
- Department of Pathology; Perelman School of Medicine at University of Pennsylvania; Philadelphia PA USA
| | - Kojo SJ Elenitoba-Johnson
- Department of Pathology; Perelman School of Medicine at University of Pennsylvania; Philadelphia PA USA
| | - Noah A Brown
- Department of Pathology; University of Michigan Health System; Ann Arbor MI USA
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41
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Valderrabano P, Leon ME, Centeno BA, Otto KJ, Khazai L, McCaffrey JC, Russell JS, McIver B. Institutional prevalence of malignancy of indeterminate thyroid cytology is necessary but insufficient to accurately interpret molecular marker tests. Eur J Endocrinol 2016; 174:621-9. [PMID: 26903551 DOI: 10.1530/eje-15-1163] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/17/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Several molecular marker tests are available to refine the diagnosis of thyroid nodules. Knowing the true prevalence of malignancy (PoM) within each cytological category is considered necessary to select the most appropriate test and to interpret results accurately. We describe our institutional PoM among cytological categories and report our experience with molecular markers. DESIGN Single-center retrospective study. METHODS We calculated the institutional PoM for each category of the Bethesda system (Bethesda) on all thyroid nodules with cytological evaluation from October 2008 to May 2014. We estimated the predictive values for Afirma, miRInform, and ThyroSeq v2, based on published sensitivity and specificity. Finally, we assessed our own experience with miRInform. RESULTS The PoMs for Bethesda III and IV categories were 21 and 28%, respectively. ThyroSeq v2 achieves the highest theoretical negative and positive predictive values (NPV and PPV) in Bethesda III (98 and 75%) and Bethesda IV categories (96 and 83%). At our institution, miRInform detected a mutation in 16% of 109 indeterminate nodules tested, all in Bethesda IV specimens. Histology was available in 56 (51%) nodules. The observed sensitivity and specificity in Bethesda IV specimens were 63 and 86%, yielding an NPV and a PPV of 75 and 77%, respectively. CONCLUSIONS For our current Bethesda III and IV PoM, the actual performance of miRInform was worse than expected. Theoretically ThyroSeq v2 should have the best performance, but it could be affected in the same way as miRInform, given the similarities between the tests. Assessing the institutional performance of each test is necessary along with PoM individualization.
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Affiliation(s)
| | - Marino E Leon
- Department of Anatomic PathologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Barbara A Centeno
- Department of Anatomic PathologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Kristen J Otto
- Department of Head and Neck, and Endocrine OncologyTampa, Florida, USA
| | - Laila Khazai
- Department of Anatomic PathologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | | | - Jeffery S Russell
- Department of Head and Neck, and Endocrine OncologyTampa, Florida, USA
| | - Bryan McIver
- Department of Head and Neck, and Endocrine OncologyTampa, Florida, USA
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Joudeh AA, Shareef SQ, Al-Abbadi MA. Fine-Needle Aspiration Followed by Core-Needle Biopsy in the Same Setting: Modifying Our Approach. Acta Cytol 2016; 60:1-13. [PMID: 26963594 DOI: 10.1159/000444386] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/29/2016] [Indexed: 01/01/2023]
Abstract
Fine-needle aspiration biopsy (FNAB) is a well-established initial diagnostic tool. However, in some instances limitations and shortcomings arise, making it insufficient for determining a specific diagnosis. Consequently, patients have to undergo another diagnostic procedure. The second procedure is either repeat FNAB, core-needle or open biopsy, and can be inconvenient and costly. In some centers, the FNAB is immediately followed by core-needle biopsy (CNB) in the same setting after assuring adequacy on the initial FNAB utilizing rapid on-site specimen evaluation (ROSE). It is argued that implementing such an approach will eventually have additional critical advantages that include the following: (a) it is more convenient to patients to have both procedures in one visit, (b) the tissue procured by both procedures will be more adequate, enabling cytopathologists to reach an accurate diagnosis, and (c) it is ultimately a cost-effective approach if we take into consideration the avoidance of a potential second more invasive diagnostic procedure. Since we are living in an era of patient-centered medicine coupled with cost-cutting strategies, we present here a brief review of the topic with analysis of this alternative approach, review of the pertinent literature and shed light on a few scenarios that justify this approach.
