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Jermain PR, Oswald M, Langdun T, Wright S, Khan A, Stadelmann T, Abdulkadir A, Yaroslavsky AN. Deep learning-based cell segmentation for rapid optical cytopathology of thyroid cancer. Sci Rep 2024; 14:16389. [PMID: 39013980 PMCID: PMC11252353 DOI: 10.1038/s41598-024-64855-2] [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: 03/18/2024] [Accepted: 06/12/2024] [Indexed: 07/18/2024] Open
Abstract
Fluorescence polarization (Fpol) imaging of methylene blue (MB) is a promising quantitative approach to thyroid cancer detection. Clinical translation of MB Fpol technology requires reduction of the data analysis time that can be achieved via deep learning-based automated cell segmentation with a 2D U-Net convolutional neural network. The model was trained and tested using images of pathologically diverse human thyroid cells and evaluated by comparing the number of cells selected, segmented areas, and Fpol values obtained using automated (AU) and manual (MA) data processing methods. Overall, the model segmented 15.8% more cells than the human operator. Differences in AU and MA segmented cell areas varied between - 55.2 and + 31.0%, whereas differences in Fpol values varied from - 20.7 and + 10.7%. No statistically significant differences between AU and MA derived Fpol data were observed. The largest differences in Fpol values correlated with greatest discrepancies in AU versus MA segmented cell areas. Time required for auto-processing was reduced to 10 s versus one hour required for MA data processing. Implementation of the automated cell analysis makes quantitative fluorescence polarization-based diagnosis clinically feasible.
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Affiliation(s)
- Peter R Jermain
- Advanced Biophotonics Laboratory, University of Massachusetts Lowell, Lowell, MA, USA
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Martin Oswald
- Centre for Artificial Intelligence, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Tenzin Langdun
- Centre for Artificial Intelligence, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Santana Wright
- Advanced Biophotonics Laboratory, University of Massachusetts Lowell, Lowell, MA, USA
| | - Ashraf Khan
- Department of Pathology, UMASS Chan Medical School-Baystate, Springfield, MA, USA
| | - Thilo Stadelmann
- Centre for Artificial Intelligence, Zurich University of Applied Sciences, Winterthur, Switzerland
- ECLT European Centre for Living Technology, Venice, Italy
| | - Ahmed Abdulkadir
- Centre for Artificial Intelligence, Zurich University of Applied Sciences, Winterthur, Switzerland
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Anna N Yaroslavsky
- Advanced Biophotonics Laboratory, University of Massachusetts Lowell, Lowell, MA, USA.
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.
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Zhang R, Hu L, Cheng Y, Chang L, Dong L, Han L, Yu W, Zhang R, Liu P, Wei X, Yu J. Targeted sequencing of DNA/RNA combined with radiomics predicts lymph node metastasis of papillary thyroid carcinoma. Cancer Imaging 2024; 24:75. [PMID: 38886866 PMCID: PMC11181663 DOI: 10.1186/s40644-024-00719-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/08/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE The aim of our study is to find a better way to identify a group of papillary thyroid carcinoma (PTC) with more aggressive behaviors and to provide a prediction model for lymph node metastasis to assist in clinic practice. METHODS Targeted sequencing of DNA/RNA was used to detect genetic alterations. Gene expression level was measured by quantitative real-time PCR, western blotting or immunohistochemistry. CCK8, transwell assay and flow cytometry were used to investigate the effects of concomitant gene alterations in PTC. LASSO-logistics regression algorithm was used to construct a nomogram model integrating radiomic features, mutated genes and clinical characteristics. RESULTS 172 high-risk variants and 7 fusion types were detected. The mutation frequencies in BRAF, TERT, RET, ATM and GGT1 were significantly higher in cancer tissues than benign nodules. Gene fusions were detected in 16 samples (2 at the DNA level and 14 at the RNA level). ATM mutation (ATMMUT) was frequently accompanied by BRAFMUT, TERTMUT or gene fusions. ATMMUT alone or ATM co-mutations were significantly positively correlated with lymph node metastasis. Accordingly, ATM knock-down PTC cells bearing BRAFV600E, KRASG12R or CCDC6-RET had higher proliferative ability and more aggressive potency than cells without ATM knock-down in vitro. Furthermore, combining gene alterations and clinical features significantly improved the predictive efficacy for lymph node metastasis of radiomic features, from 71.5 to 87.0%. CONCLUSIONS Targeted sequencing of comprehensive genetic alterations in PTC has high prognostic value. These alterations, in combination with clinical and radiomic features, may aid in predicting invasive PTC with higher accuracy.
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Affiliation(s)
- Runjiao Zhang
- Cancer Molecular Diagnostics Core, Key Laboratory of Cancer Immunology and Biotherapy, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Linfei Hu
- Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Department of Thyroid and Neck Tumor, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Yanan Cheng
- Cancer Molecular Diagnostics Core, Key Laboratory of Cancer Immunology and Biotherapy, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Luchen Chang
- Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Department of Diagnostic and Therapeutic Ultrasonography, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, China
| | - Li Dong
- Cancer Molecular Diagnostics Core, Key Laboratory of Cancer Immunology and Biotherapy, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Lei Han
- Cancer Molecular Diagnostics Core, Key Laboratory of Cancer Immunology and Biotherapy, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Wenwen Yu
- Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Department of Immunology, Key Laboratory of Cancer Immunology and Biotherapy, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Rui Zhang
- Cancer Molecular Diagnostics Core, Key Laboratory of Cancer Immunology and Biotherapy, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Pengpeng Liu
- Cancer Molecular Diagnostics Core, Key Laboratory of Cancer Immunology and Biotherapy, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Xi Wei
- Tianjin's Clinical Research Center for Cancer, Tianjin, China.
- Department of Diagnostic and Therapeutic Ultrasonography, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, China.
| | - Jinpu Yu
- Cancer Molecular Diagnostics Core, Key Laboratory of Cancer Immunology and Biotherapy, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, China.
- Tianjin's Clinical Research Center for Cancer, Tianjin, China.
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Borlea A, Moisa-Luca L, Popescu A, Bende F, Stoian D. Combining CEUS and ultrasound parameters in thyroid nodule and cancer diagnosis: a TIRADS-based evaluation. Front Endocrinol (Lausanne) 2024; 15:1417449. [PMID: 38952390 PMCID: PMC11215041 DOI: 10.3389/fendo.2024.1417449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 05/20/2024] [Indexed: 07/03/2024] Open
Abstract
Contrast-enhanced ultrasonography (CEUS) has been established as a diagnostic tool for assessing microvascularization, essential for understanding angiogenesis in neoplastic development. AIM This study assesses the effectiveness of CEUS as a supplementary tool to TIRADS in enhancing the ultrasound-based diagnosis of thyroid cancer. METHODS AND MATERIALS Over one year, 157 nodules in 133 patients, with predominantly solid thyroid nodules, were examined using ultrasound and CEUS and underwent thyroidectomy, allowing for a comparison of ultrasound findings with pathological reports. RESULTS Thyroid cancer was identified in 31.21% (49/157) of cases. Significant CEUS high-risk features included inhomogeneous enhancement, enhancement defects, and complete hypoenhancement (AUC 0.818, 0.767, 0.864 respectively). Nodules exhibiting any of these features were classified as high-risk in CEUS. The diagnostic performance of TIRADS improved when combined with CEUS, with AUC increasing from 0.707 to 0.840 and improved sensitivity. CONCLUSION The integration of CEUS with TIRADS significantly enhances the diagnostic accuracy and specificity in identifying thyroid cancer. This combination proves to be a more effective method for risk stratification and diagnosis, highlighting the value of CEUS as an adjunctive tool in thyroid cancer evaluation.
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Affiliation(s)
- Andreea Borlea
- Division of Endocrinology, Department of Internal Medicine II, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
| | - Luciana Moisa-Luca
- Division of Endocrinology, Department of Internal Medicine II, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
| | - Alina Popescu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine II, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Felix Bende
- Division of Gastroenterology and Hepatology, Department of Internal Medicine II, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Dana Stoian
- Division of Endocrinology, Department of Internal Medicine II, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
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Morand GB, Tessler I, Noik M, Krasner J, Yamin T, Pusztaszeri MP, Avior G, Payne RJ. Molecular Profiling for Bethesda III to VI Nodules: Results of a Multicenter International Retrospective Study. Endocr Pract 2024; 30:319-326. [PMID: 38184241 DOI: 10.1016/j.eprac.2024.01.002] [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] [Received: 09/28/2023] [Revised: 12/26/2023] [Accepted: 01/02/2024] [Indexed: 01/08/2024]
Abstract
OBJECTIVE Molecular testing is a well-established tool that assists in the management of thyroid nodules. We describe our experience using molecular testing of thyroid nodules with Bethesda III to VI cytology. METHODS This is a retrospective multicenter, multinational study of thyroid nodules that underwent preoperative molecular profiling with ThyGenX/ThyGeNEXT or ThyroSeq V3 between 2015 and 2022. The clinical characteristics and mutational profiles of tumors were compared. Collected data included demographics, cytology results, surgical pathology, and molecular alterations. Molecular alterations were categorized into 3 main phenotypes: BRAF-like, RAS-like, and non-BRAF-non-RAS (NBNR). RESULTS Overall, 784 patients who had surgery were included, of which 603 (76.2%) were females. The most common histologic type was papillary thyroid cancer (PTC) with 727 (91.9%) cases. In total, 205 (28.2%) cases showed an aggressive subtype of PTC (eg, tall cell and hobnail). BRAF-like alterations were most likely to be found in Bethesda V and VI nodules and show extrathyroidal extension (ETE), nodal disease, and/or aggressive subtypes of PTC (P < .001 for all). RAS-like alterations were more commonly found in Bethesda III and IV nodules and were less likely to show ETE, nodal disease, and/or aggressive histology (P < .001 for all). NBNR alterations were more commonly found in Bethesda III and IV nodules and were less likely to show ETE, nodal disease, and/or aggressive subtypes of PTC. However, they were rarely but significantly associated with poorly differentiated thyroid cancer (P < .005). CONCLUSION Molecular testing of thyroid nodules can help determine the likelihood of malignancy and classify nodules into several tumor phenotypes, predicting their behaviors and potentially allowing for a more tailored treatment. NBNR alterations should be managed with caution.
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Affiliation(s)
- Grégoire B Morand
- Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Department of Otorhinolaryngology - Head and Neck Surgery, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland.
| | - Idit Tessler
- Department of Otolaryngology - Head and Neck Surgery, Sheba Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Maxine Noik
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Josh Krasner
- Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Tzahi Yamin
- Department of Otolaryngology - Head and Neck Surgery, Sheba Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Marc P Pusztaszeri
- Department of Pathology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Galit Avior
- Department of Otolaryngology - Head and Neck Surgery, Sheba Medical Center, Technion University, Tel-Aviv, Israel
| | - Richard J Payne
- Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Morand GB, Tessler I, Krasner J, Pusztaszeri MP, Yamin T, Gecel NA, Avior G, Payne RJ. Investigation of genetic sex-specific molecular profile in well-differentiated thyroid cancer: Is there a difference between females and males? Clin Otolaryngol 2023; 48:748-755. [PMID: 37212457 DOI: 10.1111/coa.14075] [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: 11/22/2022] [Revised: 03/28/2023] [Accepted: 05/01/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Although more common in females, thyroid cancer is deemed to be more aggressive in males. The reasons for sex disparities in thyroid cancer are not well understood. We hypothesised that differences in molecular mutations between females and males contribute to this phenomenon. METHODS Retrospective multicentre multinational study of thyroid nodules that underwent preoperative molecular profiling between 2015 and 2022. The clinical characteristics and mutational profiles of tumours in female and male patients were compared. Collected data included demographics, cytology results, surgical pathology, and molecular alterations. RESULTS A total of 738 patients were included of which 571 (77.4%) were females. The extrathyroidal extension was more common in malignancies in males (chi-squared, p = 0.028). The rate of point mutations and gene fusions were similar in both sex groups (p > 0.05 for all mutations). Patients with nodules with BRAFV600E mutations were significantly younger than BRAF wild-type nodule patients (t-test, p = 0.0001). Conversely, patients with TERT promoter mutations were significantly older than patients with wild-type TERT (t-test, p < 0.0001). For patients harbouring both BRAFV600E and TERT mutations, the difference in age at presentation was significantly different in females (t-test, p = 0.009) but not in males (t-test, p = 0.433). Among females, patients with BRAFV600E and TERT mutations were significantly older than their wild-type or single-mutation counterpart (t-test, p = 0.003). CONCLUSION The absolute rate of molecular mutations was similar in females and males. We found that extrathyroidal extension was more common in males. Moreover, BRAFV600E and TERT mutations occur at a younger age in males than in females. These two findings are factors that may explain the tendency of more aggressive disease in males.
