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Teodoriu L, Ungureanu MC, Matei M, Grierosu I, Saviuc AI, Wael J, Ivanov I, Dragos L, Danila R, Cristian V, Costandache MA, Iftene A, Preda C, Stefanescu C. BRAF Detection in FNAC Combined with Semi-Quantitative 99mTc-MIBI Technique and AI Model, an Economic and Efficient Predicting Tool for Malignancy in Thyroid Nodules. Diagnostics (Basel) 2024; 14:1398. [PMID: 39001288 PMCID: PMC11241294 DOI: 10.3390/diagnostics14131398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 06/22/2024] [Accepted: 06/27/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Technology allows us to predict a histopathological diagnosis, but the high costs prevent the large-scale use of these possibilities. The current liberal indication for surgery in benign thyroid conditions led to a rising frequency of incidental thyroid carcinoma, especially low-risk papillary micro-carcinomas. METHODS We selected a cohort of 148 patients with thyroid nodules by ultrasound characteristics and investigated them by fine needle aspiration cytology (FNAC)and prospective BRAF collection for 70 patients. Also, we selected 44 patients with thyroid nodules using semi-quantitative functional imaging with an oncological, 99mTc-methoxy-isobutyl-isonitrile (99mTc-MIBI) radiotracer. RESULTS Following a correlation with final histopathological reports in patients who underwent thyroidectomy, we introduced the results in a machine learning program (AI) in order to obtain a pattern. For semi-quantitative functional visual pattern imaging, we found a sensitivity of 33%, a specificity of 66.67%, an accuracy of 60% and a negative predicting value (NPV) of 88.6%. For the wash-out index (WOind), we found a sensitivity of 57.14%, a specificity of 50%, an accuracy of 70% and an NPV of 90.06%.The results of BRAF in FNAC included 87.50% sensitivity, 75.00% specificity, 83.33% accuracy, 75.00% NPV and 87.50% PPV. The prevalence of malignancy in our small cohort was 11.4%. CONCLUSIONS We intend to continue combining preoperative investigations such as molecular detection in FNAC, 99mTc-MIBI scanning and AI training with the obtained results on a larger cohort. The combination of these investigations may generate an efficient and cost-effective diagnostic tool, but confirmation of the results on a larger scale is necessary.
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Affiliation(s)
- Laura Teodoriu
- Endocrinology Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Maria-Christina Ungureanu
- Endocrinology Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Mioara Matei
- Preventive Medicine and Interdisciplinarity Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Irena Grierosu
- Biophysics and Medical Physics-Nuclear Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Alexandra Iuliana Saviuc
- Biophysics and Medical Physics-Nuclear Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Jalloul Wael
- Biophysics and Medical Physics-Nuclear Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Iuliu Ivanov
- Center of Fundamental Research and Experimental Development in Translational Medicine, Regional Institute of Oncology, 700483 Iasi, Romania
| | - Loredana Dragos
- Center of Fundamental Research and Experimental Development in Translational Medicine, Regional Institute of Oncology, 700483 Iasi, Romania
| | - Radu Danila
- Department of Surgery, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Velicescu Cristian
- Department of Surgery, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania
| | | | - Adrian Iftene
- Faculty of Computer Science, "Alexandru Ioan Cuza" University, 700506 Iasi, Romania
| | - Cristina Preda
- Endocrinology Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Cipriana Stefanescu
- Biophysics and Medical Physics-Nuclear Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania
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Jin X, Lew M, Pantanowitz L, Iyengar JJ, Haymart MR, Papaleontiou M, Broome D, Sandouk Z, Raja SS, Hughes DT, Smola B, Jing X. Performance of Afirma genomic sequencing classifier and histopathological outcome in Bethesda category III thyroid nodules: Initial versus repeat fine-needle aspiration. Diagn Cytopathol 2023; 51:698-704. [PMID: 37519144 DOI: 10.1002/dc.25203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/10/2023] [Accepted: 07/20/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND There is limited data comparing the performance of Afirma Genomic Sequencing Classifier (GSC) in thyroid nodules carrying an initial versus a repeat diagnosis of atypia of undetermined significance (AUS). This study reported an institutional experience in this regard. MATERIALS AND METHODS This retrospective study included consecutive thyroid nodules that had an initial or a repeat AUS diagnosis and had a subsequent GSC diagnostic result (benign or suspicious) from 2017 to 2021. All nodules were followed by surgical intervention or by clinical and/or ultrasound monitoring. GSC's benign call rate (BCR), rate of histology-proven malignancy associated with a suspicious GSC result, and diagnostic parameters of GSC were calculated and compared between the two cohorts (initial versus repeat AUS). Statistical significance was defined with a p-value of <.05 for all analysis. RESULTS A total of 202 cases fulfilled inclusion criteria, including 67 and 135 thyroid nodules with an initial and a repeat AUS diagnosis, respectively. BCR was 67% and 66% in initial and repeat AUS cohorts, respectively. Rate of histology-proven malignancy associated with a suspicious GSC result were 22% and 24% in initial and repeat AUS cohorts, respectively. Compared with the repeat AUS cohort, the initial AUS cohort showed slightly lower sensitivity (83% vs. 100%), specificity (70% vs. 73%), PPV (23% vs. 24%), NPV (98% vs. 100%), and diagnostic accuracy (72% vs. 75%). Nevertheless, these differences did not reach statistical significance. CONCLUSION GSC demonstrated comparable performance in thyroid nodules with a repeat AUS diagnosis versus nodules with an initial AUS diagnosis.
