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Yakubouski SU, Kandratsenka HH, Fridman MV, Kondratovich VA, Perkhova OA. Diagnostic Performance of Thyroid FNA: Experience of Belarusian National Referral Thyroid Cancer Center. Diagn Cytopathol 2024. [PMID: 39221609 DOI: 10.1002/dc.25391] [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: 04/18/2024] [Revised: 07/20/2024] [Accepted: 07/24/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND A fine-needle aspiration (FNA) biopsy is a basic procedure to verify the morphology of thyroid nodules. However, significant variations in the diagnostic performance of FNA, as well as fluctuations in the rate of malignancy (ROM) in different categories of the Bethesda System for Reporting Thyroid Cytopathology, have been discovered in many studies. The development and employment of additional molecular tests in daily clinical practice require an understanding of the prevalence and structure of thyroid malignancy in each category of the Bethesda system. METHODS Current research is a continuous retrospective cohort study of the results of the examination and treatment of 1652 patients with thyroid tumors who have undergone primary surgery in 2021 at a national referral thyroid cancer center. FNA diagnostic performance was studied by comparing cytological diagnoses with histological outcomes. The authors evaluated ROM in each Bethesda category and identified the tumors representing a diagnostic pitfall. RESULTS The overall ROM was 72.4%. When considering ROM in each Bethesda category, it was 16.7% in Bethesda I, 10.1% in Bethesda II, 23.0% in Bethesda IV, 74.8% in Bethesda V, 99.4% in Bethesda VI. The false-positive rate was 65.0%, false negative-0.67%. Follicular and oncocytic adenomas, as well as the follicular variant of papillary thyroid cancer, were the most troublesome entities for patients' management. CONCLUSION ROM was comparable to the values implied by the Bethesda system. Follicular tumors were the main source of high false-positive rates. This necessitates the refinement of existing tests and the development of new diagnostic tests to overcome the abovementioned problems.
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Affiliation(s)
| | | | - Michael V Fridman
- Educational Institution, Belarusian State Medical University, Minsk, Belarus
- Minsk City Clinical Oncological Centre, Public Health Institution, Minsk, Belarus
| | | | - Olga A Perkhova
- Minsk City Clinical Oncological Centre, Public Health Institution, Minsk, Belarus
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Álvarez-Mancha AI, Mancha-Doblas I, Molina-Vega M, Fernández-García D, Gómez-Pérez AM, Gallego-Domínguez E, Ortega-Jiménez MV, Hierro-Martín I, Tinahones FJ. Evolutionary analysis of indeterminate cytology and risk of malignancy in a thyroid nodule unit. Eur Thyroid J 2024; 13:ETJ-24-0076. [PMID: 38743822 PMCID: PMC11227092 DOI: 10.1530/etj-24-0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/14/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVE The objective of this study was to analyze the evolution in the diagnosis and management of indeterminate thyroid nodules over three time periods. METHODS 3020 patients with thyroid nodules underwent cytological evaluation during three periods (2006-2008, 2012-2014, 2017-2019). Distribution of diagnostic cytologies, risk of malignancy, diagnostic performance indices of FNA, and cytologic-histologic correlation in indeterminate cytologies were analyzed. RESULTS only 2.2% of cytology tests were insufficient for a diagnosis. 86.9% cytologies were benign, 1.7% malignant, and 11.4% indeterminate. Indeterminate cytology rates were 15.9% (2006-2008), 10.1% (2012-2014), and 10% (2017-2019). Surgery was performed in 13% of benign cytology, result-ing in malignant histology in 2.7%. All malignant and suspicious cytologies underwent surgery: malig-nancy confirmed in 98% and 77% of cases, respectively. All 'indeterminate with atypia' cytologies (2006-2008) and Bethesda IV (2012-2014; 2017-2019) un-derwent surgery, with malignancy confirmed in 19.6%, 43.8%, and 25.7%, respectively. In the 'inde-terminate without atypia' category (2006-2008) and Bethesda III (2012-2014; 2017-2019), diagnostic surgery was performed in 57.7%, 78.6%, and 59.4%, respectively, with malignancy confirmed in 3.3%, 20.5%, and 31.6%. The FNA sensitivity was 91.6% with a negative predictive value greater than 96% in all periods. The specificity exceeded 75% in the last two periods. CONCLUSION Bethesda system reduces indeterminate cytologies and improves the accuracy of FNA diagnosis. We reported a higher proportion of malignancy than expected in Bethesda III, underscoring the importance of having institution-specific data to guide decision-making. However, there is a need for risk stratification tools that allow for conservative management in low-risk cases.