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Affiliation(s)
- Grégoire B Morand
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
- Department of Otorhinolaryngology-Head and Neck Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Idit Tessler
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Josh Krasner
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Marc P Pusztaszeri
- Department of Pathology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Tzahi Yamin
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir A Gecel
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Galit Avior
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Technion University, Tel-Aviv, Israel
| | - Richard J Payne
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Zhang W, Yun X, Xu T, Wang X, Li Q, Zhang T, Xie L, Wang S, Li D, Wei X, Yu Y, Qian B. Integrated gene profiling of fine-needle aspiration sample improves lymph node metastasis risk stratification for thyroid cancer. Cancer Med 2023; 12:10385-10392. [PMID: 36916410 DOI: 10.1002/cam4.5770] [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: 06/13/2022] [Revised: 02/08/2023] [Accepted: 02/22/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Lymph node metastasis risk stratification is crucial for the surgical decision-making of thyroid cancer. This study investigated whether the integrated gene profiling (combining expression, SNV, fusion) of Fine-Needle Aspiration (FNA) samples can improve the prediction of lymph node metastasis in patients with papillary thyroid cancer. METHODS In this retrospective cohort study, patients with papillary thyroid cancer who went through thyroidectomy and central lymph node dissection were included. Multi-omics data of FNA samples were assessed by an integrated array. To predict lymph node metastasis, we built models using gene expressions or mutations (SNV and fusion) only and an Integrated Risk Stratification (IRS) model combining genetic and clinical information. Blinded histopathology served as the reference standard. ROC curve and decision curve analysis was applied to evaluate the predictive models. RESULTS One hundred and thirty two patients with pathologically confirmed papillary thyroid cancer were included between 2016-2017. The IRS model demonstrated greater performance [AUC = 0.87 (0.80-0.94)] than either expression classifier [AUC = 0.67 (0.61-0.74)], mutation classifier [AUC = 0.61 (0.55-0.67)] or TIRADS score [AUC = 0.68 (0.62-0.74)] with statistical significance (p < 0.001), and the IRS model had similar predictive performance in large nodule [>1 cm, AUC = 0.88 (0.79-0.97)] and small nodule [≤1 cm, AUC = 0.84 (0.74-0.93)] subgroups. The genetic risk factor showed independent predictive value (OR = 10.3, 95% CI:1.1-105.3) of lymph node metastasis in addition to the preoperative clinical information, including TIRADS grade, age, and nodule size. CONCLUSION The integrated gene profiling of FNA samples and the IRS model developed by the machine-learning method significantly improve the risk stratification of thyroid cancer, thus helping make wise decisions and reducing unnecessary extensive surgeries.
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Affiliation(s)
- Weituo Zhang
- Hongqiao International Institute of Medicine, Shanghai Tong Ren Hospital and Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinwei Yun
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Tianyu Xu
- Hongqiao International Institute of Medicine, Shanghai Tong Ren Hospital and Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Clinical Research Promotion and Development Center, Shanghai Hospital Development Center, Shanghai, China
| | - Xiaoqing Wang
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Qiang Li
- Hongqiao International Institute of Medicine, Shanghai Tong Ren Hospital and Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tiantian Zhang
- Hongqiao International Institute of Medicine, Shanghai Tong Ren Hospital and Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Xie
- Hongqiao International Institute of Medicine, Shanghai Tong Ren Hospital and Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Suna Wang
- Hongqiao International Institute of Medicine, Shanghai Tong Ren Hospital and Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dapeng Li
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Xi Wei
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Yang Yu
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Biyun Qian
- Hongqiao International Institute of Medicine, Shanghai Tong Ren Hospital and Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Clinical Research Promotion and Development Center, Shanghai Hospital Development Center, Shanghai, China
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Li C, Dong X, Yuan Q, Xu G, Di Z, Yang Y, Hou J, Zheng L, Chen W, Wu G. Identification of novel characteristic biomarkers and immune infiltration profile for the anaplastic thyroid cancer via machine learning algorithms. J Endocrinol Invest 2023:10.1007/s40618-023-02022-6. [PMID: 36725810 DOI: 10.1007/s40618-023-02022-6] [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: 10/17/2022] [Accepted: 01/24/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE Anaplastic thyroid cancer (ATC) is a rare and lethal malignant cancer. In recent years, the application of molecular-driven targeted therapy and immunotherapy has markedly improved the prognosis of ATC. This study aimed to identify characteristic genes for ATC diagnosis and revealed the role of ATC characteristic genes in drug sensitivity and immune cell infiltration. METHODS We downloaded ATC RNA-sequencing data from the GEO database. Following the combination and normalization of the dataset, we first divided the combined datasets into the training cohort and the validation cohort. We identified differentially expressed genes (DEGs) in ATC by differential expression analysis in the training cohort. We used two machine learning algorithms, least absolute shrinkage and selection operator (LASSO) and support vector machine-recursive feature elimination (SVM-RFE) to identify ATC characteristic genes. The CIBERSORT algorithm was performed to calculate the abundance of various immune cells in ATC. Finally, we validated the expression of ATC characteristic genes by quantitative RT-PCR (RT-qPCR) in ATC cell lines and immunohistochemistry (IHC). RESULTS A total of 425 DEGs were identified in the training cohort, including 240 upregulated genes and 185 downregulated genes. Four ATC characteristic genes (ADM, PXDN, MMP1, and TFF3) were identified, and their diagnostic value was validated in the validation cohort (AUC in ROC analysis > 0.75). We established a practical gene expression-based nomogram to accurately predict the probability of ATC. We also found that ATC characteristic biomarkers are associated with the tumor immune microenvironment and drug sensitivity. CONCLUSION ADM, PXDN, MMP1, and TFF3 might serve as potential ATC diagnostic biomarkers and may be helpful for ATC molecular targeted therapy and immunotherapy.
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Affiliation(s)
- C Li
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - X Dong
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Q Yuan
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - G Xu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Z Di
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Gastric and Colorectal Surgical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Y Yang
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - J Hou
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - L Zheng
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - W Chen
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China.
| | - G Wu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China.
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Turner SA, Abou Shaar R, Yang Z. The basics of commonly used molecular techniques for diagnosis, and application of molecular testing in cytology. Diagn Cytopathol 2023; 51:83-94. [PMID: 36345929 PMCID: PMC10098847 DOI: 10.1002/dc.25067] [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: 08/09/2022] [Revised: 10/11/2022] [Accepted: 10/16/2022] [Indexed: 11/11/2022]
Abstract
Molecular diagnostics has expanded to become the standard of care for a variety of solid tumor types. With limited diagnostic material, it is often desirable to use cytological preparations to provide rapid and accurate molecular results. This review covers important pre-analytic considerations and limitations, and a description of common techniques that the modern cytopathologist should understand when ordering and interpreting molecular tests in practice.
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Affiliation(s)
- Scott A Turner
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Rand Abou Shaar
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Zhongbo Yang
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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9
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Płuciennik A, Płaczek A, Wilk A, Student S, Oczko-Wojciechowska M, Fujarewicz K. Data Integration–Possibilities of Molecular and Clinical Data Fusion on the Example of Thyroid Cancer Diagnostics. Int J Mol Sci 2022; 23:ijms231911880. [PMID: 36233181 PMCID: PMC9569592 DOI: 10.3390/ijms231911880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 11/23/2022] Open
Abstract
(1) Background: The data from independent gene expression sources may be integrated for the purpose of molecular diagnostics of cancer. So far, multiple approaches were described. Here, we investigated the impacts of different data fusion strategies on classification accuracy and feature selection stability, which allow the costs of diagnostic tests to be reduced. (2) Methods: We used molecular features (gene expression) combined with a feature extracted from the independent clinical data describing a patient’s sample. We considered the dependencies between selected features in two data fusion strategies (early fusion and late fusion) compared to classification models based on molecular features only. We compared the best accuracy classification models in terms of the number of features, which is connected to the potential cost reduction of the diagnostic classifier. (3) Results: We show that for thyroid cancer, the extracted clinical feature is correlated with (but not redundant to) the molecular data. The usage of data fusion allows a model to be obtained with similar or even higher classification quality (with a statistically significant accuracy improvement, a p-value below 0.05) and with a reduction in molecular dimensionality of the feature space from 15 to 3–8 (depending on the feature selection method). (4) Conclusions: Both strategies give comparable quality results, but the early fusion method provides better feature selection stability.
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Affiliation(s)
- Alicja Płuciennik
- Department of Systems Biology and Engineering, Faculty of Automatic Control, Electronics and Computer Science, Silesian University of Technology, Akademicka 16, 44-100 Gliwice, Poland
- Department of Technology Development, Gabos Software Sp z o.o., Mikołowska 100, 40-065 Katowice, Poland
- Correspondence: (A.P.); (S.S.)
| | - Aleksander Płaczek
- Department of Technology Development, Gabos Software Sp z o.o., Mikołowska 100, 40-065 Katowice, Poland
- Department of Applied Informatics, Faculty of Automatic Control, Electronics and Computer Science, Silesian University of Technology, Akademicka 16, 44-100 Gliwice, Poland
| | - Agata Wilk
- Department of Systems Biology and Engineering, Faculty of Automatic Control, Electronics and Computer Science, Silesian University of Technology, Akademicka 16, 44-100 Gliwice, Poland
- Department of Biostatistics and Bioinformatics, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeze AK 14, 44-100 Gliwice, Poland
| | - Sebastian Student
- Department of Systems Biology and Engineering, Faculty of Automatic Control, Electronics and Computer Science, Silesian University of Technology, Akademicka 16, 44-100 Gliwice, Poland
- Biotechnology Center, Silesian University of Technology, Bolesława Krzywoustego 8, 44-100 Gliwice, Poland
- Correspondence: (A.P.); (S.S.)
| | - Małgorzata Oczko-Wojciechowska
- Department of Clinical and Molecular Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeze AK 14, 44-100 Gliwice, Poland
| | - Krzysztof Fujarewicz
- Department of Systems Biology and Engineering, Faculty of Automatic Control, Electronics and Computer Science, Silesian University of Technology, Akademicka 16, 44-100 Gliwice, Poland
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10
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Jermain PR, Fischer AH, Joseph L, Muzikansky A, Yaroslavsky AN. Fluorescence Polarization Imaging of Methylene Blue Facilitates Quantitative Detection of Thyroid Cancer in Single Cells. Cancers (Basel) 2022; 14:cancers14051339. [PMID: 35267647 PMCID: PMC8908998 DOI: 10.3390/cancers14051339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Accurate diagnosis of thyroid fine-needle aspiration cytology is a significant clinical challenge. A method to detect thyroid cancer at the cellular level would be invaluable to reduce diagnostic uncertainty and improve clinical decision making. We studied the ability of confocal fluorescence polarization imaging of an exogenous fluorophore, methylene blue, to provide quantitative discrimination of cancerous cells in human samples. Our results indicate that fluorescence polarization imaging provides a reliable biomarker of thyroid cancer and holds the potential to shift the paradigm of cellular level cancer diagnosis from subjective visual assessment to objective measurement. Abstract Background: Diagnostic accuracy of the standard of care fine-needle aspiration cytology (FNAC) remains a significant problem in thyroid oncology. Therefore, a robust and accurate method for reducing uncertainty of cytopathological evaluation would be invaluable. Methods: In this double-blind study, we employed fluorescence emission and quantitative fluorescence polarization (Fpol) confocal imaging for sorting thyroid cells into benign/malignant categories. Samples were collected from malignant tumors, benign nodules, and normal thyroid epithelial tissues. Results: A total of 32 samples, including 12 from cytologically indeterminate categories, were stained using aqueous methylene blue (MB) solution, imaged, and analyzed. Fluorescence emission images yielded diagnostically relevant information on cytomorphology. Significantly higher MB Fpol was measured in thyroid cancer as compared to benign and normal cells. The results obtained from 12 indeterminate samples revealed that MB Fpol accurately differentiated benign and malignant thyroid nodules. Conclusions: The developed imaging approach holds the potential to provide an accurate and objective biomarker for thyroid cancer, improve diagnostic accuracy of cytopathology, and decrease the number of lobectomy and near-total thyroidectomy procedures.
