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Lacoste-Collin L, Decaussin-Petrucci M, Buffet C. [Molecular and other ancillary tests proposed by The Bethesda system for reporting thyroid cytopathology 2023]. Ann Pathol 2024; 44:36-46. [PMID: 37953129 DOI: 10.1016/j.annpat.2023.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
For the first time the 2023 version of The Bethesda System for Reporting Thyroid Cytology dedicates a whole chapter (chapter 14) to ancillary studies almost exclusively represented by molecular testing. The latest data reported bring some evidence that molecular testing could help to optimize the diagnostic performance of « indeterminate » categories (AUS and NF). Other studies suggest a promising role to guide the management of suspicious of malignancy and malignant categories. Indeed, the recognition of prognostic and predictive biomarkers analyzed on cytological samples, regardless of how it is collected, has progressed thanks to advances in our knowledge of molecular abnormalities of thyroid tumors. The chapter 14 is presented here highlighting the current and emerging roles of « in-house » and commercialized molecular testing as presented by TSBRTC.
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Affiliation(s)
| | - Myriam Decaussin-Petrucci
- Service d'anatomie pathologique, centre hospitalier Lyon Sud, hospices civils de Lyon, EA 3738, université Lyon 1, Lyon, France
| | - Camille Buffet
- Service des pathologies thyroïdiennes et tumorales endocrines, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, GRC n(o) 16, GRC tumeurs thyroïdiennes, 75013 Paris, France; Laboratoire d'Imagerie Biomédicale, CNRS, Inserm, 75006 Paris, France
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2
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Riju J, Thomas N, Paul TV, Abraham DT, Pai R, Prabhu AJ, Jacob PM, Rajan R, Michael RC, Tirkey AJ, Ramalingam N, Asha HS, Kapoor N. Role of Genetic Testing in the Management of Indeterminate Thyroid Nodules in the Indian Setting. Indian J Endocrinol Metab 2024; 28:3-10. [PMID: 38533287 PMCID: PMC10962768 DOI: 10.4103/ijem.ijem_415_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/15/2023] [Accepted: 01/20/2024] [Indexed: 03/28/2024] Open
Abstract
The increased detection of thyroid nodules in the human population has led to an increase in the number of thyroid surgeries without an improvement in survival outcomes. Though the choice for surgery is straightforward in malignant thyroid nodules, the decision is far more complex in those nodules that get categorized into indeterminate thyroid nodules (ITN) by fine needle aspiration. Therefore, there is a pressing need to develop a tool that will aid in decision-making among the ITN. In this context, the development of various molecular testing (MT) panels has helped to confirm or rule out malignancy, reducing unnecessary surgeries and potentially guiding the extent of surgery as well. Currently, such tests are widely used among the Western population but these MT panels are not used by the South Asian population because of non-availability of validated panels and the high cost involved. There is a need to develop a suitable panel which is population-specific and validate the same. In this review, we would focus on current trends in the management of ITN among the South Asian population and how to develop a novel MT panel which is cost-effective, with high diagnostic accuracy obviating the need for expensive panels that already exist.
