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Idrees T, Rashied AA, Kim B. Non-Diagnostic Fine Needle Aspiration of Thyroid Nodules: Review of Pre-disposing Factors. Endocr Pract 2024:S1530-891X(24)00690-6. [PMID: 39343170 DOI: 10.1016/j.eprac.2024.09.015] [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: 05/30/2024] [Revised: 09/04/2024] [Accepted: 09/23/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND Fine needle aspiration (FNA) of thyroid nodules is the gold standard screening test for thyroid malignancy. Unfortunately, FNA may produce insufficient material for diagnosis. If nodules requiring FNA with a higher risk for non-diagnostic (ND) cytology could be identified pre-procedure, this might allow better patient guidance and potentially facilitate an altered approach to FNA. SUMMARY The literature investigating risk factors for ND cytology was reviewed, including studies of patient factors, sonographic or nodule factors, and procedural factors. Twenty-five studies that included assessment of at least two potential factors in ND outcomes for initial FNA were identified. Individual factors were evaluated in terms of the general consensus of studies reporting either a positive significant association with ND cytology or no association. CONCLUSION Most patient and nodule factors lack consensus as far as their association with ND cytology across these studies. However, a number of study design improvements suggested by this review could realistically be incorporated into higher powered future studies. Novel factors such as tissue composition anterior to the nodule or the age of the patient could also be investigated in future work. Operator experiences is the most convincing procedural factor, and approaches to future studies of the FNA technique itself are proposed. That said, the factors with consensus amongst studies can be seen leading candidates for this future research, and the published studies illuminate a number of as yet unexplored factors that could in many cases be studied retrospectively.
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Affiliation(s)
- Thaer Idrees
- Emory University School of Medicine, Atlanta, GA.
| | - Ammar A Rashied
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health of Emory University, Atlanta, GA
| | - Brian Kim
- University of Chicago School of Medicine, Chicago, IL
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2
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Şenoymak M, Erbatur N, Engin I, Yönem A. THE IMPACT OF PATIENT ANXIETY AND PAIN PERCEPTION ON THE ADEQUACY OF THYROID FINE-NEEDLE ASPIRATION BIOPSY SAMPLES: A PROSPECTIVE STUDY. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2024; 20:39-44. [PMID: 39372293 PMCID: PMC11449249 DOI: 10.4183/aeb.2024.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/08/2024]
Abstract
Background Fine-needle aspiration biopsy (FNAB) is the most accurate diagnostic method to assess the malignancy risk of thyroid nodules. However, non-diagnostic results may delay diagnosis, cause unnecessary interventions, and distress patients. Aim We aimed to determine whether a correlation exists between patients' situational anxiety, pain perception and non-diagnostic cytology results. Methods The prospective study included patients who underwent thyroid FNAB at the Endocrinology Clinic of Sultan Abdulhamid Training and Research Hospital between 11/2022 and 02/2023. The State-Trait Anxiety Inventory (STAI) questionnaire and visual analogue scale (VAS) assessed situational anxiety and pain in patients undergoing biopsy procedures. We evaluated whether the STAI-S and VAS score is related to non-diagnostic results. Results Of the 119 patients included in the study, 98 were female, and 21 were male. 25 (21%) nodules were non-diagnostic. The patients' mean STAI-S score before the biopsy was 47.31±12.37, and the mean VAS score after the thyroid biopsy was 2.57±1.51. A statistically significant relation was found between the patient's STAI-S score and VAS score and the cytology result of non-diagnostic (p= 0.001 and p=0.008). In univariate logistic regression, high pre-procedural anxiety (OR:3.09, 95% CI:1.07-8.94, P =0.037) and VAS score (OR:1.57, 95% CI: 1.17-2.10, P =0.002) were associated with non-diagnostic cytology. In multivariate logistic regression analysis, VAS score (OR: 1.59, 95% CI: 1.07-2.34, p=0.019) was still an independent factor related to specimen adequacy. Conclusions Anxiety level and pain perception during FNAB may be considered risk factors for non-diagnostic cytology. Thus, reducing anxiety and pain may decrease the incidence of non-diagnostic outcomes.