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Affiliation(s)
- Xiaobing Jin
- Department of Pathology, University of Michigan-Michigan Medicine, Ann Arbor, Michigan, USA
| | - Madelyn Lew
- Department of Pathology, University of Michigan-Michigan Medicine, Ann Arbor, Michigan, USA
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jennifer J Iyengar
- Department of Internal Medicine, University of Michigan-Michigan Medicine, Ann Arbor, Michigan, USA
| | - Megan R Haymart
- Department of Internal Medicine, University of Michigan-Michigan Medicine, Ann Arbor, Michigan, USA
| | - Maria Papaleontiou
- Department of Internal Medicine, University of Michigan-Michigan Medicine, Ann Arbor, Michigan, USA
| | - David Broome
- Department of Internal Medicine, University of Michigan-Michigan Medicine, Ann Arbor, Michigan, USA
| | - Zahrae Sandouk
- Department of Internal Medicine, University of Michigan-Michigan Medicine, Ann Arbor, Michigan, USA
| | - Sobia S Raja
- Department of Internal Medicine, University of Michigan-Michigan Medicine, Ann Arbor, Michigan, USA
| | - David T Hughes
- Department of Surgery, University of Michigan-Michigan Medicine, Ann Arbor, Michigan, USA
| | - Brian Smola
- Department of Pathology, University of Michigan-Michigan Medicine, Ann Arbor, Michigan, USA
| | - Xin Jing
- Department of Pathology, University of Michigan-Michigan Medicine, Ann Arbor, Michigan, USA
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Słowińska-Klencka D, Klencki M, Duda-Szymańska J, Popowicz B. Optimization of the Management of Category III Thyroid Nodules Using Repeat FNA and TIRADS. Cancers (Basel) 2022; 14:cancers14184489. [PMID: 36139649 PMCID: PMC9496843 DOI: 10.3390/cancers14184489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of the study was to examine the benefits of the joint use of repeat FNA (rFNA) and EU-TIRADS in category III nodules in relation to the kind of atypia: nuclear vs. architectural (denoted by AUS and FLUS respectively). The study included 127 AUS and 1739 FLUS nodules with a known category of EU-TIRADS. Repeat FNA was performed in 82 AUS and 934 FLUS nodules of which 57 and 515 were excised, respectively. AUS nodules had higher malignancy risk than FLUS nodules. EU-TIRADS showed higher accuracy for AUS nodules, the opposite to rFNA, that had higher accuracy for FLUS nodules. The combined criterion for AUS nodules (at least rFNA-V or EU-TIRADS-4) maximized sensitivity (92.3%) with acceptable specificity (70.0%); OR: 28.0. In the case of FLUS nodules, the combined criterion (rFNA-V or EU-TIRADS-5) maximized specificity (95.2%) with 57.7% sensitivity and a low percentage (13.9%) of positive nodules, OR: 27.0. In both types of nodules, the low risk category in EU-TIRADS and benign result of rFNA excluded cancer. Concluding, category III nodules with and without nuclear atypia differ in their risk of malignancy and, consequently, diagnostic criteria adopted for the evaluation of these nodules with rFNA and EU-TIRADS should be specific to AUS and FLUS nodules.
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Affiliation(s)
- Dorota Słowińska-Klencka
- Department of Morphometry of Endocrine Glands, Medical University of Lodz, 251 Pomorska Str., 92-213 Lodz, Poland
- Correspondence: (D.S.-K.); (M.K.)
| | - Mariusz Klencki
- Department of Morphometry of Endocrine Glands, Medical University of Lodz, 251 Pomorska Str., 92-213 Lodz, Poland
- Correspondence: (D.S.-K.); (M.K.)
| | - Joanna Duda-Szymańska
- Department of Pathomorphology, Medical University of Lodz, 251 Pomorska Str., 92-213 Lodz, Poland
| | - Bożena Popowicz
- Department of Morphometry of Endocrine Glands, Medical University of Lodz, 251 Pomorska Str., 92-213 Lodz, Poland
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