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Affiliation(s)
- Peter R. Jermain
- Advanced Biophotonics Laboratory, University of Massachusetts Lowell, Lowell, MA 01854, USA;
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Andrew H. Fischer
- Department of Pathology, University of Massachusetts Medical School, Worcester, MA 01655, USA;
| | - Lija Joseph
- Department of Pathology and Laboratory Medicine, Lowell General Hospital, Lowell, MA 01854, USA;
| | - Alona Muzikansky
- Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Anna N. Yaroslavsky
- Advanced Biophotonics Laboratory, University of Massachusetts Lowell, Lowell, MA 01854, USA;
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
- Correspondence: ; Tel.: +1-978-934-3766
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11
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Hirokawa M, Suzuki A, Kawakami M, Kudo T, Miyauchi A. Criteria for follow-up of thyroid nodules diagnosed as follicular neoplasm without molecular testing - The experience of a high-volume thyroid centre in Japan. Diagn Cytopathol 2022; 50:223-229. [PMID: 35133716 PMCID: PMC9304300 DOI: 10.1002/dc.24937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Clinical management of follicular neoplasms (FNs) using molecular testing of thyroid-aspirated materials is not routinely performed in Japan. This article aims to identify low-risk FN nodules that can be followed up without molecular testing. METHODS The relationship between preoperative findings, factors influencing surgical decision, and the risk of malignancy (ROM) was examined in 356 thyroid nodules with cytological diagnosis of FN at Kuma Hospital from January to December 2020. RESULTS ROMs of FN with cytology results favouring malignancy (41.2%) were significantly higher than those favouring benign (7.7%) or borderline (8.2%) (p < .001). Moreover, ROMs of FN with ultrasonography results of high suspicion (54.5%) were significantly higher than those with low (4.5%) or intermediate suspicion (0%) (p < .0001). There was a large difference in overall ROM in tumours bordering 30 mm in size (<30 mm; 3.6%, ≥30 mm; 20.0%). ROMs of FNs with a tumour volume doubling rate (TVDR) of 1.0/year or more (28.6%) were higher than those of FNs with a lower TVDR (9.9%) (p < .05). The ROMs of FNs with or without one or more of the following four findings suggestive of malignancy: cytological findings favouring malignancy, ultrasonography findings of high suspicion, tumour size ≥30 mm, and TV-DR ≥1.0/year, were 14.6% and 1.0%, respectively. CONCLUSION FNs with no cytological findings favouring malignancy, no ultrasonography findings of high suspicion, tumour size <30 mm and TV-DR <1.0/year, are considered low risk and can be followed up without the need for molecular testing.
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Affiliation(s)
| | - Ayana Suzuki
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan
| | - Makoto Kawakami
- Medical Information Management Section, Kuma Hospital, Kobe, Japan
| | - Takumi Kudo
- Department of Internal Medicine, Kuma Hospital, Kobe, Japan
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12
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Zhang Q, Xin X, Wang L. A Bibliometric Analysis of 8271 Publications on Thyroid Nodules From 2000 to 2021. Front Endocrinol (Lausanne) 2022; 13:845776. [PMID: 35528005 PMCID: PMC9068984 DOI: 10.3389/fendo.2022.845776] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/17/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Thyroid nodules (TNs) are a common clinical condition. The probability of thyroid nodules being malignant is 7-15%. However, in recent decades, a number of publications on TNs have not been well summarized and discussed. The aim of this study was to summarize and sort out medical publications on TNs over the past 2 decades using a bibliometric method. MATERIALS AND METHODS Medical publications from January 1st, 2000, to November 1st, 2021, were searched in the Web of Science Core Collection database using the Medical Subject Heading (MeSH) term "thyroid nodule". Full associated data were downloaded, and detailed information was extracted using the bibliometric analysis platform VOSviewer. RESULTS A total of 8271 publications related to TNs from the last 2 decades were found and included in this study. An increasing trend was presented in the annual number of publications. The United States, China and Italy contributed the most publications. Carcinoma, management, ultrasound, and fine-needle aspiration were the most popular subjects in the field of TNs. The topics of the studies could be stratified into four clusters. The first cluster was using ultrasound to evaluate the nodules, including the thyroid imaging reporting and data system (TI-RADS), elastography and benign features. The second cluster was the fine-needle aspiration method, including the Bethesda system, cytology and BRAF mutations. The third cluster was the management of nodules, including radiofrequency and thermal ablation, surgery, and consensus statements. The last cluster was carcinoma, which is correlated with all three clusters described above. The preoperative diagnosis of cytologically indeterminate nodules was particularly highlighted in the top 10 most cited publications in recent years. CONCLUSION How to diagnose thyroid nodules as malignant or benign, especially in cytologically indeterminate nodules, is still the most concerning topic in TN research. Although the fine-needle aspiration method and gene-expression classifiers show promising results, there is still a crucial need for translations from fundamental studies to clinical applications.
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Affiliation(s)
- Qianqian Zhang
- Department of Endocrine and Metabolism, Zhuhai People’s Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai, China
| | - Xiaoyan Xin
- Department of Endocrine and Metabolism, Zhuhai People’s Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai, China
| | - Li Wang
- Department of Endocrine and Metabolism, Zhuhai People’s Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai, China
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
- *Correspondence: Li Wang,
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13
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Rossi ED, Locantore P, Bruno C, Dell’Aquila M, Tralongo P, Curatolo M, Revelli L, Raffaelli M, Larocca LM, Pantanowitz L, Pontecorvi A. Molecular Characterization of Thyroid Follicular Lesions in the Era of "Next-Generation" Techniques. Front Endocrinol (Lausanne) 2022; 13:834456. [PMID: 35634500 PMCID: PMC9134849 DOI: 10.3389/fendo.2022.834456] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/29/2022] [Indexed: 12/26/2022] Open
Abstract
It is unequivocally recognized that thyroid nodules are frequently detected in the adult population and mostly characterized by benign lesions (up to 70% of them), with only 5%-15% malignant lesions. The evaluation of thyroid lesions with fine-needle aspiration cytology (FNAC) represents one of the first and most useful diagnostic tools in the definition of their nature. Despite the fact that the majority of thyroid lesions are correctly diagnosed as either benign (70%-75%) or malignant (5%-10%) entities, the remaining nodules (20%-25%) represent the "gray zone" of follicular lesions, which belong to indeterminate categories, according to the different classification systems. This indeterminate group of lesions includes both benign and malignant entities, which cannot be easily discriminate with morphology alone. In these last decades, the increasing role of molecular testings, feasibly performed on cytological material combined with the discoveries of specific genetic alterations in the field of thyroid pathology, has opened the pace to their more accurate and specific contribution on cytology. In fact, in 2015, in the revised management guidelines for patients with thyroid nodules and well-differentiated thyroid cancers (WDTCs), the American Thyroid Association (ATA) confirmed the performance of molecular testing in thyroid indeterminate cytology, and the same performance was addressed in recent update of the management of thyroid nodules in the second edition of the Bethesda system for reporting thyroid cytopathology (TBSRTC). In the current review, we discuss the role of molecular tests for the different thyroid diagnostic categories of the Bethesda system for reporting thyroid cytopathology, mostly focusing our attention on the follicular and indeterminate lesions.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli” - IRCCS, Rome, Italy
- *Correspondence: Esther Diana Rossi,
| | - Pietro Locantore
- Division of Endocrinology, Fondazione Policlinico Universitario “Agostino Gemelli” - IRCCS, Rome, Italy
| | - Carmine Bruno
- Division of Endocrinology, Fondazione Policlinico Universitario “Agostino Gemelli” - IRCCS, Rome, Italy
| | - Marco Dell’Aquila
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli” - IRCCS, Rome, Italy
| | - Pietro Tralongo
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli” - IRCCS, Rome, Italy
| | - Mariangela Curatolo
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli” - IRCCS, Rome, Italy
| | - Luca Revelli
- Division of Endocrine Surgery, Fondazione Policlinico Universitario “Agostino Gemelli”- IRCCS, Rome, Italy
| | - Marco Raffaelli
- Division of Endocrine Surgery, Fondazione Policlinico Universitario “Agostino Gemelli”- IRCCS, Rome, Italy
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli” - IRCCS, Rome, Italy
| | - Liron Pantanowitz
- Department of Pathology, University of Michigan, Ann Arbor, MI, United States
| | - Alfredo Pontecorvi
- Division of Endocrinology, Fondazione Policlinico Universitario “Agostino Gemelli” - IRCCS, Rome, Italy
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14
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Agrawal T, Xi L, Navarro W, Raffeld M, Patel SB, Roth MJ, Klubo‐Gwiezdzinska J, Filie AC. An Effective Approach for
BRAF V600E
Mutation Analysis of Routine Thyroid Fine Needle Aspirates. Cytopathology 2021; 33:344-349. [DOI: 10.1111/cyt.13093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 11/30/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Tanupriya Agrawal
- Laboratory of Pathology National Cancer Institute National Institutes of Health 10 Center Drive Bethesda MD 20892 USA
- Department of Pathology University of Rochester Medical Center Rochester
| | - Liqiang Xi
- Laboratory of Pathology National Cancer Institute National Institutes of Health 10 Center Drive Bethesda MD 20892 USA
| | - Winnifred Navarro
- Laboratory of Pathology National Cancer Institute National Institutes of Health 10 Center Drive Bethesda MD 20892 USA
| | - Mark Raffeld
- Laboratory of Pathology National Cancer Institute National Institutes of Health 10 Center Drive Bethesda MD 20892 USA
| | - Snehal B. Patel
- Laboratory of Pathology National Cancer Institute National Institutes of Health 10 Center Drive Bethesda MD 20892 USA
- Snehal B. Patel ‐ HeloGenika LLC Dexter
| | - Mark J. Roth
- Laboratory of Pathology National Cancer Institute National Institutes of Health 10 Center Drive Bethesda MD 20892 USA
| | - Joanna Klubo‐Gwiezdzinska
- National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health 9000 Rockville Pike Bethesda MD 20892 USA
| | - Armando C. Filie
- Laboratory of Pathology National Cancer Institute National Institutes of Health 10 Center Drive Bethesda MD 20892 USA
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15
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Rosvall BR, Kostiuk M, Williams J, Matkin A, Harris J, Seikaly H, O'Connell DA, Biron VL. Utility of droplet digital polymerase chain reaction for TERT and BRAF mutational profiling of thyroid nodules. BMC Cancer 2021; 21:1142. [PMID: 34702207 PMCID: PMC8547072 DOI: 10.1186/s12885-021-08810-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/22/2021] [Indexed: 12/07/2022] Open
Abstract
Background Mutations involving BRAF and TERT are important predictors of disease severity in thyroid cancer, but molecular testing is limited by cost and lack of adequate tissue sample. This study aimed to assess the utility of BRAFV600E and TERT testing using droplet digital PCR (ddPCR) as a diagnostic and prognostic tool for thyroid fine needle aspirate biopsy (FNAB). Methods Patients with thyroid nodules were prospectively enrolled from March 2015 to September 2018. Pre-operative FNAB was collected for standard cytology and molecular testing. BRAFV600E and TERT levels were analyzed by ddPCR. Cytology (Bethesda system) and ddPCR results were correlated to surgical pathology. Results A total of 222 patients were enrolled, of which 124 received thyroid surgery. Pre-operative cytology alone with Bethesda ≥5 was 100% specific and 70% sensitive for malignancy on final surgical pathology. BRAFV600E positivity or TERT overexpression was 100% specific and 60.0% sensitive. Combining cytology (Bethesda ≥5) with BRAFV600E and TERT testing increased the sensitivity of a malignant diagnosis to 80.0%. High TERT levels and/or BRAFV600E was associated with aggressive or advanced stage pathology. Conclusions Combining cytology with ddPCR analysis of BRAFV600E and TERT can improve the diagnostic accuracy of thyroid FNAB, and help predict aggressive pathology. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08810-8.
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Affiliation(s)
- Brandon R Rosvall
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 St, Edmonton, Alberta, T6G 2B7, Canada
| | - Morris Kostiuk
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 St, Edmonton, Alberta, T6G 2B7, Canada
| | - Jordana Williams
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 St, Edmonton, Alberta, T6G 2B7, Canada
| | - Ashlee Matkin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey Harris
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 St, Edmonton, Alberta, T6G 2B7, Canada
| | - Hadi Seikaly
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 St, Edmonton, Alberta, T6G 2B7, Canada
| | - Daniel A O'Connell
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 St, Edmonton, Alberta, T6G 2B7, Canada
| | - Vincent L Biron
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 St, Edmonton, Alberta, T6G 2B7, Canada.