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Affiliation(s)
- M.C. Şenoymak
- University of Health Sciences, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
| | - N.H. Erbatur
- University of Health Sciences, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
| | - I. Engin
- University of Health Sciences, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
| | - A. Yönem
- University of Health Sciences, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
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3
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Wang CY, Zhou Y, Ren YY, Luan YS, Jiang ZC, Wang ZX. Analysis of the influencing factors on fine-needle aspiration biopsy results of the thyroid. Front Surg 2022; 9:907086. [PMID: 36132196 PMCID: PMC9483012 DOI: 10.3389/fsurg.2022.907086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/28/2022] [Indexed: 12/04/2022] Open
Abstract
Objective The objective of the study is to analyze the influencing factors on the results of thyroid fine-needle aspiration biopsy (FNAB). Method A total of 339 patients who underwent FNAB in our hospital from December 2018 to July 2021 were retrospectively selected. The patients were chosen according to the gender ratio, age, and thyroid ultrasound characteristics and were divided into three groups: (1) a 22G needle vacuum aspiration group (Group 1, n = 85), (2) a 22G biopsy needle non-vacuum aspiration group (Group 2, n = 50), and (3) a 25G biopsy needle non-vacuum aspiration group (Group 3, n = 204). Patients in these groups were evaluated for determining the FNAB dissatisfaction rate of pathological samples. A bivariate regression analysis of independent risk factors related to the unsatisfactory pathological diagnosis of samples was performed. Results The specimen dissatisfaction rates of the three groups were 22/85 (25.9%), 15/50 (30%), and 18/186 (9.7%), respectively. The overall sample dissatisfaction rate was 55/339 (16.2%), and the sample satisfaction rate of Group 3 was higher than that of Groups 1 and 2 (P < 0.05). Logistic bivariate regression analysis showed that the age of the patients and the capillary sampling needles and aspiration methods were two independent risk factors for determining the dissatisfaction rate of FNAB pathological samples. Conclusion A 25G capillary sampling aspiration biopsy needle was selected to perform FNAB in thyroid nodules without vacuum aspiration, which could effectively improve the accuracy of FNAB results with a high specimen satisfaction rate.
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Affiliation(s)
- Chun-Yan Wang
- Department of Endocrinology, Aviation General Hospital, Beijing, China
- Correspondence: Chun-Yan Wang
| | - Yan Zhou
- Department of Endocrinology, Aviation General Hospital, Beijing, China
| | - Yu-Yuan Ren
- Department of Pathology, Aviation General Hospital, Beijing, China
| | - Yu-Shuang Luan
- Department of Ultrasonography, Aviation General Hospital, Beijing, China
| | - Zhong-Cai Jiang
- Department of Pathology, Aviation General Hospital, Beijing, China
| | - Zhi-Xing Wang
- Department of Endocrinology, Aviation General Hospital, Beijing, China
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4
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Asakly M, Farhat R, El Khatib N, Khater A, Safia A, karam M, Massoud S, Bishara T, Avraham Y, Sharabi-Nov A, Merchavy S. Ultrasound-Guided Fine Needle Aspiration of Deep Thyroid Nodule: Is There a Correlation between the Nodule's Depth and Nondiagnostic Results? J Thyroid Res 2022; 2022:8212636. [PMID: 36071949 PMCID: PMC9444405 DOI: 10.1155/2022/8212636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/03/2022] [Accepted: 06/21/2022] [Indexed: 11/26/2022] Open
Abstract