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Affiliation(s)
- Jeyashanth Riju
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nihal Thomas
- Department of Endocrinology Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Thomas V. Paul
- Department of Endocrinology Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Deepak Thomas Abraham
- Department of Endocrine Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rekha Pai
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anne J. Prabhu
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Remya Rajan
- Department of Endocrinology Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rajiv C. Michael
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Amit Jiwan Tirkey
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Natarajan Ramalingam
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Hesarghatta S. Asha
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nitin Kapoor
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
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Kakudo K, Jung CK, Liu Z, Hirokawa M, Bychkov A, Vuong HG, Keelawat S, Srinivasan R, Hang JF, Lai CR. The Asian Thyroid Working Group, from 2017 to 2023. J Pathol Transl Med 2023; 57:289-304. [PMID: 37981725 PMCID: PMC10660359 DOI: 10.4132/jptm.2023.10.04] [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: 09/19/2023] [Accepted: 10/04/2023] [Indexed: 11/21/2023] Open
Abstract
The Asian Thyroid Working Group was founded in 2017 at the 12th Asia Oceania Thyroid Association (AOTA) Congress in Busan, Korea. This group activity aims to characterize Asian thyroid nodule practice and establish strict diagnostic criteria for thyroid carcinomas, a reporting system for thyroid fine needle aspiration cytology without the aid of gene panel tests, and new clinical guidelines appropriate to conservative Asian thyroid nodule practice based on scientific evidence obtained from Asian patient cohorts. Asian thyroid nodule practice is usually designed for patient-centered clinical practice, which is based on the Hippocratic Oath, "First do not harm patients," and an oriental filial piety "Do not harm one's own body because it is a precious gift from parents," which is remote from defensive medical practice in the West where physicians, including pathologists, suffer from severe malpractice climate. Furthermore, Asian practice emphasizes the importance of resource management in navigating the overdiagnosis of low-risk thyroid carcinomas. This article summarizes the Asian Thyroid Working Group activities in the past 7 years, from 2017 to 2023, highlighting the diversity of thyroid nodule practice between Asia and the West and the background reasons why Asian clinicians and pathologists modified Western systems significantly.
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Affiliation(s)
- Kennichi Kakudo
- Department of Pathology, Cancer Genome Center and Thyroid Disease Center, Izumi City General Hospital, Izumi, Osaka, Japan
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Zhiyan Liu
- Department of Pathology, Shanghai Sixth People’s Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Huy Gia Vuong
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Somboon Keelawat
- Special Task Force for Activating Research (STAR), Department of Pathology, Chulalongkorn University, Bangkok, Thailand
| | - Radhika Srinivasan
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jen-Fan Hang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chiung-Ru Lai
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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4
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Słowińska-Klencka D, Popowicz B, Kulczycka-Wojdala D, Szymańska B, Duda-Szymańska J, Wojtaszek-Nowicka M, Kaczka K, Klencki M. Effective Use of microRNA, BRAF and Sonographic Risk Assessment in Bethesda III Thyroid Nodules Requires a Different Approach to Nodules with Features of Nuclear Atypia and Other Types of Atypia. Cancers (Basel) 2023; 15:4287. [PMID: 37686562 PMCID: PMC10486535 DOI: 10.3390/cancers15174287] [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: 08/06/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
The aim of the study was to analyze the diagnostic usefulness of the combined assessment of the ultrasound risk category of the nodule (evaluated with EU-TIRADS system), the presence of BRAF V600E mutation and the expression of selected microRNAs (miR-146b, miR-221 and miR-222) in Bethesda category III thyroid nodules, separately for cases with nuclear atypia (AUS-nuclear) and cases with other types of atypia (AUS-other). We evaluated 161 nodules (66 AUS-nuclear and 95 AUS-other) with known results of postoperative histopathological examination. The rate of cancer and the rate of PTC among cancers were nearly three times higher in the AUS-nuclear than the AUS-other group. For AUS-nuclear nodules, the most effective diagnostic panel included, in addition to repeat FNA, the assessment of BRAF V600E mutation and the expression of miR-146b and miR-222 (sensitivity: 93.5%, specificity: 80.0%). For AUS-other nodules, a two-step procedure was most effective: at the first stage, forgoing surgical treatment in subjects with a benign repeat FNA outcome, and, at the second stage, the assessment of miR-222 expression and the EU-TIRADS category (sensitivity: 92.3%, specificity: 76.8%). The optimal use of molecular methods in the diagnostics of category III thyroid nodules requires a separate approach for nodules with nuclear atypia and nodules with other types of atypia.