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16
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Yousefi E, Sura GH, Somma J. The gray zone of thyroid nodules: Using a nomogram to provide malignancy risk assessment and guide patient management. Cancer Med 2021; 10:2723-2731. [PMID: 33763983 PMCID: PMC8026948 DOI: 10.1002/cam4.3866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/04/2021] [Accepted: 03/13/2021] [Indexed: 01/21/2023] Open
Abstract
Background Thyroid nodules have a low prevalence of malignancy and most proven cancers do not behave aggressively. Thus, risk‐stratification of nodules is a critical step to avoid surgical overtreatment. We hypothesized that a risk management system superior to those currently in use could be created to reduce the number of clinically indeterminate nodules (i.e., the “gray zone”) by concurrently considering the malignancy risks conferred by clinical, ultrasonographic, and cytologic variables. Methods Thyroidectomy cases were reviewed from three institutions. Their benign versus malignant outcome was used to evaluate the variables for correlation. A binary logistic regression model was trained and, using indeterminate nodules with Bethesda III and IV results, validated. A scoring nomogram was designed to demonstrate the application of the model in clinical practice. Results One hundred thirty thyroidectomies (28% malignant) met inclusion criteria. The final logistic regression model included difficulty in swallowing, hypothyroidism, echogenicity, hypervascularity, margins, calcification, and cytology diagnosis as input parameters. The model was highly successful in determining the outcome (p value: 0.001) with a R2(Nagelkerke) score of 0.93. The area under the curve as determined by receiver operating characteristics was 0.91. The accuracy of the model on the training dataset was 93% (sensitivity and specificity 92% and 96%, respectively) and, on the validation dataset, 80% (sensitivity and specificity 91% and 67%, respectively). Conclusions We report a model for risk assessment of thyroid nodules that has the potential to significantly reduce indeterminates and surgical overtreatment. We illustrate its application via a straightforward nomogram, which integrates clinical, ultrasonographic, and cytologic data, and can be used to create clear, evidence‐based management plans for patients.
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Affiliation(s)
- Elham Yousefi
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Gloria H Sura
- Department of Pathology, LSU Health Sciences Center, New Orleans, LA, USA
| | - Jonathan Somma
- Department of Pathology, LSU Health Sciences Center, New Orleans, LA, USA
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17
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Madgar O, Avior G, Shochat I, Joshua BZ, Baraf L, Avidor Y, Avi Khafif, Assadi N, Alon EE. Thyroid malignancy rates according to the Bethesda reporting system in Israel - A multicenter study. Eur J Surg Oncol 2021; 47:1370-1375. [PMID: 33745793 DOI: 10.1016/j.ejso.2021.03.237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The Bethesda System for Reporting Thyroid Cytopathology was developed in 2007 to facilitate an accurate, reproducible communication of thyroid fine-needle aspiration (FNA) interpretations between clinicians and cytopathologists and to serve as a guide for treatment. Based on large patient series, the system details the risk of malignancy for each category as well as a suggested management for each FNA result. Though this system has been widely adopted, there are only few studies to determine whether results are applicable for Israel. METHODS A multicenter, retrospective analysis of medical charts of all patients who underwent thyroid surgery between January 1st, 2012 and December 31st, 2016 in four medical centers in Israel was performed. Data was analyzed for the overall risk of malignancy for the Bethesda system groups as well as comparison between the different laboratories performing the test. RESULTS Records of 810 thyroidectomies in which preoperative cytological reports and final pathology were available and reviewed. The malignancy rates according to the Bethesda groups' I-VI for our cohort were: 27.8%, 17.6%, 41.4%, 41.4%, 86.9%, and 98.1% respectively. Similar results were seen when results were analyzed according to the different laboratories performing the tests. CONCLUSIONS Post-surgical review of all Bethesda groups had higher malignancy rates than those reported in the original report. These results indicate a difference in the malignancy rates for the different Bethesda system groups in Israel compared to those reported. Physicians are encouraged to use data validated for their own country or patients' community in addition to published values.
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Affiliation(s)
- Ory Madgar
- Department of Otolaryngology, Head and Neck Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.
| | - Galit Avior
- Otolaryngology - Head and Neck Surgery Unit, The Hillel Yaffe Medical Center, Hadera, Israel; Faculty of Medicine, Technion, Haifa, Israel
| | - Isaac Shochat
- Otolaryngology - Head and Neck Surgery Unit, The Hillel Yaffe Medical Center, Hadera, Israel
| | - Ben-Zion Joshua
- Department of Otolaryngology, Head and Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel. Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lior Baraf
- Endocrinology Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Yuval Avidor
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Avi Khafif
- ARM Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel; Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Niddal Assadi
- ARM Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel
| | - Eran E Alon
- Department of Otolaryngology, Head and Neck Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
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18
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Ham J, Wang B, Po JW, Singh A, Niles N, Lee CS. Cancer-associated fibroblasts (CAFs) in thyroid papillary carcinoma: molecular networks and interactions. J Clin Pathol 2021; 74:759-765. [PMID: 33619218 DOI: 10.1136/jclinpath-2020-207357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/04/2021] [Indexed: 01/17/2023]
Abstract
In 1989, Stephen Paget proposed the 'seed and soil' theory of cancer metastasis. This theory has led to previous researchers focusing on the role of a tumour as a cancer seed and antiangiogenesis agents as cancer soil fumigant; for the latter to be effective, it is important for them to be able to distinguish cancer cells from stromal cells. However, antiangiogenesis agents have not produced dramatic survival benefits in vivo. This may be related to their inability to destroy the supporting stroma that promote cancer cell growth. Therefore, in order to effectively arrest cancer cell growth for therapeutic purposes, a paradigm shift is required in our fundamental approach to decipher the molecular events and networks in the stromal environment that cancer cells can thrive and proliferate. The pathogenesis of cancer is a multidimensional process of pathological molecular and cellular pathways, influencing different stromal properties and achieving a mutually negotiated crosstalk between cancer cells and stromal cells. This review summarises the clinical presentation of current knowledge of classical papillary thyroid carcinoma (PTC), emerging molecular diagnostics and future directions of classical PTC research.
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Affiliation(s)
- Jeehoon Ham
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,Discipline of Pathology, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.,CONCERT Biobank, Ingham Institute, Liverpool, New South Wales, Australia
| | - Bin Wang
- Discipline of Pathology, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.,Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Joseph William Po
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,CONCERT Biobank, Ingham Institute, Liverpool, New South Wales, Australia.,Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,Surgical Innovation Unit, Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Amandeep Singh
- Discipline of Pathology, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.,Thyroid Cancer Group, Ingham Institute, Liverpool, New South Wales, Australia.,Department of Head & Neck Surgery, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Navin Niles
- CONCERT Biobank, Ingham Institute, Liverpool, New South Wales, Australia.,Thyroid Cancer Group, Ingham Institute, Liverpool, New South Wales, Australia.,Department of Head & Neck Surgery, Liverpool Hospital, Liverpool, New South Wales, Australia.,School of Medicine, Western Sydney University, Campbelltown Campus, Campbelltown, New South Wales, Australia
| | - Cheok Soon Lee
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia .,Discipline of Pathology, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.,CONCERT Biobank, Ingham Institute, Liverpool, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Campbelltown Campus, Campbelltown, New South Wales, Australia.,Central Clinical School, University of Sydney, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Department of Anatomical Pathology, Liverpool Hospital, Liverpool, New South Wales, Australia
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19
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The importance of using fine-needle aspiration cytology in the diagnosis of thyroid nodules. Ann Med Surg (Lond) 2021; 63:102153. [PMID: 33659056 PMCID: PMC7890107 DOI: 10.1016/j.amsu.2021.01.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/28/2021] [Accepted: 01/28/2021] [Indexed: 01/02/2023] Open
Abstract
Background Thyroid nodules are common diseases, frequent in middle-aged women; only 5%–30% are malignant. Fine needle aspiration cytology is a simple, rapid and non invasive diagnostic test, performed to predict malignancy and avoid unnecessary surgery. The aim of this study is to evaluate the accuracy of fine needle aspiration in the management of thyroid lesions. Materials and methods Our study was retrospective, including all cases of thyroid fine needle aspiration between January 2010 and December 2017, which were verified by microscopic examination, Data was obtained from the files of Pathology and ENT Department of Farhat Hached Hospital of Sousse and from nuclear medicine department of Sahloul Hospital of Sousse, Tunisia. Results A total of 58 cases were studied, the main age was 40 ± 15,57 years and the sex ratio was 0.03 with female predominance. Concordance between fine needle aspiration and histology was seen in 45 cases. The sensitivity was 60% and the specificity was 100%. The negative and positive predictive values were 100 and 92%, respectively. The concordance index Kappa was of 0.67. Conclusion Thyroid fine needle aspiration in experienced hands is an easily performed diagnostic procedure with very little associated risk. It should be performed in suspect nodules for treatment stratification. The thyroid nodules are a frequent disease. We present a serie case of 58 thyroid nodules to enhance the importance of using of fine needle cytology to predict malignancy and avoid unnecessary surgery. We describe clinical, gross and microscopic examinations for diagnosis and treatment.
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20
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Kezlarian B, Lin O. Artificial Intelligence in Thyroid Fine Needle Aspiration Biopsies. Acta Cytol 2020; 65:324-329. [PMID: 33326953 DOI: 10.1159/000512097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/06/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND From cell phones to aerospace, artificial intelligence (AI) has wide-reaching influence in the modern age. In this review, we discuss the application of AI solutions to an equally ubiquitous problem in cytopathology - thyroid fine needle aspiration biopsy (FNAB). Thyroid nodules are common in the general population, and FNAB is the sampling modality of choice. The resulting prevalence in the practicing pathologist's daily workload makes thyroid FNAB an appealing target for the application of AI solutions. SUMMARY This review summarizes all available literature on the application of AI to thyroid cytopathology. We follow the evolution from morphometric analysis to convolutional neural networks. We explore the application of AI technology to different questions in thyroid cytopathology, including distinguishing papillary carcinoma from benign, distinguishing follicular adenoma from carcinoma and identifying non-invasive follicular thyroid neoplasm with papillary-like nuclear features by key words and phrases. Key Messages: The current literature shows promise towards the application of AI technology to thyroid fine needle aspiration biopsy. Much work is needed to define how this powerful technology will be of best use to the future of cytopathology practice.
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Affiliation(s)
- Brie Kezlarian
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA,
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21
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Geng Y, Aguilar-Jakthong JS, Moatamed NA. Comparison of Afirma Gene Expression Classifier with Gene Sequencing Classifier in indeterminate thyroid nodules: A single-institutional experience. Cytopathology 2020; 32:187-191. [PMID: 33010060 DOI: 10.1111/cyt.12920] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/05/2020] [Accepted: 09/24/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The Afirma test has been used in the diagnosis of cytologically indeterminate thyroid nodules to reduce diagnostic uncertainty and unnecessary surgeries. Gene Sequencing Classifier (GSC) was developed to improve the positive predictive value and overall test performance of Gene Expression Classifier (GEC). Here we present our experience comparing the performance of first-generation assay of Afirma (GEC) with the new assay (GSC). METHODS Retrospective analysis was performed on all Bethesda III and IV cytology thyroid nodules tested with GEC and GSC. Test performance was evaluated by surgical pathology outcomes. RESULTS In total, 167 cases were tested with GEC, of which 49% were reported as benign. Fourteen cases had surgical follow-up with 11 benign, one non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) and two malignant diagnoses. Of the 167 cases, 51% had suspicious GEC result. Fifty-seven of these suspicious GEC cases had surgical follow-up with 28 benign, nine NIFTP and 20 malignant histology. There 133 cases tested with GSC, of which 61% were reported as benign. Ten cases had surgical follow-up, all of which showed benign results and 32% of the cases were tested as suspicious. Thirty-six cases with suspicious GSC had surgical follow-up. Fourteen of them had benign, five NIFTP, and 17 malignant surgical pathology. Based on molecular testing, surgical resection could have been be prevented 61% with GSC, compared to 49% with GEC test. CONCLUSION Our experience shows that GSC has a better test performance than GEC. Also, our data support that GSC identify more cases as benign and reduces the number of unnecessary surgeries compared to GEC.