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Affiliation(s)
- Amani A Joudeh
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia
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Zolotov S. Genetic Testing in Differentiated Thyroid Carcinoma: Indications and Clinical Implications. Rambam Maimonides Med J 2016; 7:RMMJ.10236. [PMID: 26886957 PMCID: PMC4737515 DOI: 10.5041/rmmj.10236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Differentiated thyroid cancer (DTC) is a common and diverse endocrine malignancy. In most patients DTC results in an indolent and curable disease. Nevertheless, disease recurrence rates are relatively high (10%-30%), while 5% of the patients are resistant to conventional treatment and some of these patients are incurable. Over the past 20 years much progress has been made in identifying genetic changes that occur in DTC. In addition, studies aimed to understand the role of these genetic changes in tumorigenesis and their effects on the clinical characteristics of the disease have been conducted. The accrued knowledge has set the stage for development of genetic tests aimed to identify these changes in samples obtained from DTC patients and use this information in the clinical decision process. This paper reviews genetic changes that were identified in DTC, and how the emerging data obtained by genetic testing are currently used to gain key information on the diagnosis, risk stratification, and personalized care of DTC patients.
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Affiliation(s)
- Sagit Zolotov
- Institute of Endocrinology, Diabetes, and Metabolism, Rambam Health Care Campus, Haifa, Israel
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Lu JY, Hung PJ, Chen PL, Yen RF, Kuo KT, Yang TL, Wang CY, Chang TC, Huang TS, Chang CC. Follicular thyroid carcinoma with NRAS Q61K and GNAS R201H mutations that had a good (131)I treatment response. Endocrinol Diabetes Metab Case Rep 2016; 2016:150067. [PMID: 26788326 PMCID: PMC4716662 DOI: 10.1530/edm-15-0067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 01/05/2016] [Indexed: 12/13/2022] Open
Abstract
UNLABELLED We report a case of follicular thyroid carcinoma with concomitant NRAS p.Q61K and GNAS p.R201H mutations, which manifested as a 13.5 cm thyroid mass with lung, humerus and T9 spine metastases, and exhibited good response to radioactive iodine treatment. LEARNING POINTS GNAS p.R201H somatic mutation is an activating or gain-of-function mutation resulting in constitutively activated Gs-alpha protein and downstream cAMP cascade, independent of TSH signaling, causing autonomously functioning thyroid nodules. NRAS p.Q61K mutations with GNAS p.R201H mutations are known for a good radioactive iodine treatment response.Further exploration of the GNAS-activating pathway may provide therapeutic insights into the treatment of metastatic follicular carcinoma.
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Affiliation(s)
- Jin-Ying Lu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital , Taipei, 100 , Taiwan
| | - Po-Ju Hung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital , Taipei, 100 , Taiwan
| | - Pei-Lung Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan; Department of Medical Genetics, National Taiwan University Hospital, Taipei, 100, Taiwan; Graduate Institute of Medical Genomics and Proteomics, National Taiwan University, Taipei, 100, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, 100, Taiwan; Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, 100, Taiwan
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University , Taipei, 100 , Taiwan
| | - Kuan-Ting Kuo
- Graduate Institute of Pathology, College of Medicine, National Taiwan University, Taipei, 100, Taiwan; Department of Pathology, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Tsung-Lin Yang
- Department of Otolaryngology, National Taiwan University Hospital , Taipei, 100 , Taiwan
| | - Chih-Yuan Wang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital , Taipei, 100 , Taiwan
| | - Tien-Chun Chang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan; Department of Medicine, College of Medicine, National Taiwan University, Taipei, 100, Taiwan
| | - Tien-Shang Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan; Department of Medicine, College of Medicine, National Taiwan University, Taipei, 100, Taiwan; Department of Social Medicine, College of Medicine, National Taiwan University, Taipei, 100, Taiwan; Department of Medicine, Cathay General Hospital, Taipei, 106, Taiwan
| | - Ching-Chung Chang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan; Department of Medicine, College of Medicine, National Taiwan University, Taipei, 100, Taiwan; Department of Internal Medicine, China Medical University Hospital, Taichung, 404, Taiwan; Department of Internal Medicine, China Medical University, Taichung, 404, Taiwan