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Affiliation(s)
- Dorota Słowińska-Klencka
- Department of Morphometry of Endocrine Glands, Medical University of Lodz, Pomorska 251 St., 92-213 Lodz, Poland; (D.S.-K.); (B.P.)
| | - Bożena Popowicz
- Department of Morphometry of Endocrine Glands, Medical University of Lodz, Pomorska 251 St., 92-213 Lodz, Poland; (D.S.-K.); (B.P.)
| | - Dominika Kulczycka-Wojdala
- Research Laboratory CoreLab, Medical University of Lodz, Mazowiecka 6/8 St., 92-215 Lodz, Poland; (D.K.-W.); (B.S.)
| | - Bożena Szymańska
- Research Laboratory CoreLab, Medical University of Lodz, Mazowiecka 6/8 St., 92-215 Lodz, Poland; (D.K.-W.); (B.S.)
| | - Joanna Duda-Szymańska
- Department of Pathomorphology, Medical University of Lodz, Pomorska 251 St., 92-213 Lodz, Poland;
| | - Martyna Wojtaszek-Nowicka
- Department of Clinical Endocrinology, Medical University of Lodz, Pomorska 251 St., 92-213 Lodz, Poland;
| | - Krzysztof Kaczka
- Department of General and Oncological Surgery, Surgical Clinical Sciences, Medical University of Lodz, Pomorska 251 St., 92-213 Lodz, Poland;
| | - Mariusz Klencki
- Department of Morphometry of Endocrine Glands, Medical University of Lodz, Pomorska 251 St., 92-213 Lodz, Poland; (D.S.-K.); (B.P.)
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Lazure P, Sireci A, Subbiah V, Murray S, Grohé C, Sherman SI, Kelly E, Bubach P, Péloquin S. Challenges in diagnosis and biomarker testing for RET-altered lung and thyroid cancer care: an international mixed-method study. BMC MEDICAL EDUCATION 2023; 23:410. [PMID: 37277734 DOI: 10.1186/s12909-023-04396-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 05/25/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND The introduction of new targeted therapies for RET-altered lung and thyroid cancers (LC/TC) has impacted pathologists' practice by making genomic testing more relevant. Variations in health systems and treatment access result in distinct clinical challenges and barriers. This study aimed to assess practice gaps and challenges experienced by pathologists involved in the diagnosis of RET-altered LC/TC, including biomarker testing, to inform educational solutions. METHODS Pathologists in Germany, Japan, the UK, and US participated in this ethics-approved mixed-methods study, which included interviews and surveys (data collected January-March 2020). Qualitative data was thematically analysed, quantitative data was analysed with chi-square and Kruskal-Wallis H-tests, and both were triangulated. RESULTS A total of 107 pathologists took part in this study. Knowledge gaps were reported regarding genomic testing for LC/TC in Japan (79/60%), the UK (73/66%), and the US (53/30%). Skill gaps were reported when selecting genomic biomarker tests to diagnose TC in Japan (79%), the UK (73%) and US (57%) and when performing specific biomarker tests, especially in Japan (82% for RET) and in the UK (75% for RET). Japanese participants (80%) reported uncertainty about what information to share with the multidisciplinary team to ensure optimal patient-centered care. At the time of data collection, pathologists in Japan faced access barriers to using RET biomarker tests: only 28% agreed that there are relevant RET genomic biomarker tests available in Japan, versus 67% to 90% in other countries. CONCLUSIONS This study identified areas where pathologists need additional continuing professional development opportunities to enhance their competencies and better support delivery of care to patients with RET-altered lung or thyroid tumours. Addressing identified gaps and improving competencies of pathologists in this field should be emphasised in continuing medical education curricula and through quality improvement initiatives. Strategies deployed on an institutional and health system level should aim to improve interprofessional communication and genetic biomarker testing expertise.
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Affiliation(s)
- Patrice Lazure
- AXDEV Group Inc., 8, Place du Commerce, Suite 210, Brossard, Québec, J4W 3H2, Canada.