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Affiliation(s)
- Yipeng Geng
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Josephine S Aguilar-Jakthong
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Neda A Moatamed
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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22
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Chin PD, Zhu CY, Sajed DP, Fishbein GA, Yeh MW, Leung AM, Livhits MJ. Correlation of ThyroSeq Results with Surgical Histopathology in Cytologically Indeterminate Thyroid Nodules. Endocr Pathol 2020; 31:377-384. [PMID: 32671653 DOI: 10.1007/s12022-020-09641-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2020] [Indexed: 02/07/2023]
Abstract
The ThyroSeq next-generation sequencing test refines the risk of malignancy in cytologically indeterminate thyroid nodules. Specific genetic alterations have distinct cancer probabilities and clinical phenotypes. There is limited data on the association between specific genetic alterations and histopathologic features. The aim of this study was to evaluate specific ThyroSeq alterations in prognosticating high-risk histopathologic characteristics. We performed a retrospective single-institution study of all patients diagnosed with indeterminate thyroid nodules (May 2016-December 2019) who had a mutation identified with ThyroSeq v2 or v3 and underwent surgical resection. Specific genetic alterations were correlated with surgical histopathology. The main outcomes were risk of malignancy and structural recurrence risk based on histopathologic features and the 2015 American Thyroid Association (ATA) risk stratification. Of the 78 nodules, 50 (64%) were thyroid cancer or noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) on surgical histopathology. Nodules with high-risk TERT or TP53 combination mutations (TERT/TP53) and those with BRAF-like mutations were associated with a 100% probability of cancer and higher rates of extrathyroidal extension and regional nodal involvement than nodules with RAS-like mutations. Among nodules with RAS-like mutations, there was an even distribution between benign, NIFTP, and malignant results, the latter of which were all ATA low risk for structural disease recurrence. Overall, TERT/TP53 and BRAF-like ThyroSeq mutations are associated with an increased cancer probability and risk of recurrence defined by histopathologic features, while RAS-like mutations are associated with lower cancer probability and indolent disease. Individualized management, including extent of surgery, should be considered based on specific genetic alterations found in cytologically indeterminate thyroid nodules.
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Affiliation(s)
- Patrick D Chin
- Section of Endocrine Surgery, University of California Los Angeles David Geffen School of Medicine, 10833 Le Conte Ave, Suite 72-228 CHS, Los Angeles, CA, 90095, USA
| | - Catherine Y Zhu
- Section of Endocrine Surgery, University of California Los Angeles David Geffen School of Medicine, 10833 Le Conte Ave, Suite 72-228 CHS, Los Angeles, CA, 90095, USA
| | - Dipti P Sajed
- Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - Gregory A Fishbein
- Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - Michael W Yeh
- Section of Endocrine Surgery, University of California Los Angeles David Geffen School of Medicine, 10833 Le Conte Ave, Suite 72-228 CHS, Los Angeles, CA, 90095, USA
| | - Angela M Leung
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Masha J Livhits
- Section of Endocrine Surgery, University of California Los Angeles David Geffen School of Medicine, 10833 Le Conte Ave, Suite 72-228 CHS, Los Angeles, CA, 90095, USA.
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23
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Vielh P, Balogh Z, Suciu V, Richon C, Job B, Meurice G, Valent A, Lacroix L, Marty V, Motte N, Dessen P, Caillou B, Ghuzlan AA, Bidart JM, Lazar V, Hofman P, Scoazec JY, El-Naggar AK, Schlumberger M. DNA FISH Diagnostic Assay on Cytological Samples of Thyroid Follicular Neoplasms. Cancers (Basel) 2020; 12:cancers12092529. [PMID: 32899953 PMCID: PMC7564487 DOI: 10.3390/cancers12092529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/30/2020] [Accepted: 09/02/2020] [Indexed: 12/31/2022] Open
Abstract
Simple Summary Cytopathology cannot distinguish benign from malignant follicular lesions in 20–30% of cases. These indeterminate cases includes the so-called follicular neoplasms (FNs) according to The Bethesda System for Reporting Thyroid Cytopathology. Frozen samples from 66 classic follicular adenomas (cFAs) and carcinomas (cFTCs) studied by array-comparative genomic hybridization identified three specific alterations of cFTCs (losses of 1p36.33-35.1 and 22q13.2-13.31, and gain of whole chromosome X) confirmed by fluorescent in situ hybridization (FISH) in a second independent series of 60 touch preparations from frozen samples of cFAs and cFTCs. In a third independent set of 27 cases of already stained pre-operative fine-needle aspiration cytology samples diagnosed as FNs and histologically verified, FISH analysis using these three markers identified half of cFTCs. Specificity of our assay for identifying cFTCs is higher than 98% which might be comparable with BRAF600E testing in cases of suspicion of classic papillary thyroid carcinomas. Abstract Although fine-needle aspiration cytology (FNAC) is helpful in determining whether thyroid nodules are benign or malignant, this distinction remains a cytological challenge in follicular neoplasms. Identification of genomic alterations in cytological specimens with direct and routine techniques would therefore have great clinical value. A series of 153 cases consisting of 72 and 81 histopathologically confirmed classic follicular adenomas (cFAs) and classic follicular thyroid carcinomas (cFTCs), respectively, was studied by means of different molecular techniques in three different cohorts of patients (pts). In the first cohort (training set) of 66 pts, three specific alterations characterized by array comparative genomic hybridization (aCGH) were exclusively found in half of cFTCs. These structural abnormalities corresponded to losses of 1p36.33-35.1 and 22q13.2-13.31, and gain of whole chromosome X. The second independent cohort (validation set) of 60 pts confirmed these data on touch preparations of frozen follicular neoplasms by triple DNA fluorescent in situ hybridization using selected commercially available probes. The third cohort, consisting of 27 archived cytological samples from an equal number of pts that had been obtained for preoperative FNAC and morphologically classified as and histologically verified to be follicular neoplasms, confirmed our previous findings and showed the feasibility of the DNA FISH (DNA fluorescent in situ hybridization) assay. All together, these data suggest that our triple DNA FISH diagnostic assay may detect 50% of cFTCs with a specificity higher than 98% and be useful as a low-cost adjunct to cytomorphology to help further classify follicular neoplasms on already routinely stained cytological specimens.
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Affiliation(s)
- Philippe Vielh
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
- Correspondence: or
| | - Zsofia Balogh
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Voichita Suciu
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Catherine Richon
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Bastien Job
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Guillaume Meurice
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Alexander Valent
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Ludovic Lacroix
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Virginie Marty
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Nelly Motte
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Philippe Dessen
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Bernard Caillou
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Abir Al Ghuzlan
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Jean-Michel Bidart
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Vladimir Lazar
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology and Biobank, Pasteur Hospital, 06002 Nice, France;
| | - Jean-Yves Scoazec
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Adel K. El-Naggar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Martin Schlumberger
- Department of Endocrinology, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France;
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Wang MM, Beckett K, Douek M, Masamed R, Patel M, Tseng CH, Yeh MW, Leung AM, Livhits MJ. Diagnostic Value of Molecular Testing in Sonographically Suspicious Thyroid Nodules. J Endocr Soc 2020; 4:bvaa081. [PMID: 32856009 PMCID: PMC7442277 DOI: 10.1210/jendso/bvaa081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/12/2020] [Indexed: 01/21/2023] Open
Abstract
Objective Molecular testing can refine the diagnosis for the 20% of thyroid fine-needle aspiration biopsies that have indeterminate cytology. We assessed the diagnostic accuracy of molecular testing based on ultrasound risk classification. Methods This retrospective cohort study analyzed all thyroid nodules with indeterminate cytology at an academic US medical center (2012-2016). All indeterminate nodules underwent reflexive molecular testing with the Afirma Gene Expression Classifier (GEC). Radiologists performed blinded reviews to categorize each nodule according to the American Thyroid Association (ATA) ultrasound classification and the American College of Radiology Thyroid Imaging, Reporting and Data System. GEC results and diagnostic performance were compared across ultrasound risk categories. Results Of 297 nodules, histopathology confirmed malignancy in 65 (22%). Nodules by ATA classification were 8% high suspicion, 44% intermediate, and 48% low/very low suspicion. A suspicious GEC result was more likely in ATA high-suspicion nodules (81%) than in nodules of all other ATA categories (57%; P = .04). The positive predictive value (PPV) of GEC remained consistent across ultrasound categories (ATA high suspicion, 64% vs all other ATA categories, 48%; P = .39). The ATA high-suspicion category had higher specificity than a suspicious GEC result (93% vs 51%; P < .01). A suspicious GEC result did not increase specificity for the ATA high-suspicion category. Conclusion The PPV of molecular testing remained consistent across ultrasound risk categories. However, a suspicious GEC result was very likely in ATA high-suspicion nodules and did not improve specificity in this sonographic category.
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Affiliation(s)
- Maxwell M Wang
- David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
| | - Katrina Beckett
- Department of Radiology, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
| | - Michael Douek
- Department of Radiology, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
| | - Rinat Masamed
- Department of Radiology, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
| | - Maitraya Patel
- Department of Radiology, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
| | - Chi-Hong Tseng
- Department of Medicine, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
| | - Michael W Yeh
- Section of Endocrine Surgery, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
| | - Angela M Leung
- Division of Endocrinology, Diabetes, and Metabolism, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California.,Division of Endocrinology, Diabetes, and Metabolism; VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Masha J Livhits
- Section of Endocrine Surgery, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
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25
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Deftereos G, Schmechel SC, Waner EE, Itani M, Dighe MK, Tylee TS. Differential outcomes of patients with thyroid FNA diagnoses of AUS/FLUS with and without nuclear atypia: The potential need for separation in the Bethesda System. Diagn Cytopathol 2020; 48:610-617. [PMID: 32259404 DOI: 10.1002/dc.24424] [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] [Received: 01/25/2020] [Revised: 03/17/2020] [Accepted: 03/24/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND In the current version of The Bethesda System (TBS) for thyroid cytopathology, the atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) category has an estimated risk of malignancy of 10% to 30%. Diagnostic criteria include presence of nuclear atypia, suggestive of papillary thyroid carcinoma (PTC), as well as other types of atypia, which can be seen with non-malignant entities. Aim of this study was to investigate differential outcomes of AUS/FLUS, based on specific morphologic criteria, and assess their respective malignancy risks. METHODS From a total of 1233 patients undergoing thyroid FNAs between 2010 and 2014 at the University of Washington, 119 had AUS/FLUS without nuclear atypia, and 64 with nuclear atypia. Outcomes for patients with and without nuclear atypia (with the exception of 24 patients lost to follow-up) were evaluated and results were compared. RESULTS 16/57 (28.1%) patients with AUS/FLUS and nuclear atypia subsequently had carcinomas on thyroidectomy, statistically higher than the 8/102 patients (7.8%, P = .001) without nuclear atypia. When comparing only patients who underwent surgery (n = 63), again those with AUS/FLUS and nuclear atypia had statistically higher rates of carcinoma (16/31, 51.6%), compared to those without (8/32, 25%; P = .0394). Overall, 24/159 (15.1%) of patients with AUS/FLUS had carcinoma on subsequent histology. CONCLUSION Malignancy rates for AUS/FLUS were in line with TBS estimated risks. However, our data demonstrate that the presence or absence of nuclear atypia is associated with different malignancy rates, suggesting the possibility that the AUS/FLUS category may best be split into two subcategories with different implied risks of malignancy.
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Affiliation(s)
- Georgios Deftereos
- Department of Pathology, University of Washington, Seattle, WA, USA.,Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, UT
| | - Stephen C Schmechel
- Department of Pathology, University of Washington, Seattle, WA, USA.,Sarapath Diagnostics, FL
| | - Emily E Waner
- Department of Medicine, University of Washington, Seattle, WA.,Division of Hospital Medicine, University of Colorado, Denver, CO
| | - Malak Itani
- Department of Radiology, University of Washington, Seattle, WA.,Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Manjiri K Dighe
- Department of Radiology, University of Washington, Seattle, WA
| | - Tracy S Tylee
- Department of Medicine, Division of Metabolism, University of Washington, Seattle, WA
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26
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Xu B, Ghossein RA. Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP): An Update. Head Neck Pathol 2020; 14:303-310. [PMID: 32124418 PMCID: PMC7235108 DOI: 10.1007/s12105-019-01124-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/26/2019] [Indexed: 12/16/2022]
Abstract
Based on evidence accumulated over the past three decades showing that noninvasive encapsulated follicular variant of papillary thyroid carcinoma has an indolent clinical behavior and a RAS-like molecular profile similar to follicular adenoma, the Endocrine Pathology Society working group in 2016 proposed to rename this entity as "noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)" in order to eliminate the term "carcinoma" from the diagnosis. It is a major evidence-based attempt initiated by an international group of endocrine pathologists to tackle the epidemic of thyroid cancer overdiagnosis and overtreatment. However, its creation and continuous existence are not without controversies. NIFTP has sparked a wave of follow up studies aiming to decipher the exact nature of this new entity. In this review, we summarize the rationale, diagnostic criteria, controversies and subsequent changes to the NIFTP concept, and their impact on patient care and pathology practice.