Objective To evaluate whether thyroid nodule depth correlates with nondiagnostic results in ultrasound-guided fine needle aspiration cytopathology. Background Many factors correlate with nondiagnostic ultrasound-guided fine needle aspiration cytology (FNAC) results, including older age, macrocalcification, small-sized nodules, aspirin medication, and cystic portion in more than 50% of the thyroid nodules. However, there are few studies which have examined whether there is a relationship between the depth of nodules and the percentage of nondiagnostic results in cytology (Bethesda category I). We conducted this study in order to investigate if such a correlation exists. Materials and Methods FNAC was performed on 283 thyroid nodules between January 2019 and December 2020. Cytological analyses of the nodules were reviewed and sorted as nondiagnostic and diagnostic according to the Bethesda score. Patient files and ultra sound (US) scans were reviewed for clinical information (such as age, sex, and ethnic group) and sonographic features of nodules (such as depth, size, cystic portion, type of calcification, and echogenicity) and were compared between the nondiagnostic and diagnostic nodule results. The depth of a nodule was calculated as the shortest distance from the skin to the most superficial border of the nodule in the axial plane, using our medical center's computer program, which allows reviewing all saved shots of the US scan. Results Age, sex, and ethnicity were not significantly different between the nondiagnostic group and the diagnostic group (p > 0.05). Nodule diameter, cystic portion, calcification, and echogenicity were also not associated with the frequency of nondiagnostic results. The depth of nodules ≥9 mm was correlated with nondiagnostic US-guided FNA cytological results (OR = 2.55, p=0.018). Conclusions Deep thyroid nodules correlated with nondiagnostic US-guided FNA cytological results. Further studies are needed for optimizing the approach to deep thyroid nodules in order to improve the efficacy of FNA in deep thyroid nodules.
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Affiliation(s)
- Majd Asakly
- Otolaryngology, Head & Neck Surgery Unit, Rebecca Ziv Medical Center, Safed, Israel
- Bar-Ilan University's Azrieli Faculty of Medicine, Safed, Israel
| | - Raed Farhat
- Otolaryngology, Head & Neck Surgery Unit, Rebecca Ziv Medical Center, Safed, Israel
- Bar-Ilan University's Azrieli Faculty of Medicine, Safed, Israel
| | - Nidal El Khatib
- Otolaryngology, Head & Neck Surgery Unit, Rebecca Ziv Medical Center, Safed, Israel
- Bar-Ilan University's Azrieli Faculty of Medicine, Safed, Israel
| | - Ashraf Khater
- Otolaryngology, Head & Neck Surgery Unit, Rebecca Ziv Medical Center, Safed, Israel
- Bar-Ilan University's Azrieli Faculty of Medicine, Safed, Israel
| | - Alaa Safia
- Otolaryngology, Head & Neck Surgery Unit, Rebecca Ziv Medical Center, Safed, Israel
- Bar-Ilan University's Azrieli Faculty of Medicine, Safed, Israel
| | - Marwan karam
- Otolaryngology, Head & Neck Surgery Unit, Rebecca Ziv Medical Center, Safed, Israel
- Bar-Ilan University's Azrieli Faculty of Medicine, Safed, Israel
| | - Saqer Massoud
- Otolaryngology, Head & Neck Surgery Unit, Rebecca Ziv Medical Center, Safed, Israel
- Bar-Ilan University's Azrieli Faculty of Medicine, Safed, Israel
| | - Taiser Bishara
- Otolaryngology, Head & Neck Surgery Unit, Rebecca Ziv Medical Center, Safed, Israel
- Bar-Ilan University's Azrieli Faculty of Medicine, Safed, Israel
| | - Yaniv Avraham
- Research Wing, Rebecca Ziv Medical Center, Safed, Israel
| | | | - Shlomo Merchavy
- Otolaryngology, Head & Neck Surgery Unit, Rebecca Ziv Medical Center, Safed, Israel
- Bar-Ilan University's Azrieli Faculty of Medicine, Safed, Israel
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5