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Affiliation(s)
- Ana Isabel Álvarez-Mancha
- Department of Medicine, University of Malaga, Malaga, Spain
- Department of Pathology, General University Hospital of Ciudad Real, Ciudad Real, Spain
| | - Isabel Mancha-Doblas
- Department of Medicine, University of Malaga, Malaga, Spain
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain
| | - María Molina-Vega
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain
- The Biomedical Research Institute of Malaga and Platform in Nanomedicine (IBIMA-BIONAND Platform), University of Malaga, Malaga, Spain
| | - Diego Fernández-García
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain
| | - Ana María Gómez-Pérez
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain
- The Biomedical Research Institute of Malaga and Platform in Nanomedicine (IBIMA-BIONAND Platform), University of Malaga, Malaga, Spain
| | - Elena Gallego-Domínguez
- Department of Medicine, University of Malaga, Malaga, Spain
- Department of Pathology, Virgen de la Victoria University Hospital, Málaga, Spain
| | - María Victoria Ortega-Jiménez
- Department of Medicine, University of Malaga, Malaga, Spain
- Department of Pathology, Virgen de la Victoria University Hospital, Málaga, Spain
| | - Isabel Hierro-Martín
- Department of Pathology, Virgen de la Victoria University Hospital, Málaga, Spain
| | - Francisco J Tinahones
- Department of Medicine, University of Malaga, Malaga, Spain
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain
- The Biomedical Research Institute of Malaga and Platform in Nanomedicine (IBIMA-BIONAND Platform), University of Malaga, Malaga, Spain
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Suzuki A, Nojima S, Tahara S, Motooka D, Kohara M, Okuzaki D, Hirokawa M, Morii E. Identification of invasive subpopulations using spatial transcriptome analysis in thyroid follicular tumors. J Pathol Transl Med 2024; 58:22-28. [PMID: 38229431 DOI: 10.4132/jptm.2023.11.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 11/21/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Follicular tumors include follicular thyroid adenomas and carcinomas; however, it is difficult to distinguish between the two when the cytology or biopsy material is obtained from a portion of the tumor. The presence or absence of invasion in the resected material is used to differentiate between adenomas and carcinomas, which often results in the unnecessary removal of the adenomas. If nodules that may be follicular thyroid carcinomas are identified preoperatively, active surveillance of other nodules as adenomas is possible, which reduces the risk of surgical complications and the expenses incurred during medical treatment. Therefore, we aimed to identify biomarkers in the invasive subpopulation of follicular tumor cells. METHODS We performed a spatial transcriptome analysis of a case of follicular thyroid carcinoma and examined the dynamics of CD74 expression in 36 cases. RESULTS We identified a subpopulation in a region close to the invasive area, and this subpopulation expressed high levels of CD74. Immunohistochemically, CD74 was highly expressed in the invasive and peripheral areas of the tumor. CONCLUSIONS Although high CD74 expression has been reported in papillary and anaplastic thyroid carcinomas, it has not been analyzed in follicular thyroid carcinomas. Furthermore, the heterogeneity of CD74 expression in thyroid tumors has not yet been reported. The CD74-positive subpopulation identified in this study may be useful in predicting invasion of follicular thyroid carcinomas.
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Affiliation(s)
- Ayana Suzuki
- Department of Pathology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Hyogo, Japan
| | - Satoshi Nojima
- Department of Pathology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Shinichiro Tahara
- Department of Pathology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Daisuke Motooka
- Genome Information Research Center, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka, Japan
| | - Masaharu Kohara
- Department of Pathology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Daisuke Okuzaki
- Genome Information Research Center, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka, Japan
- Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Osaka, Japan
| | - Mitsuyoshi Hirokawa
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Hyogo, Japan
| | - Eiichi Morii
- Department of Pathology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
- Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Osaka, Japan
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Hirokawa M, Niioka H, Suzuki A, Abe M, Arai Y, Nagahara H, Miyauchi A, Akamizu T. Application of deep learning as an ancillary diagnostic tool for thyroid FNA cytology. Cancer Cytopathol 2022; 131:217-225. [PMID: 36524985 DOI: 10.1002/cncy.22669] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/20/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Several studies have used artificial intelligence (AI) to analyze cytology images, but AI has yet to be adopted in clinical practice. The objective of this study was to demonstrate the accuracy of AI-based image analysis for thyroid fine-needle aspiration cytology (FNAC) and to propose its application in clinical practice. METHODS In total, 148,395 microscopic images of FNAC were obtained from 393 thyroid nodules to train and validate the data, and EfficientNetV2-L was used as the image-classification model. The 35 nodules that were classified as atypia of undetermined significance (AUS) were predicted using AI training. RESULTS The precision-recall area under the curve (PR AUC) was >0.95, except for poorly differentiated thyroid carcinoma (PR AUC = 0.49) and medullary thyroid carcinoma (PR AUC = 0.91). Poorly differentiated thyroid carcinoma had the lowest recall (35.4%) and was difficult to distinguish from papillary thyroid carcinoma, medullary thyroid carcinoma, and follicular thyroid carcinoma. Follicular adenomas and follicular thyroid carcinomas were distinguished from each other by 86.7% and 93.9% recall, respectively. For two-dimensional mapping of the data using t-distributed stochastic neighbor embedding, the lymphomas, follicular adenomas, and anaplastic thyroid carcinomas were divided into three, two, and two groups, respectively. Analysis of the AUS nodules showed 94.7% sensitivity, 14.4% specificity, 56.3% positive predictive value, and 66.7% negative predictive value. CONCLUSIONS The authors developed an AI-based approach to analyze thyroid FNAC cases encountered in routine practice. This analysis could be useful for the clinical management of AUS and follicular neoplasm nodules (e.g., an online AI platform for thyroid cytology consultations).
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Affiliation(s)
| | - Hirohiko Niioka
- Institute for Datability Science Osaka University Suita Japan
| | - Ayana Suzuki
- Department of Diagnostic Pathology and Cytology Kuma Hospital Kobe Japan
| | - Masatoshi Abe
- Institute for Datability Science Osaka University Suita Japan
| | - Yusuke Arai
- Institute for Datability Science Osaka University Suita Japan
| | - Hajime Nagahara
- Institute for Datability Science Osaka University Suita Japan
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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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