| | | | - Vivek Subbiah
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Suzanne Murray
- AXDEV Group Inc., 8, Place du Commerce, Suite 210, Brossard, Québec, J4W 3H2, Canada
| | | | - Steven I Sherman
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Sophie Péloquin
- AXDEV Group Inc., 8, Place du Commerce, Suite 210, Brossard, Québec, J4W 3H2, Canada
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Rossi ED, Baloch Z. The Impact of the 2022 WHO Classification of Thyroid Neoplasms on Everyday Practice of Cytopathology. Endocr Pathol 2023; 34:23-33. [PMID: 36797454 DOI: 10.1007/s12022-023-09756-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 02/18/2023]
Abstract
This review outlines how the alterations in the 5th edition of the WHO Classification of Endocrine and Neuroendocrine Tumors of the thyroid gland are likely to impact thyroid cytopathology. It is important to note that WHO subclassifies thyroid tumors into several new categories based on increased comprehension of the cell of origin, pathologic features (including cytopathology), molecular classification, and biological behavior. The 3rd edition of the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) will debut in the near future and will include changes in diagnostic category designations. The changes in the 5th edition of the WHO will in some instances subtly, and in other instances significantly, impact the cytological diagnoses. Moreover, these changes will also affect other thyroid FNA classification schemes used internationally for classifying thyroid FNA specimens.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology- Fondazione, Policlinico Universitario A.Gemelli-IRCCS, Largo Agostino Gemelli, 8 - 00168 , Rome, Italy
| | - Zubair Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA.
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Le HT, Nguyen TPX, Hirokawa M, Katoh R, Mitsutake N, Matsuse M, Sako A, Kondo T, Vasan N, Kim YM, Liu Y, Hassell L, Kakudo K, Vuong HG. Primary Thyroid Mucoepidermoid Carcinoma (MEC) Is Clinically, Prognostically, and Molecularly Different from Sclerosing MEC with Eosinophilia: A Multicenter and Integrated Study. Endocr Pathol 2023; 34:100-111. [PMID: 36394696 DOI: 10.1007/s12022-022-09741-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2022] [Indexed: 11/19/2022]
Abstract
Mucoepidermoid carcinoma (MEC) and sclerosing MEC with eosinophilia (SMECE) are rare primary thyroid carcinomas. In this study, we aimed to present our multicenter series of MEC and SMECE and integrated our data with published literature to further investigate the clinicopathological characteristics and prognoses of these tumors. We found 2 MECs and 4 SMECEs in our multicenter archives. We performed fluorescence in situ hybridization (FISH) to determine the MAML2 gene rearrangement. We screened for mutations in BRAF, TERT promoter, and RAS mutations using Sanger sequencing and digital polymerase chain reaction. Histopathologically, MECs and SMECEs were composed of two main cell types including epidermoid and mucin-secreting cells, arranged in cords, nests, and tubules. SMECEs were characterized by a densely sclerotic stroma with abundant eosinophils. We did not detect any MAML2 fusion in any of our cases. Two MEC cases harbored concomitant BRAF p.V600E and TERT C228T mutations. RAS mutations were absent in all cases. Concurrent foci of another thyroid malignancy were more commonly seen in MECs (p < 0.001), whereas SMECEs were associated with chronic lymphocytic thyroiditis (p < 0.001). MECs and SMECEs had equivalent recurrence-free survival (RFS) but MECs conferred significantly dismal disease-specific survival (DSS) as compared to SMECEs (p = 0.007). In conclusion, MECs and SMECEs not only shared some similarities but also demonstrated differences in clinicopathological characteristics, prognoses, and molecular profiles. SMECEs had a superior DSS in comparison to MECs, suggesting that they are low-grade cancers. This could help clinicians better evaluate patient outcomes and decide appropriate treatment plans.
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Affiliation(s)
- Hieu Trong Le
- Department of Pathology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 700-000, Vietnam
| | - Truong P X Nguyen
- Department of Pathology, Chulalongkorn University, Krung Thep Maha Nakhon , Bangkok, 10300, Thailand
| | - Mitsuyoshi Hirokawa
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Hyogo, 650-0011, Japan
| | - Ryohei Katoh
- Department of Pathology, Ito Hospital, Shibuya, Tokyo, 150-8308, Japan
| | - Norisato Mitsutake
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, 852-8523, Japan
| | - Michiko Matsuse
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, 852-8523, Japan
| | - Ayaka Sako
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, 852-8523, Japan
| | - Tetsuo Kondo
- Department of Pathology, University of Yamanashi, Yamanashi, 409-3821, Japan
| | - Nilesh Vasan
- Department of Otolaryngology, Oklahoma University Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Young Mi Kim
- Genetics Laboratory, Oklahoma University Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Ying Liu
- Genetics Laboratory, Oklahoma University Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Lewis Hassell
- Department of Pathology, Oklahoma University Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Kennichi Kakudo
- Department of Pathology, Cancer Genome Center and Thyroid Disease Center, Izumi City General Hospital, Izumi, Japan
| | - Huy Gia Vuong
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.