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Saraph S, Cohen H, Ronen O. Effect of needle gauge on thyroid FNA diagnostic rate. Endocrine 2021; 74:625-631. [PMID: 34146249 DOI: 10.1007/s12020-021-02797-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Thyroid Bethesda classification system provides 6 diagnostic categories, the first being a sample deemed non-diagnostic or insufficient and requiring a subsequent second biopsy. Our objective was to evaluate differences in non-diagnostic fine needle aspiration (FNA) of thyroid nodules conducted with a 23-gauge(G) needle vs. those conducted with a 25 G needle. METHODS Data from 298 aspiration procedures using either 23 G or 25 G needles were collected, including cytological findings, ultrasound characteristics and patient demographics. The samples were classified as diagnostic or non-diagnostic according to final cytology. RESULTS There was no statistically significant difference between the 25 G and 23 G needles in terms of non-diagnostic rates (35.7%, 31.9%; p = 0.494). Nodules defined as cystic had higher non-diagnostic rates (p < 0.05). Older patients as well as cystic nodules were associated with a higher non-diagnostic rate (OR = 1.018, p = 0.047, OR = 13.533, p = 0.0001, respectively), while nodule size was associated with lower non-diagnostic rates (OR = 0.747, p = 0.017). CONCLUSIONS The use of 25 G needle did not produce a lower non-diagnostic rate when compared to 23 G needle. Larger nodules might increase diagnostic rates, while older patients and cystic nodules are prone to inadequate samples. Patients and caregivers should be aware that FNA of small or cystic nodules as well as nodules in older patients may result in a higher non-diagnostic rate. Further research comparing other needles gauges should be conducted.
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Affiliation(s)
- Sivan Saraph
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Hector Cohen
- Department of Pathology, Galilee Medical Center, Nahariya, Israel
| | - Ohad Ronen
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
- Department of Otolaryngology - Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel.
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Goulart APFE, Batista ERM, Figueira MG, Magalhães PKR, Maciel LMZ. Evaluation of thyroid nodules in the Brazilian Public Health Care System, Supplementary Health System, and Private Health System in the northeastern region of the State of São Paulo. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 64:779-786. [PMID: 33049130 PMCID: PMC10528606 DOI: 10.20945/2359-3997000000294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/06/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To obtain data about the evaluation of thyroid nodules (TNs) in the northeastern of the State of São Paulo, compared by health care type, and measure the performance of cytology as a screening test for thyroid cancer (TC). METHODS We collected data of 597 patients treated in the Brazilian public health care system (SUS), supplementary health (SH) and in private health system (PHS) in 2014. A total of 803 TNs were aspirated, and 125 patients underwent surgery. RESULTS The distribution of all cytologic results according to the Bethesda system was: I, 135 (16.8%); II, 475 (59.2%); III, 107 (13.3%); IV, 32 (4.0%); V, 20 (2.5%); VI, 34 (4.2%). The time between cytologic analysis and surgery was longer in the SUS than in the SH for TNs in general (p < 0.001) and for TNs with Bethesda V and VI cytology (p = 0.01). The sizes of the TNs and resected malignant TNs was larger in the SUS than in the SH (p = 0.001 and p = 0.02, respectively). The number of PHS surgeries was too small and was not compared. The prevalence of TC was 9.2% and 23.6% of them were treated in the SUS. Cytology showed a 93.6% sensitivity, 95.8% specificity, and 94.7% accuracy when Bethesda III and IV were excluded. CONCLUSION Cytology was a good screening test for TC categories Bethesda II, V, and VI. The differences between the SUS and SH indicate a need for improved access to consultations and specialized tests in the SUS.