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Affiliation(s)
- Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10021, USA
| | - Ronald A Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10021, USA.
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27
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Seneldir H, Kir G, Soylemez T, Girgin RB, Ozbay N, Ozen F, Ankarali H, Bas G, Alimoglu O. Diagnostic accuracy of molecular testing with three molecular markers on thyroid fine-needle aspiration cytology with abnormal category. Diagn Cytopathol 2020; 48:507-515. [PMID: 32031330 DOI: 10.1002/dc.24394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/12/2020] [Accepted: 01/30/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cases with abnormal category, determined by thyroid fine-needle aspiration (FNA), frequently undergo surgical resection, despite the majority of cases being identified as benign after resection. Additional diagnostic markers are needed to guide the management of patients with abnormal thyroid nodules. MATERIALS AND METHODS The retrospective study enrolled 150 cases diagnosed abnormal by FNA cytology that had undergone molecular testing with three markers (BRAF V600E, NRAS, and KRAS) on the cell block. Seventy-one cases had a surgical follow-up. RESULTS When NIFTP is not considered as malignant, positive predictive values (PPVs) of cytology and combined cytology and molecular testing (CC-MT) were 67.6% (95% CI: 0.555-0.782) and 89.2% (95% CI: 0.746-0.970) (P = .004), respectively. The sensitivity of the CC-MT was 68.8%, specificity was 82.5%, and the false-positive rate was 17.4%. When NIFTP is considered as malignant, PPVs of cytology and CC-MT were 83.1% (95% CI: 0.743-0.918) and 94.6% (95% CI: 0.873-1.018) (P = .047), respectively. The sensitivity of the CC-MT was 59.3%, specificity was 83.3%, and the false-positive rate was 16.7%. CONCLUSION The addition of molecular testing with a small panel to FNA cytology may increase the PPV of cytology in abnormal categories. Small panel (BRAF V600E, KRAS, and NRAS) with high specificity and high PPVs may be used particularly for the detection of thyroid malignancy. Cell blocks can be an especially useful and straightforward method for molecular diagnostic studies.
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Affiliation(s)
- Hatice Seneldir
- Department of Pathology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Gozde Kir
- Department of Pathology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Tuce Soylemez
- Department of Pathology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Rabia B Girgin
- Department of Pathology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Nurver Ozbay
- Department of Pathology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Filiz Ozen
- Department of Medical Genetics, Istanbul Medeniyet University, Istanbul, Turkey
| | - Handan Ankarali
- Department of Biostatistics and Medical Informatics, Istanbul Medeniyet University, Istanbul, Turkey
| | - Gurhan Bas
- Department of General Surgery, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Orhan Alimoglu
- Department of General Surgery, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
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28
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Chronic Lymphocytic Thyroiditis May Lower Accuracy of AUS/FLUS Cytopathology in Surgical Patients. J Surg Res 2020; 245:244-248. [DOI: 10.1016/j.jss.2019.07.068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 06/28/2019] [Accepted: 07/19/2019] [Indexed: 11/21/2022]
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29
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Gan Q, Edeiken BS, Chen MM, Grubbs EG, Busaidy NL, Zafereo M, Perrier ND, Gule-Monroe MD, Krishnamurthy S. Utility of subcategorization of atypia of undetermined significance/follicular lesion of undetermined significance category in ultrasound-guided thyroid fine-needle aspiration in a large referral cancer center. J Am Soc Cytopathol 2019; 8:309-316. [PMID: 31526696 DOI: 10.1016/j.jasc.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/04/2019] [Accepted: 08/07/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Subclassification of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is encouraged in the Bethesda System. In our practice, we subclassified AUS/FLUS into 3 subcategories: atypical follicular cells of undetermined significance (ACUS) for cases with cytologic atypia; follicular lesion (FL) for cellular cases with follicular cells with-minimal or no atypia, arranged in a macro- and micro-follicular pattern with scant colloid; and indeterminate follicular lesion, favor benign (IFL-FB) for cases with few clusters of follicular cells without atypia associated with minimal or no colloid. The objective of our study was to evaluate the prevalence, clinical management, and risk of malignancy for each subcategory. MATERIALS AND METHODS We retrospectively identified ultrasound-guided fine-needle aspiration (US-FNA) of thyroid cases that were subcategorized as ACUS, IFL-FB, and FL at our-institution during 2014-2016. The results of US-FNA were correlated with clinical outcome in the subsequent 2 years including repeat US-FNA, thyroid surgery, and clinical/imaging follow-up. RESULTS Of 3207 thyroid US-FNA cases, 718 (22.4%) cases were included in the study. Of these 718 cases, 104 (14.5%) were subcategorized as ACUS, 166 (23.1%) as FL, and 448 (62.4%) as IFL-FB. The surgery rate was 39.4% (41 of 104) for ACUS, 13.6% (61 of 448) for IFL-FB, and 27.1% (45 of 166) for FL. The risk of malignancy (ROM) was 25% (26 of 104) for ACUS, and 2.9% (13 of 448) for IFL-FB, 6.0% (10 of 166) for FL. The surgery rate and ROM was significantly higher for ACUS in comparison to IFL-FB (P < 0.05) and FL (P < 0.05). CONCLUSIONS Subclassification of AUS/FLUS into 3 groups based on cytopathologic findings alone not only improved the triage of patients for subsequent clinical management but also effectively stratified the risk of malignancy.
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Affiliation(s)
- Qiong Gan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Beth S Edeiken
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Melissa M Chen
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth G Grubbs
- Department of Surgical Onclology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Naifa L Busaidy
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark Zafereo
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nancy D Perrier
- Department of Surgical Onclology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Maria D Gule-Monroe
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Savitri Krishnamurthy
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Abstract
Thyroid carcinoma is the most common cancer in the endocrine system. Recent advances, using next-generation sequencing, have shed light on the molecular pathogenesis of thyroid cancer. Constitutional activation of the mitogen-activated protein kinase pathway through RAS mutation, BRAF mutation, and/or fusions involving receptor tyrosine kinase (eg, (REarranged during Transfection) RET-PTC) plays a central role in tumorigenesis and opens doors to promising tyrosine kinase inhibitor therapy. Several molecular signatures, such as TERT promoter mutation and TP53 mutation, are associated with tumor progression. This article provides a concise and updated summary of the main genetic alterations in thyroid carcinoma.
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Affiliation(s)
| | - Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Khatami F, Larijani B, Nikfar S, Hasanzad M, Fendereski K, Tavangar SM. Personalized treatment options for thyroid cancer: current perspectives. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2019; 12:235-245. [PMID: 31571972 PMCID: PMC6750856 DOI: 10.2147/pgpm.s181520] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/14/2019] [Indexed: 12/16/2022]
Abstract
Thyroid cancer is one of the most common endocrine malignancies, with increasing incidence all over the world. In spite of good prognosis for differentiated thyroid carcinoma, for an unknown reason, about 5–10% of the patients, the cancer will show aggressive behavior, develop metastasis, and be refractory to treatment strategies like radioactive iodine. Regarding the genetic information, each thyroid cancer patient can be considered as an individual unique one, with unique genetic information. Contrary to standard chemotherapy drugs, target therapy components aim at one or more definite molecular pathway on cancer cells, so their selection is underlying patient’s genetic information. Nowadays, several mutations and rearrangements including BRAF, VEGF receptors, RET, and RET/PTC, KDR, KIT, PDGFRA, CD274, and JAK2 are taken into account for the therapeutic components like larotrectinib (TRK inhibitor), vemurafenib, sunitinib, sorafenib, selumetinib, and axitinib. With the new concept of personalized treatment of thyroid cancer diagnoses, planning treatment, finding out how well treatment will work, and estimating a prognosis has changed for the better over the last decade.
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Affiliation(s)
- Fatemeh Khatami
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Personalized Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shekoufeh Nikfar
- Personalized Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mandana Hasanzad
- Personalized Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Medical Genomics Research Center, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Kiarad Fendereski
- Pediateric Urology and Regenerative Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Tavangar
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Pathology, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Endo M, Nabhan F, Porter K, Roll K, Shirley LA, Azaryan I, Tonkovich D, Perlick J, Ryan LE, Khawaja R, Meng S, Phay JE, Ringel MD, Sipos JA. Afirma Gene Sequencing Classifier Compared with Gene Expression Classifier in Indeterminate Thyroid Nodules. Thyroid 2019; 29:1115-1124. [PMID: 31154940 PMCID: PMC7141558 DOI: 10.1089/thy.2018.0733] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: The Afirma Gene Expression Classifier (GEC) has been used to further characterize cytologically indeterminate (cyto-I) thyroid nodules into either benign or suspicious categories. However, its relatively low positive predictive value (PPV) limited its use as a classifier for patients with suspicious results. The Afirma Gene Sequencing Classifier (GSC) was developed to improve PPV while maintaining a high negative predictive value (NPV), yet real-world assessment of its performance is lacking. Methods: We analyzed all patients who had cyto-I nodules and molecular testing with either GEC or GSC between 2011 and 2018 at a single academic medical center. Clinical information was obtained for 343 GEC-tested nodules and 164 GSC-tested nodules. Results: The GSC had a statistically significant higher benign call rate (76.2% vs. 48.1%, p < 0.001), PPV (60.0% vs. 33.3%, p = 0.01), and specificity (94.3% vs. 61.4%, p < 0.001) than the GEC. Improvement was statistically significant in both Bethesda III and Bethesda IV nodules. In particular, the benign call rate of GSC was significantly higher in nodules with Hürthle cell changes (88.8% vs. 25.7%, p < 0.01). The rate of surgical intervention in the indeterminate nodule cohort has decreased by 66.4% since switching to the GSC; 52.5% of indeterminate nodules went to surgery while using the GEC compared with 17.6% with the GSC (p < 0.001). This reduction was statistically significant in nodules with Bethesda III diagnoses, demonstrating a 70.9% decrease (GEC 51.3% vs. GSC 14.9%, p < 0.001), and in nodules with Bethesda IV cytology, a 39.2% decrease was noted (GEC 54.8% vs. GSC 33.3%, p = 0.003). Conclusions: Data from a single academic tertiary center show an improved specificity and PPV while maintaining high sensitivity and NPV for GSC compared with GEC. A statistically significant increase in benign call rates was observed in GSC compared with GEC, likely indicating fewer false positive results. After implementation of GSC, surgical interventions have been reduced by 68%.