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Personalized Diagnosis in Differentiated Thyroid Cancers by Molecular and Functional Imaging Biomarkers: Present and Future. Diagnostics (Basel) 2022; 12:diagnostics12040944. [PMID: 35453992 PMCID: PMC9030409 DOI: 10.3390/diagnostics12040944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022] Open
Abstract
Personalized diagnosis can save unnecessary thyroid surgeries, in cases of indeterminate thyroid nodules, when clinicians tend to aggressively treat all these patients. Personalized diagnosis benefits from a combination of imagery and molecular biomarkers, as well as artificial intelligence algorithms, which are used more and more in our timeline. Functional imaging diagnosis such as SPECT, PET, or fused images (SPECT/CT, PET/CT, PET/MRI), is exploited at maximum in thyroid nodules, with a long history in the past and a bright future with many suitable radiotracers that could properly contribute to diagnosing malignancy in thyroid nodules. In this way, patients will be spared surgery complications, and apparently more expensive diagnostic workouts will financially compensate each patient and also the healthcare system. In this review we will summarize essential available diagnostic tools for malignant and benignant thyroid nodules, beginning with functional imaging, molecular analysis, and combinations of these two and other future strategies, including AI or NIS targeted gene therapy for thyroid carcinoma diagnosis and treatment as well.
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Wang J, Wang J, Quan J, Liu J, Tian L, Dong C. Relationship between serum NDRG3 and papillary thyroid carcinoma. Front Endocrinol (Lausanne) 2022; 13:1091462. [PMID: 36619553 PMCID: PMC9811643 DOI: 10.3389/fendo.2022.1091462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In recent years, papillary thyroid carcinoma is considered to be one of the fastest increaseing cancer. NDRG family member 3 (NDRG3) has been proposed as a molecular marker of tumor, and is expected to be used in clinic. METHODS Enzyme-linked immunosorbent assay was used to detect the serum NDRG3 expression in 81 papillary thyroid carcinoma cases, 75 benign thyroid nodules cases and 77 healthy control cases, respectively. Electrochemiluminescence method was applied to measure the levels of triiodothyronine, tetraiodothyronine, thyrotropin, thyroglobulin antibody and thyroid peroxidase antibody. Immunohistochemical staining was used to detect the expression of NDRG3 in papillary thyroid carcinoma, benign thyroid nodules and normal tissues adjacent to cancer. RESULTS The expression of serum triiodothyronine, tetraiodothyronine, thyrotropin, thyroglobulin antibody and thyroid peroxidase antibody and NDRG3 were significantly different among benign thyroid nodules, papillary thyroid carcinoma cases and healthy control groups (P <0.001). Only the expression of serum NDRG3 was significantly different between benign thyroid nodules and papillary thyroid carcinoma groups (P <0.001). Immunohistochemistry showed that NDRG3 was expressed in all three groups, the lowest in papillary thyroid carcinoma, the second in benign thyroid nodules, and the highest in normal tissues adjacent to cancer. Logistic regression analysis showed that serum NDRG3 was an independent protective factor for papillary thyroid carcinoma (OR =0.964, 95%CI =0.953 to 0.974, P <0.001). The ROC curve of non-papillary thyroid carcinoma diagnosed by serum NDRG3 showed the optimal cut-off value of 481.38 pg/ml, sensitivity of 72.4%, specificity of 90.1%, and the maximum area under the curve (AUC =0.902, 95%CI =0.863 to 0.940, P <0.001). The ROC curve of benign thyroid nodules diagnosed by serum NDRG3 showed the optimal critical value of 459.28 pg/ml, sensitivity of 81.3%, and specificity of 74.1% (AUC =0.863, 95%CI =0.808 to 0.919, P <0.001). The expression level of serum NDRG3 was significantly correlated with extrathyroid extensionand (P =0.007) and lymphatic metastasis of papillary thyroid carcinoma (P =0.019). CONCLUSIONS The decrease of NDRG3 expression can not only differential diagnosis benign thyroid nodules and papillary thyroid carcinoma, but also serve as a molecular marker for the diagnosis of papillary thyroid carcinoma.