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Affiliation(s)
- Ana Paula Figueiredo Engler Goulart
- Divisão de Endocrinologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | | | | | - Patrícia Künzle Ribeiro Magalhães
- Divisão de Endocrinologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Léa Maria Zanini Maciel
- Divisão de Endocrinologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP, Brasil,
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7
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Michael CW, Kameyama K, Kitagawa W, Azar N. Rapid on-site evaluation (ROSE) for fine needle aspiration of thyroid: benefits, challenges and innovative solutions. Gland Surg 2020; 9:1708-1715. [PMID: 33224848 DOI: 10.21037/gs-2019-catp-23] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Rapid on-site evaluation/adequacy assessment (ROSE) is considered an essential component of thyroid fine needle aspiration (FNA) and many reported that it significantly decreases the nondiagnostic (ND) rate. The average reported ND rate without ROSE is about 20% and is improved by 12% when ROSE is implemented. However, the data also suggest that the improvement in ND rate after implementation of ROSE is directly related to the ND rate prior to ROSE and that it is mostly beneficial to aspirators with less experience. Several studies have also raised concerns regarding the impact of ROSE as it prolongs the procedure time, requires additional resources and increases the cost incurred by the additional fees. This resulted in a wide variation in the methodology applied to acquire the sample and implement ROSE across the globe with variation in the number of passes performed, stain utilized and the personnel reviewing the slides, e.g., cytotechnologists versus pathologist. This review summarized the literature reporting the impact of ROSE including its pros and cons, its accuracy and reproducibility, concordance between cytotechnologists and pathologists based on final diagnosis and highlights the different ways laboratories attempted to circumvent the challenges. In particular, the review highlights a unique approach practiced in Ito Hospital, Tokyo, Japan.
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Affiliation(s)
- Claire W Michael
- Department of Pathology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Kaori Kameyama
- Department of Pathology, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Wataru Kitagawa
- Department of Surgery, Ito Hospital, Shibuya-ku, Tokyo, Japan
| | - Nami Azar
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, OH, USA
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8
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Wang J, Zhu Y, Song Y, Xu G, Yu H, Wang T, Zhang B. Determining whether surgeons perform thyroid fine-needle aspiration as well as radiologists: an analysis of the adequacy and efficiency of ultrasound-guided fine-needle aspiration performed by newly trained head and neck surgeons and radiologists. Gland Surg 2020; 9:711-720. [PMID: 32775261 DOI: 10.21037/gs.2020.03.34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Ultrasound-guided fine-needle aspiration (FNA) cytology is a crucial diagnostic technique used to assess thyroid nodules. In the past, ultrasound-guided FNA was performed mainly by radiologists. However, many surgeons are increasingly being trained for this procedure now. In this study, we aimed to compare the adequacy and efficiency of ultrasound-guided FNA performed by newly trained head and neck surgeons with experienced radiologists in a single institution. We also assessed the malignancy rates in nondiagnostic nodules and the differences between benign and malignant nodules. Methods This is a retrospective study. The data from patients who underwent ultrasound-guided FNA performed by surgeons or radiologists in two consecutive years were collected. Medical records, cytology results, and surgical pathology results were analyzed. Results During the study period, a total of 2,405 ultrasound-guided FNAs were performed on 2,163 patients. The head and neck surgeons and radiologists performed 1,132 and 1,273 ultrasound-guided FNA procedures, respectively. The nondiagnostic rate was 14.49% for surgeons and 15.40% for radiologists (P=0.533). There were no differences in patient age, gender, nodule size, and other sonographic characteristics between the groups of patients who were treated by radiologists versus surgeons. The median waiting time from biopsy appointment to performing ultrasound-guided FNA was 0 days for head and neck surgeons, and 6 days for radiologists (P<0.001). Of the 40 patients who had a repeat FNA or surgery, 19 (47.50%) had a malignancy. Preoperative information about age, gender, operator, and characteristics of nodules did not predict the outcome of nodules with Bethesda category I. Conclusions The adequacy of ultrasound-guided FNAs performed by head and neck surgeons is similar to that of skilled radiologists, while surgeons are more efficient than radiologists. Nondiagnostic FNA reports should not be considered benign, and repeat FNA or selective surgical treatment is recommended.