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MESH Headings
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/genetics
- Adenocarcinoma, Follicular/pathology
- Adenoma, Oxyphilic/diagnosis
- Adenoma, Oxyphilic/genetics
- Adenoma, Oxyphilic/pathology
- Adult
- Aged
- Biopsy, Fine-Needle
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/genetics
- Carcinoma, Papillary/pathology
- Female
- Gene Expression
- Gene Expression Profiling
- Humans
- Male
- Middle Aged
- Predictive Value of Tests
- Retrospective Studies
- Sequence Analysis, DNA
- Thyroid Cancer, Papillary/diagnosis
- Thyroid Cancer, Papillary/genetics
- Thyroid Cancer, Papillary/pathology
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/genetics
- Thyroid Neoplasms/pathology
- Thyroid Nodule/genetics
- Thyroid Nodule/pathology
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Affiliation(s)
- Mayumi Endo
- Division of Endocrinology, Diabetes, and Metabolism; The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
- Address correspondence to: Mayumi Endo, MD, Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University and Arthur G. James Cancer Center, 1581 Dodd Drive, Columbus, OH 43210
| | - Fadi Nabhan
- Division of Endocrinology, Diabetes, and Metabolism; The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - Kyle Porter
- Department of Biomedical Informatics, Center for Biostatistics and Bioinformatics, The Ohio State University, Columbus, Ohio
| | - Katie Roll
- Division of Endocrinology, Diabetes, and Metabolism; The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - Lawrence A. Shirley
- Division of Surgical Oncology; The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - Irina Azaryan
- Division of Endocrinology, Diabetes, and Metabolism; The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - Dena Tonkovich
- Division of Pathology, The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - Jeanette Perlick
- Division of Endocrinology, Diabetes, and Metabolism; The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - Laura E. Ryan
- Division of Endocrinology, Diabetes, and Metabolism; The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - Raheela Khawaja
- Division of Endocrinology, Diabetes, and Metabolism; The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - Shumei Meng
- Division of Endocrinology, Diabetes, and Metabolism; The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - John E. Phay
- Division of Surgical Oncology; The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - Matthew D. Ringel
- Division of Endocrinology, Diabetes, and Metabolism; The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - Jennifer A. Sipos
- Division of Endocrinology, Diabetes, and Metabolism; The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
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Schatz-Siemers N, Brandler TC, Oweity T, Sun W, Hernandez A, Levine P. Hürthle cell lesions on thyroid fine needle aspiration cytology: Molecular and histologic correlation. Diagn Cytopathol 2019; 47:977-985. [PMID: 31293091 DOI: 10.1002/dc.24247] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 04/25/2019] [Accepted: 05/23/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hürthle cell lesions often pose diagnostic challenges, despite their common occurrence on thyroid fine-needle aspiration cytology (FNAC). The associated molecular alterations are also not well understood. Therefore, our study aimed to delineate the molecular profile of Hürthle cell lesions classified as Bethesda Categories III or IV (atypia of undetermined significance (AUS) or suspicious for follicular neoplasm (SFN)) on FNAC and to correlate this molecular profile with surgical resection findings. METHODS This study consisted of 188 Hürthle cell lesions with indeterminate cytology and ThyroSeq® v2/v3 molecular testing results. Surgical follow-up was available for 33 cases. RESULTS The majority of indeterminate Hürthle cell lesions had negative ThyroSeq® results (61%) and were benign on available surgical follow-up. The most prevalent mutations involved the RAS gene (21%), which were associated with benign lesions, non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP), and malignancy. The remaining mutations involved less than 18% of the cases, including PAX8/PPARG (3.7%), TSHR (3.7%), EIF1AX (2.7%), MET (2.1%), PTEN (1.6%), clonal copy number alteration (1.6%), TERT (1.1%), and 0.5% each of GNAS, PIK3CA, and TP53 mutations. On follow-up, 45% were benign, 24% were NIFTP, and 30% were malignant. The malignant cases had different molecular alterations. CONCLUSION No single molecular alteration defines cytologically indeterminate Hürthle cell lesions; the majority of cases have low-risk or no molecular alterations and are benign on follow-up. These findings suggest that molecular testing may be useful, but is not definitive, in determining which cases may be managed conservatively; additional studies are needed to fully determine the negative predictive value in ruling out malignancy.
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Affiliation(s)
- Nina Schatz-Siemers
- Department of Pathology, New York University School of Medicine, New York, New York
| | - Tamar C Brandler
- Department of Pathology, New York University School of Medicine, New York, New York
| | - Thaira Oweity
- Department of Pathology, New York University School of Medicine, New York, New York
| | - Wei Sun
- Department of Pathology, New York University School of Medicine, New York, New York
| | - Andrea Hernandez
- Department of Pathology, New York University School of Medicine, New York, New York
| | - Pascale Levine
- Department of Pathology, New York University School of Medicine, New York, New York
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Wong R, Farrell SG, Grossmann M. Thyroid nodules: diagnosis and management. Med J Aust 2019; 209:92-98. [PMID: 29996756 DOI: 10.5694/mja17.01204] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 04/20/2018] [Indexed: 12/11/2022]
Abstract
Thyroid nodules are common. Their importance lies in the need to assess thyroid function, degree of and future risk of mass effect, and exclude thyroid cancer, which occurs in 7-15% of thyroid nodules. There are four key components to thyroid nodule assessment: clinical history and examination, serum thyroid stimulating hormone (TSH) measurement, ultrasound and, if indicated, fine-needle aspiration (FNA). If the serum TSH is suppressed, a thyroid scan with 99Tc can distinguish between a solitary hot nodule, a toxic multinodular goitre or, less commonly, thyroiditis or Graves' disease within a coexisting nodular thyroid. Scintigraphically cold nodules are evaluated in the same way as in the setting of normal or elevated serum TSH levels. Thyroid ultrasonography should be performed only for palpable goitre and thyroid nodules and by specialists with expertise in thyroid sonography. Routine thyroid cancer screening is not recommended, except in high risk individuals, as the detection of early thyroid cancer has not been shown to improve survival. FNA may be performed for nodules ≥ 1.0 cm depending on clinical and sonographic risk factors for thyroid cancer. FNA specimens should be read by an experienced cytopathologist and be reported according to the Bethesda Classification System. Molecular analysis of indeterminate FNA samples has potential to better discriminate benign from malignant nodules and thus guide management. Surgery is indicated for FNA findings of malignancy or indeterminate cytology when there is a high risk clinical context. Surgery may also be indicated for suspicion of malignancy; larger nodules, especially with symptoms of mass effect; and in some patients with thyrotoxicosis.
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35
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Pritzker KPH, Nieminen HJ. Needle Biopsy Adequacy in the Era of Precision Medicine and Value-Based Health Care. Arch Pathol Lab Med 2019; 143:1399-1415. [PMID: 31100015 DOI: 10.5858/arpa.2018-0463-ra] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT.— Needle biopsy of diseased tissue is an essential diagnostic tool that is becoming even more important as precision medicine develops. However, the capability of this modality to efficiently provide samples adequate for diagnostic and prognostic analysis remains quite limited relative to current diagnostic needs. For physicians and patients, inadequate biopsy frequently leads to diagnostic delay, procedure duplication, or insufficient information about tumor biology leading to delay in treatment; for health systems, this results in substantial incremental costs and inefficient use of scarce specialized diagnostic resources. OBJECTIVE.— To review current needle biopsy technology, devices, and practice with a perspective to identify current limitations and opportunities for improvement in the context of advancing precision medicine. DATA SOURCES.— PubMed searches of fine-needle aspiration and core needle biopsy devices and similar technologies were made generally, by tissue site, and by adequacy as well as by health economics of these technologies. CONCLUSIONS.— Needle biopsy adequacy can be improved by recognizing the importance of this diagnostic tool by promoting common criteria for needle biopsy adequacy; by optimizing needle biopsy procedural technique, technologies, clinical practice, professional education, and quality assurance; and by bundling biopsy procedure costs with downstream diagnostic modalities to provide better accountability and incentives to improve the diagnostic process.
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Affiliation(s)
- Kenneth P H Pritzker
- From the Departments of Laboratory Medicine and Pathobiology, and Surgery, University of Toronto, Toronto, Ontario, Canada (Dr Pritzker); and the Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland (Dr Nieminen)
| | - Heikki J Nieminen
- From the Departments of Laboratory Medicine and Pathobiology, and Surgery, University of Toronto, Toronto, Ontario, Canada (Dr Pritzker); and the Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland (Dr Nieminen)
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36
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Mitchell J, Yip L. Decision Making in Indeterminate Thyroid Nodules and the Role of Molecular Testing. Surg Clin North Am 2019; 99:587-598. [PMID: 31255193 DOI: 10.1016/j.suc.2019.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Cytologically indeterminate thyroid nodules are associated with a broad range (5%-75%) of malignant risk and accurately informing definitive management poses a challenge. Advancements in molecular testing of fine-needle aspiration biopsies have improved preoperative diagnostic accuracy and prognostication. For indeterminate nodules, such testing ideally will reduce the need for surgery for benign nodules and potentially guide appropriate extent of initial surgery for malignancy.
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Affiliation(s)
- Janeil Mitchell
- Fox Valley Surgical Associates, Endocrine Surgery, 1818 North Meade Street, Appleton, WI 54911, USA
| | - Linwah Yip
- Department of Surgery, Division of Endocrine Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, 3471 Fifth Avenue, Suite 101, Pittsburgh, PA 15213, USA.
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Cohen DS, Tongson-Ignacio JE, Lolachi CM, Ghaderi VS, Jahan-Parwar B, Thompson LDR. Rethinking Malignancy Risk in Indeterminate Thyroid Nodules with Positive Molecular Studies: Southern California Permanente Experience. Otolaryngol Head Neck Surg 2019; 161:419-423. [DOI: 10.1177/0194599819842859] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To recognize that thyroid nodules with atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS; Bethesda III) have different risks of malignancy based on genetic mutation and to consider molecular testing of nodules with AUS/FLUS to help avoid unnecessary morbidity or cost. Study Design Retrospective cohort study. Setting Multiple locations within Southern California Permanente Medical Group. Subjects and Methods Patients included those with indeterminate thyroid nodules and AUS/FLUS on 2 separate fine-needle aspirations with positive ThyGenX testing from 2014 to 2017 who underwent thyroid surgery. Patients were classified as having benign or malignant disease. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features was considered benign. Results A total of 231 patients had repeat AUS/FLUS with positive molecular testing and surgery. The most frequent type of malignancy was papillary carcinoma, followed by follicular carcinoma. The overall prevalence of malignancy in nodules with mutations was 74.0%, although there was considerable variation: BRAF = 100%, RET = 100%, PAX8-PPARγ = 84.6%, HRAS = 70.7%, NRAS = 63.4%, and KRAS = 33%—a statistically significant finding ( P < .001). Conclusions Not all molecular mutations in thyroid nodules with AUS/FLUS have a high risk of malignancy. Of note, patients with BRAF and RET mutations in our population had a 100% risk of malignancy. Patients with PAX, HRAS, or NRAS mutations had a high risk of malignancy, while patients with KRAS mutations had a lower risk of malignancy. Further studies are needed to determine if the presence of certain molecular mutations can help personalize care and aid in the decision for thyroid surgery.
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Affiliation(s)
- David S. Cohen
- Department of Head and Neck Surgery, Southern California Permanente Medical Group, Harbor City, California, USA
| | - Jane E. Tongson-Ignacio
- Department of Cytopathology, Southern California Permanente Medical Group, North Hollywood, California, USA
| | - Christopher M. Lolachi
- Department of Head and Neck Surgery, Southern California Permanente Medical Group, Harbor City, California, USA
| | - Vanessa S. Ghaderi
- Department of Endocrinology, Southern California Permanente Medical Group, Harbor City, California, USA
| | - Babak Jahan-Parwar
- Department of Head and Neck Surgery, Southern California Permanente Medical Group, Baldwin Park, California, USA
| | - Lester D. R. Thompson
- Department of Pathology, Southern California Permanente Medical Group, Woodland Hills, California, USA
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Kuo JH, McManus C, Graves CE, Madani A, Khokhar MT, Huang B, Lee JA. In brief. Curr Probl Surg 2019. [DOI: 10.1067/j.cpsurg.2018.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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39
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Pongsapich W, Chongkolwatana C, Poungvarin N, Amornpichetkul K, Piyawattayakorn N, Vejvisithsakul P, Maneeprasopchoke P. BRAF mutation in cytologically indeterminate thyroid nodules: after reclassification of a variant thyroid carcinoma. Onco Targets Ther 2019; 12:1465-1473. [PMID: 30863114 PMCID: PMC6391130 DOI: 10.2147/ott.s190001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose Fine-needle aspiration biopsy (FNAB) is regarded by the Bethesda system as the gold-standard investigation for stratifying the risk of malignancy of a thyroid nodule. However, some limitations affect the adequacy of the obtained materials, resulting in 30% of the cytological results remaining in the indeterminate category. We aimed to investigate the diagnostic value of the BRAF mutation in cytologically indeterminate thyroid nodules after the reclassification of a variant thyroid carcinoma. Patients and methods In this prospective diagnostic study, 76 patients with FNAB findings of atypia of undetermined significance (AUS) and suspicious for malignancy (SUS) were included. The BRAF V600 mutation from FNAB was confirmed by a PCR-based method (Sanger sequencing combined with allele-specific real-time PCR techniques) and immunohistochemistry (IHC). Pathological specimens and features, including noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), were reviewed and compared to the FNAB results. Results Using the PCR-based method, the BRAF mutation was positive in 13/76 cases (17.1%), with the diagnostic values of 16.7% sensitivity, 100% specificity, 100% positive predictive value (PPV), and 82.8% negative predictive value (NPV) in the AUS compared to 73.3% sensitivity, 100% specificity, 100% PPV, and 20% NPV in the SUS. For the IHC technique, only 20 of the 76 cytological specimens were qualified for testing. The BRAF mutation was positive in 13/20 cases, with the diagnostic values of 100% sensitivity, 63.6% specificity, 42.9% PPV, and 100% NPV in the AUS compared to 100% sensitivity and PPV in the SUS. The BRAF mutation was not found in the pathological reports for NIFTP. Conclusion The malignancy rate is high in our data, with specific and acceptable accuracy rates for the BRAF mutation from FNAB found by using the PCR-based method. NIFTP has been introduced after the pathological reclassification. Molecular diagnosis might be useful to establish the nature of the disease.