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Affiliation(s)
- Jiahao Wang
- The First Clinical College of Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Jun Wang
- Department of Thyroid and Breast Surgery, Gansu Cancer Hospital, Lanzhou, Gansu, China
| | - Jinxing Quan
- Department of Endocrinology in Gansu Provincial People’s Hospital and The First Clinical College of Gansu University of Chinese Medicine, Lanzhou, Gansu, China
- *Correspondence: Jinxing Quan,
| | - Juxiang Liu
- Department of Endocrinology in Gansu Provincial People’s Hospital and The First Clinical College of Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Limin Tian
- Department of Endocrinology in Gansu Provincial People’s Hospital and The First Clinical College of Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Changhong Dong
- Radiotherapy Department of Gansu Maternal and Child Health Hospital, Lanzhou, Gansu, China
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Vuong HG, Chung DGB, Ngo LM, Bui TQ, Hassell L, Jung CK, Kakudo K, Bychkov A. The Use of the Bethesda System for Reporting Thyroid Cytopathology in Pediatric Thyroid Nodules: A Meta-Analysis. Thyroid 2021; 31:1203-1211. [PMID: 33504264 DOI: 10.1089/thy.2020.0702] [Citation(s) in RCA: 25] [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] [Indexed: 12/20/2022]
Abstract
Background: Little is known about the application of the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) in pediatric thyroid nodules. This meta-analysis was aimed to investigate the use of TBSRTC in the pediatric population. Methods: Relevant articles were searched in PubMed and Web of Science. Meta-analysis of proportion and its 95% confidence interval (CI) were computed utilizing the random-effect model. We used subgroup analyses and meta-regression to explore the sources of heterogeneities. Egger's regression test and funnel plot visualization were used to examine publication bias. Results: We included 17 articles comprising of 3687 pediatric thyroid nodules for meta-analyses. TBSRTC outputs including frequency and risk of malignancy (ROM) for the majority of categories were not statistically different from recently published meta-analysis of 145,066 thyroid nodules in adult patients. The resection rate (RR) in the pediatric group was significantly higher in most of the categories compared with published adult data: benign, 23.2% [CI = 18.6-27.9] vs. 13.0% [CI = 9.5-16.5]; atypia of undetermined significance/follicular lesion of undetermined significance, 62.6% [CI = 50.3-74.9] vs. 36.2% [CI = 29.9-42.5]; follicular neoplasm/suspicious for follicular neoplasm, 84.3% [CI = 75.2-93.4] vs. 60.5% [CI = 54.5-66.5]; and suspicious for malignancy, 93.8% [CI = 90.1-97.6] vs. 69.7% [CI = 64.0-75.5]. Conclusion: TBSRTC is a valuable tool to make clinical decisions for pediatric patients with thyroid nodules. Pediatric patients with benign and indeterminate thyroid nodules had a higher RR than adult counterpart, but ROM of these categories in adults and children was not statistically different suggesting a potential risk of overtreatment in pediatric patients. Determining the best treatment guidelines and additional tools for risk stratification must be a top priority to precisely identify the target patient groups for surgical intervention.