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Affiliation(s)
- Jiaxin Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yanli Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yuntao Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Guohui Xu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Hao Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Tianxiao Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Bin Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
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9
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Biron VL, Matkin A, Kostiuk M, Williams J, Cote DW, Harris J, Seikaly H, O'Connell DA. Analytic and clinical validity of thyroid nodule mutational profiling using droplet digital polymerase chain reaction. J Otolaryngol Head Neck Surg 2018; 47:60. [PMID: 30249281 PMCID: PMC6154415 DOI: 10.1186/s40463-018-0299-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 08/26/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Recent guidelines for the management of thyroid nodules incorporate mutation testing as an adjunct for surgical decision-making, however current tests are costly with limited accuracy. Droplet digital PCR (ddPCR) is an ultrasensitive method of nucleic acid detection that is particularly useful for identifying gene mutations. This study aimed to assess the analytic and clinical validity of RAS and BRAF ddPCR mutational testing as a diagnostic tool for thyroid fine needle aspirate biopsy (FNAB). METHODS Patients with thyroid nodules meeting indication for FNAB were prospectively enrolled from March 2015 to September 2017. In addition to clinical protocol, an additional FNAB was obtained for ddPCR. Optimized ddPCR probes were used to detect mutations including HRASG12 V, HRASQ61K, HRASQ61R, NRASQ61R, NRASQ61K and BRAFV600E. The diagnostic performance of BRAF and RAS mutations was assessed individually or in combination with Bethesda classification against final surgical pathology. RESULTS A total of 208 patients underwent FNAB and mutational testing with the following Bethesda cytologic classification: 26.9% non-diagnostic, 55.2% benign, 5.3% FLUS/AUS, 2.9% FN/SPN, 2.4% SFM and 7.2% malignant. Adequate RNA was obtained from 91.3% (190) FNABs from which mutations were identified in 21.1% of HRAS, 11.5% of NRAS and 7.4% of BRAF. Malignant cytology or BRAFV600E was 100% specific for malignancy. Combining cytology with ddPCR BRAF600E mutations testing increased the sensitivity of Bethesda classification from 41.7 to 75%. Combined BRAFV600E and Bethesda results had a positive predictive value (PPV) of 100% and negative predictive value (NPV) of 89.7% for thyroid malignancy in our cohort. CONCLUSIONS DdPCR offers a novel and ultrasensitive method of detecting RAS and BRAF mutations from thyroid FNABs. BRAFV600E mutation testing by ddPCR may serve as a useful adjunct to increase sensitivity and specificity of thyroid FNAB.
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Affiliation(s)
- Vincent L Biron
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada. .,Alberta Head and Neck Centre for Oncology and Reconstruction, Walter MacKenzie Health Sciences Centre, Edmonton, AB, Canada. .,Otolaryngology-Head and Neck Surgery Research Laboratory of Alberta, University of Alberta, Edmonton, AB, Canada.
| | - Ashlee Matkin
- Alberta Head and Neck Centre for Oncology and Reconstruction, Walter MacKenzie Health Sciences Centre, Edmonton, AB, Canada.,Faculty of Medicine and Dentistry, Undergraduate Medical Education, University of Alberta, Edmonton, AB, Canada
| | - Morris Kostiuk
- Alberta Head and Neck Centre for Oncology and Reconstruction, Walter MacKenzie Health Sciences Centre, Edmonton, AB, Canada.,Otolaryngology-Head and Neck Surgery Research Laboratory of Alberta, University of Alberta, Edmonton, AB, Canada
| | - Jordana Williams
- Otolaryngology-Head and Neck Surgery Research Laboratory of Alberta, University of Alberta, Edmonton, AB, Canada
| | - David W Cote
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada
| | - Jeffrey Harris
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada.,Alberta Head and Neck Centre for Oncology and Reconstruction, Walter MacKenzie Health Sciences Centre, Edmonton, AB, Canada
| | - Hadi Seikaly
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada.,Alberta Head and Neck Centre for Oncology and Reconstruction, Walter MacKenzie Health Sciences Centre, Edmonton, AB, Canada
| | - Daniel A O'Connell
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada.,Alberta Head and Neck Centre for Oncology and Reconstruction, Walter MacKenzie Health Sciences Centre, Edmonton, AB, Canada
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