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Tumor genotype determines phenotype and disease-related outcomes in thyroid cancer: a study of 1510 patients. Ann Surg 2015; 262:519-25; discussion 524-5. [PMID: 26258321 DOI: 10.1097/sla.0000000000001420] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To correlate thyroid cancer genotype with histology and outcomes. BACKGROUND The prognostic significance of molecular signature in thyroid cancer (TC) is undefined but can potentially change surgical management. METHODS We reviewed a consecutive series of 1510 patients who had initial thyroidectomy for TC with routine testing for BRAF, RAS, RET/PTC, and PAX8/PPARG alterations. Histologic metastatic or recurrent TC was tracked for 6 or more months after oncologic thyroidectomy. RESULTS Papillary thyroid cancer (PTC) was diagnosed in 97% of patients and poorly differentiated/anaplastic TC in 1.1%. Genetic alterations were detected in 1039 (70%); the most common mutations were BRAFV600E (644/1039, 62%), and RAS isoforms (323/1039, 31%). BRAFV600E-positive PTC was often conventional or tall cell variant (58%), with frequent extrathyroidal extension (51%) and lymph node metastasis (46%). Conversely, RAS-positive PTC was commonly follicular variant (87%), with infrequent extrathyroidal extension (4.6%) and lymph node metastasis (5.6%). BRAFV600E and RET/PTC-positive PTCs were histologically similar. Analogously, RAS and PAX8/PPARG-positive PTCs were histologically similar. Compared with RAS or PAX8/PPARG-positive TCs, BRAFV600E or RET/PTC-positive TCs were more often associated with stage III/IV disease (40% vs 15%, P < 0.001) and recurrence (10% vs 0.7%, P < 0.001; mean follow-up 33 ± 21 mo). Distant metastasis was highest in patients with RET/PTC-positive TC (10.8%, P = 0.02). CONCLUSIONS In this large study of prospective mutation testing in unselected patients with TC, molecular signature was associated with distinctive phenotypes including cancers, with higher risks of both distant metastasis and early recurrence. Preoperative genotype provides valuable prognostic data to appropriately inform surgery.
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Medici M, Kwong N, Angell TE, Marqusee E, Kim MI, Frates MC, Benson CB, Cibas ES, Barletta JA, Krane JF, Ruan DT, Cho NL, Gawande AA, Moore FD, Alexander EK. The variable phenotype and low-risk nature of RAS-positive thyroid nodules. BMC Med 2015; 13:184. [PMID: 26253102 PMCID: PMC4528713 DOI: 10.1186/s12916-015-0419-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/10/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Oncogenic mutations are common in thyroid cancers. While the frequently detected RAS-oncogene mutations have been studied for diagnostic use in cytologically indeterminate thyroid nodules, no investigation has studied such mutations in an unselected population of thyroid nodules. No long-term study of RAS-positive thyroid nodules has been performed. METHODS We performed a prospective, blinded cohort study in 362 consecutive patients presenting with clinically relevant (>1 cm) thyroid nodules. Fine needle aspiration cytology and mutational testing were obtained for all nodules. Post-operative histopathology was obtained for malignant or indeterminate nodules, and benign nodules were sonographically followed. Histopathological features were compared between RAS- and BRAF-positive malignancies. RAS-positive benign nodules were analyzed for growth or cellular change from prior aspirations. RESULTS Overall, 17 of 362 nodules were RAS-positive. Nine separate nodules were BRAF-positive, of which eight underwent surgery and all proved malignant (100%). Out of the 17 RAS-positive nodules, ten underwent surgery, of which eight proved malignant (47%). All RAS-positive malignancies were low risk - all follicular variants of papillary carcinoma, without extrathyroidal extension, metastases, or lymphovascular invasion. RAS-positivity was associated with malignancy in younger patients (P = 0.028). Of the nine RAS-positive benign nodules, five had long-term prospective sonographic follow-up (mean 8.3 years) showing no growth or signs of malignancy. Four of these nodules also had previous aspirations (mean 5.8 years prior), all with similar benign results. CONCLUSIONS While RAS-oncogene mutations increase malignancy risk, these data demonstrate a low-risk phenotype for most RAS-positive cancers. Furthermore, cytologically benign, yet RAS-positive nodules behave in an indolent fashion over years. RAS-positivity alone should therefore not dictate clinical decisions.