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Affiliation(s)
- Huy Gia Vuong
- Department of Pathology; Oklahoma City, Oklahoma, USA
- Stephenson Cancer Center; Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Duy Giang Bao Chung
- Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Luan Minh Ngo
- Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Thien Quoc Bui
- Department of Preventive Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Lewis Hassell
- Department of Pathology; Oklahoma City, Oklahoma, USA
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kennichi Kakudo
- Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Izumi, Japan
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Japan
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Nishino M, Mateo R, Kilim H, Feldman A, Elliott A, Shen C, Hasselgren PO, Wang H, Hartzband P, Hennessey JV. Repeat Fine Needle Aspiration Cytology Refines the Selection of Thyroid Nodules for Afirma Gene Expression Classifier Testing. Thyroid 2021; 31:1253-1263. [PMID: 33813868 PMCID: PMC8377518 DOI: 10.1089/thy.2020.0969] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: Molecular testing (MT) refines risk stratification for thyroid nodules that are indeterminate for cancer by fine needle aspiration (FNA) cytology. Criteria for selecting nodules for MT vary and remain largely untested, raising questions about the best strategy for maximizing the usefulness of MT while minimizing the harms of overtesting. We used a unique data set to examine the effects of repeat FNA cytology-based criteria for MT on management decisions and nodule outcomes. Methods: This was a study of adults (age 25-90 years; 281 women and 72 men) with cytologically indeterminate (Bethesda III/IV) thyroid nodules who underwent repeat FNA biopsy and Afirma Gene Expression Classifier (GEC) testing (N = 363 nodules from 353 patients) between June 2013 and October 2017 at a single institution, with follow-up data collected until December 2019. Subgroup analysis was performed based on classification of repeat FNA cytology. Outcomes of GEC testing, clinical/sonographic surveillance of unresected nodules, and histopathologic diagnoses of thyroidectomies were compared between three testing approaches: (i) Reflex (MT sent on the basis of the initial Bethesda III/IV FNA), (ii) SemiRestrictive (MT sent if repeat FNA is Bethesda I-IV), and (iii) Restrictive (MT sent only if repeat FNA is Bethesda III/IV) testing approaches. Results: Restricting MT to nodules that remain Bethesda III/IV on repeat FNA would have missed 4 low-risk cancers and 3 noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) (collectively 2% of the test population) but would have avoided diagnostic surgery for 42 benign nodules (12% of the test population). The Restrictive testing strategy was more specific (delta 0.126 confidence interval [CI 0.093 to 0.159] and 0.129 [CI 0.097 to 0.161], respectively) but less sensitive (delta -0.339 [CI -0.424 to -0.253] and -0.340 [CI -0.425 to -0.255], respectively) than the Reflex and SemiRestrictive approaches for detecting NIFTP or cancer. Conclusions: Repeat FNA cytology can guide the selection of cytologically indeterminate thyroid nodules that warrant MT. The Restrictive model of performing Afirma GEC only on nodules with two separate biopsies showing Bethesda III/IV cytology would reduce the rate of diagnostic surgery for histologically benign nodules while missing only rare low-risk tumors. Given the low but nontrivial risks of thyroidectomy, the higher specificity of the Restrictive testing approach disproportionately outweighs the potential harms.
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Affiliation(s)
- Michiya Nishino
- Department of Pathology; Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
- Address correspondence to: Michiya Nishino, MD, PhD, Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Roselyn Mateo
- Division of Endocrinology, Department of Medicine; Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Holly Kilim
- Division of Endocrinology, Department of Medicine; Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Anna Feldman
- Division of Endocrinology, Department of Medicine; Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Amanda Elliott
- Division of Endocrinology, Department of Medicine; Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Changyu Shen
- Smith Center for Outcomes Research in Cardiology, Department of Medicine; Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Per-Olof Hasselgren
- Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Helen Wang
- Department of Pathology; Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Pamela Hartzband
- Division of Endocrinology, Department of Medicine; Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - James V. Hennessey
- Division of Endocrinology, Department of Medicine; Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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Molecular Tests for Risk-Stratifying Cytologically Indeterminate Thyroid Nodules: An Overview of Commercially Available Testing Platforms in the United States. JOURNAL OF MOLECULAR PATHOLOGY 2021. [DOI: 10.3390/jmp2020014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The past decade has witnessed significant advances in the application of molecular diagnostics for the pre-operative risk-stratification of cytologically indeterminate thyroid nodules. The tests that are currently marketed in the United States for this purpose combine aspects of tumor genotyping with gene and/or microRNA expression profiling. This review compares the general methodology and clinical validation studies for the three tests currently offered in the United States: ThyroSeq v3, Afirma GSC and Xpression Atlas, and ThyGeNEXT/ThyraMIR.
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