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Affiliation(s)
- Marco Medici
- Thyroid Section, Division of Endocrinology, Hypertension and Diabetes, The Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, PBB-B4 Room 417, Boston, MA, 02115, USA.
| | - Norra Kwong
- Thyroid Section, Division of Endocrinology, Hypertension and Diabetes, The Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, PBB-B4 Room 417, Boston, MA, 02115, USA.
| | - Trevor E Angell
- Thyroid Section, Division of Endocrinology, Hypertension and Diabetes, The Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, PBB-B4 Room 417, Boston, MA, 02115, USA.
| | - Ellen Marqusee
- Thyroid Section, Division of Endocrinology, Hypertension and Diabetes, The Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, PBB-B4 Room 417, Boston, MA, 02115, USA.
| | - Matthew I Kim
- Thyroid Section, Division of Endocrinology, Hypertension and Diabetes, The Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, PBB-B4 Room 417, Boston, MA, 02115, USA.
| | - Mary C Frates
- Department of Radiology, The Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Carol B Benson
- Department of Radiology, The Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Edmund S Cibas
- Department of Pathology, The Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Justine A Barletta
- Department of Pathology, The Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Jeffrey F Krane
- Department of Pathology, The Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Daniel T Ruan
- Department of Surgery, The Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Nancy L Cho
- Department of Surgery, The Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Atul A Gawande
- Department of Surgery, The Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Francis D Moore
- Department of Surgery, The Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Erik K Alexander
- Thyroid Section, Division of Endocrinology, Hypertension and Diabetes, The Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, PBB-B4 Room 417, Boston, MA, 02115, USA.
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Yoon JH, Kwon HJ, Lee HS, Kim EK, Moon HJ, Kwak JY. RAS Mutations in AUS/FLUS Cytology: Does it Have an Additional Role in BRAFV600E Mutation-Negative Nodules? Medicine (Baltimore) 2015; 94:e1084. [PMID: 26166089 PMCID: PMC4504621 DOI: 10.1097/md.0000000000001084] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The object of this study is to evaluate the additional role of RAS mutation in detecting thyroid malignancy among BRAF mutation-negative nodules diagnosed as atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) on cytology.From December 2009 to December 2011, 202 BRAF mutation-negative thyroid nodules diagnosed as AUS/FLUS cytology in 201 patients were included in this study. RAS mutation analysis was performed using residual material from ultrasonography-guided fine needle aspiration (US-FNA) cytology testing for K-RAS, N-RAS, and H-RAS codons 12/13 and 61 point mutations. The authors evaluated the association between RAS mutation status and cytopathologic characteristics.Of the 202 BRAF mutation-negative thyroid nodules with AUS/FLUS cytology, 4 were considered insufficient for mutation analysis. Of the 198 thyroid nodules, 148 (74.7%) were confirmed as benign and 50 (25.3%) as malignant. Thirty-one (15.7%) of the 198 thyroid nodules were positive for any RAS mutation, 4 positive for K-RAS 12/13, 26 for N-RAS 61, and 1 positive for H-RAS 61. Seven (22.6%) of the RAS mutation positive nodules were malignant, 1 with K-RAS 12/13, 6 with N-RAS 61. Twenty-four (77.4%) of the 31 nodules positive for K-RAS 12/13 (N = 3), N-RAS 61 (N = 20), or H-RAS 61 (N = 1) mutations were proven benign. None of the 198 thyroid nodules were positive for K-RAS 61, N-RAS 12/13, or H-RAS 12/13 mutations.N-RAS 61 mutation is the most common mutation detected among BRAF mutation-negative nodules with AUS/FLUS cytology. RAS mutation has limited value in predicting malignancy among BRAF mutation-negative thyroid nodules with AUS/FLUS cytology and further, investigation is anticipated to evaluate the true role of RAS mutation in thyroid malignancy.
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Affiliation(s)
- Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science (JHY, E-KK, HJM, JYK); Department of Pathology, Yonsei University, College of Medicine (HJK); Department of Pathology, Yonsei University, Wonju College of Medicine (HJK); and Biostastistics Collaboration Unit, Medical Research Center, Yonsei University, College of Medicine (HSL), Seoul, South Korea
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Abstract
Background Despite lack of adequate, validated, independently performed clinical studies, several molecular tests are commercially available on the market and are being used on indeterminate thyroid nodules to guide patient-care decisions. Methods We summarize the current evidence on the role and limitations of molecular tests used in combination with thyroid cytopathology to refine the presurgical diagnosis of thyroid nodules. Results The clinical performance of molecular tests depends on the pretest risk of malignancy within the specific cytological group being assessed. This risk is variable and should be assessed at each institution to optimize the selection of the molecular test and the interpretation of its results. Next-generation sequencing has increased the sensitivity of oncogene panels while maintaining high specificity. Tests assessing the gene expression pattern have shown promising results, with high sensitivity but low specificity. The impacts of molecular markers on clinical practice remains in flux and their effect on health care costs remains poorly understood. Conclusions Further large, independent, confirmatory, clinical validation studies and real-world, cost-effectiveness studies are necessary before the widespread adoption of these tests can be endorsed as standard of care.
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