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Affiliation(s)
- Warut Pongsapich
- Department of Otorhinolaryngology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand,
| | - Cheerasook Chongkolwatana
- Department of Otorhinolaryngology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand,
| | - Naravat Poungvarin
- Department of Clinical Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Kanchana Amornpichetkul
- Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Nutthaya Piyawattayakorn
- Department of Otorhinolaryngology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand,
| | - Pichpisith Vejvisithsakul
- Department of Clinical Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Prachya Maneeprasopchoke
- Department of Otorhinolaryngology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand,
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Macerola E, Rago T, Proietti A, Basolo F, Vitti P. The mutational analysis in the diagnostic work-up of thyroid nodules: the real impact in a center with large experience in thyroid cytopathology. J Endocrinol Invest 2019; 42:157-166. [PMID: 29704233 DOI: 10.1007/s40618-018-0895-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/20/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE Fine-needle aspiration (FNA) cytology is a mainstay in the evaluation of thyroid nodules, but fails to reach reliable results in 25-30% of cases. The role of molecular markers in helping clinical decisions has been investigated for the last years, but their clinical usefulness is still unsettled. METHODS Mutation analysis of BRAF, RAS genes and TERT promoter was performed in a series of 617 consecutive cytological specimens undergoing FNA. RESULTS The 617 nodules had the following cytological diagnosis: non diagnostic 22 (3.6%), benign 425 (68.9%), indeterminate 114 (18.5%), suspicious 11 (1.8%) and malignant 45 (7.3%). BRAF mutations were found in 31 cases (5.0%), all but two in suspicious and malignant nodules. RAS mutations were detected in 47 samples (7.6%): 25 benign (5.9%) and 19 indeterminate nodules (16.7%). TERT promoter mutation alone was detected in three samples. Histological outcome was available for 167 nodules, 81 of which proved malignant: all the 48 with suspicious or malignant cytology; 25 out of 56 (44.6%) with indeterminate and 8 out of 57 (14%) with benign cytology. BRAF mutations were associated with worse tumors pathological features. The presence of RAS mutations was indicative of follicular-patterned malignancies in 5 out of 8 benign nodules and 9 out of 11 indeterminate nodules. CONCLUSIONS Our study established mutational rates for BRAF and RAS genes in a large series of FNA specimens. BRAF mutations were confirmed as highly specific but not able to improve cytological diagnosis, while RAS testing proved effective in assessing malignancy in nodules with indeterminate and benign cytology.
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Affiliation(s)
- E Macerola
- Department of Surgical, Medical, Molecular Pathology and Critical Area (Anatomical Pathology Section), University of Pisa, via Savi 10, 56126, Pisa, Italy
| | - T Rago
- Department of Clinical and Experimental Medicine (Endocrinology Section), University of Pisa, via Paradisa 2, 56124, Pisa, Italy
| | - A Proietti
- Division of Anatomical Pathology, University Hospital of Pisa, via Roma 57, 56126, Pisa, Italy
| | - F Basolo
- Department of Surgical, Medical, Molecular Pathology and Critical Area (Anatomical Pathology Section), University of Pisa, via Savi 10, 56126, Pisa, Italy
| | - P Vitti
- Department of Clinical and Experimental Medicine (Endocrinology Section), University of Pisa, via Paradisa 2, 56124, Pisa, Italy.
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Ye W, Hannigan B, Zalles S, Mehrotra M, Barkoh BA, Williams MD, Cabanillas ME, Edeiken-Monroe B, Hu P, Duose D, Wistuba II, Medeiros LJ, Stewart J, Luthra R, Roy-Chowdhuri S. Centrifuged supernatants from FNA provide a liquid biopsy option for clinical next-generation sequencing of thyroid nodules. Cancer Cytopathol 2019; 127:146-160. [PMID: 30620446 DOI: 10.1002/cncy.22098] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/05/2018] [Accepted: 12/05/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Molecular testing is recommended as an adjunct to improve the preoperative diagnosis of fine-needle aspiration (FNA) of thyroid nodules. Centrifuged supernatants from FNA samples, which are typically discarded, have recently emerged as a novel liquid-based biopsy for molecular testing. This study evaluates the use of thyroid FNA supernatants for detecting clinically relevant mutations. METHODS Supernatants from thyroid FNA samples (n = 156) were evaluated. A 50-gene next-generation sequencing (NGS) assay was used, and mutation analysis results from a subset of samples were further compared with those of paired FNA smears and/or cell blocks. RESULTS All 156 samples yielded adequate DNA (median, 135 ng; range, 11-3180 ng), and 129 of these samples (83%) were successfully sequenced by NGS. The most frequently detected somatic mutations included BRAF and RAS mutations, which were followed by RET, TP53, PTEN, CDKN2A, and PIK3CA mutations. Eleven of 31 cases with an indeterminate cytologic diagnosis and 9 of 12 cases that were suspicious for malignancy had somatic mutations, including the BRAF V600E mutation, which is highly definitive for papillary thyroid carcinoma (PTC). Seven of the 9 indeterminate and suspicious cases with the BRAF V600E mutation had surgical follow-up, and they were all confirmed to be PTC. A comparison of the mutation profiles derived from supernatants with those of paired smears and/or cell blocks in a small subset of cases (n = 8) showed 100% concordance. CONCLUSIONS This study provides evidence that FNA supernatants can be used as a surrogate for thyroid molecular testing to improve diagnostic accuracy in indeterminate nodules, provide prognostic/predictive information, and improve overall patient management.
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Affiliation(s)
- Wenrui Ye
- Diagnostic Genetics, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brette Hannigan
- Diagnostic Genetics, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephanie Zalles
- Diagnostic Genetics, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Meenakshi Mehrotra
- Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bedia A Barkoh
- Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michelle D Williams
- Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Maria E Cabanillas
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Beth Edeiken-Monroe
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peter Hu
- Diagnostic Genetics, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dzifa Duose
- Department of Translational Molecular Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ignacio I Wistuba
- Department of Translational Molecular Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - L Jeffrey Medeiros
- Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John Stewart
- Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rajyalakshmi Luthra
- Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sinchita Roy-Chowdhuri
- Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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42
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Johnson DN, Cavallo AB, Uraizee I, Tanager K, Lastra RR, Antic T, Cipriani NA. A Proposal for Separation of Nuclear Atypia and Architectural Atypia in Bethesda Category III (AUS/FLUS) Based on Differing Rates of Thyroid Malignancy. Am J Clin Pathol 2019; 151:86-94. [PMID: 30212867 DOI: 10.1093/ajcp/aqy109] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objectives Bethesda category III (atypia of undetermined significance/follicular lesion of undetermined significance) includes sparsely cellular specimens with nuclear atypia (3N) and/or architectural atypia (3A). This study investigates whether the two types of atypia have different rates of malignancy (ROMs). Methods Cytologic and histologic diagnoses of resected thyroid nodules were recorded. ROM was calculated for all Bethesda categories and for 3N and 3A subcategories. Possible noninvasive follicular thyroid neoplasms with papillary-like nuclear features were reviewed and removed from malignancies, and ROM was recalculated. Results A total of 1,396 nodules were included. ROM of 3N (33.3%-26.0%) was higher than 3A (7.7%-5.0%) (P < .0001) and was similar to suspicious for follicular neoplasm (25.0%-20.3%) (P = .3). ROM of 3A approached benign (2.4%-1.5%) (P = .02). Conclusions Strong consideration should be given to separating 3N (nuclear atypia with higher risk for papillary thyroid carcinoma) from 3A (architectural atypia with higher chance of being benign) to convey different ROMs.
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Affiliation(s)
| | | | - Imran Uraizee
- Department of Pathology, University of Chicago, Chicago, IL
| | - Kevin Tanager
- Department of Pathology, University of Chicago, Chicago, IL
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago, Chicago, IL
- Division of Cytopathology, University of Chicago, Chicago, IL
- Division of Surgical Pathology, University of Chicago, Chicago, IL
| | - Tatjana Antic
- Department of Pathology, University of Chicago, Chicago, IL
- Division of Cytopathology, University of Chicago, Chicago, IL
- Division of Surgical Pathology, University of Chicago, Chicago, IL
| | - Nicole A Cipriani
- Department of Pathology, University of Chicago, Chicago, IL
- Division of Surgical Pathology, University of Chicago, Chicago, IL
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43
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Kuo JH, McManus C, Graves CE, Madani A, Khokhar MT, Huang B, Lee JA. Updates in the management of thyroid nodules. Curr Probl Surg 2018; 56:103-127. [PMID: 30798796 DOI: 10.1067/j.cpsurg.2018.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/18/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Jennifer H Kuo
- Division of Endocrine Surgery, Columbia University, New York, NY.
| | | | - Claire E Graves
- Division of Endocrine Surgery, Columbia University, New York, NY
| | - Amin Madani
- Division of Endocrine Surgery, Columbia University, New York, NY
| | - Mamoona T Khokhar
- Division of Endocrine Surgery, Banner University Medical Center, Phoenix, AZ
| | - Bernice Huang
- Division of Endocrine Surgery, Columbia University, New York, NY
| | - James A Lee
- Division of Endocrine Surgery, Columbia University, New York, NY
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Ohori NP, Landau MS, Carty SE, Yip L, LeBeau SO, Manroa P, Seethala RR, Schoedel KE, Nikiforova MN, Nikiforov YE. Benign call rate and molecular test result distribution of ThyroSeq v3. Cancer Cytopathol 2018; 127:161-168. [DOI: 10.1002/cncy.22088] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/12/2018] [Accepted: 11/05/2018] [Indexed: 01/21/2023]
Affiliation(s)
- N. Paul Ohori
- Department of Pathology University of Pittsburgh Medical Center‐Presbyterian Pittsburgh Pennsylvania
| | - Michael S. Landau
- Department of Pathology University of Pittsburgh Medical Center‐Presbyterian Pittsburgh Pennsylvania
| | - Sally E. Carty
- Division of Endocrine Surgery University of Pittsburgh Medical Center‐Presbyterian Pittsburgh Pennsylvania
| | - Linwah Yip
- Division of Endocrine Surgery University of Pittsburgh Medical Center‐Presbyterian Pittsburgh Pennsylvania
| | - Shane O. LeBeau
- Division of Endocrinology University of Pittsburgh Medical Center‐Presbyterian Pittsburgh Pennsylvania
| | - Pooja Manroa
- Division of Endocrinology University of Pittsburgh Medical Center‐Presbyterian Pittsburgh Pennsylvania
| | - Raja R. Seethala
- Department of Pathology University of Pittsburgh Medical Center‐Presbyterian Pittsburgh Pennsylvania
| | - Karen E. Schoedel
- Department of Pathology University of Pittsburgh Medical Center‐Presbyterian Pittsburgh Pennsylvania
| | - Marina N. Nikiforova
- Department of Pathology University of Pittsburgh Medical Center‐Presbyterian Pittsburgh Pennsylvania
| | - Yuri E. Nikiforov
- Department of Pathology University of Pittsburgh Medical Center‐Presbyterian Pittsburgh Pennsylvania
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45
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Yan H, Hunter E, Akoulitchev A, Park P, Winchester DJ, Moo-Young TA, Prinz RA. Epigenetic chromatin conformation changes in peripheral blood can detect thyroid cancer. Surgery 2018; 165:44-49. [PMID: 30377001 DOI: 10.1016/j.surg.2018.05.081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/28/2018] [Accepted: 05/01/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Fine needle aspiration has been the traditional method for diagnosing thyroid cancer. Epigenetic chromatin conformation changes offer an alternative method of diagnosing cancer. The purpose of this study is to evaluate an EpiSwitch assay of epigenetic markers that can be used to diagnose thyroid cancer in blood samples. METHODS From 2014 to 2016, adult patients with thyroid nodules having thyroidectomy were recruited and grouped based on benign, malignant, and atypia of undetermined significance or follicular lesions of undetermined significance fine needle aspiration cytology. Blood samples were collected before surgery. Final pathologic diagnosis was made from the thyroid specimens. Patients' blood samples were analyzed using the EpiSwitch assay, (Oxford Biodynamics, Oxford, UK), and the results were compared with surgical pathology to determine assay performance. RESULTS In total, 58 patients were recruited: 20 benign, 20 malignant, and 18 atypia or follicular lesions of undetermined significance. An analysis of the malignant and benign fine needle aspiration groups found 6 epigenetic markers for thyroid. A total of 28 (48%) patients had thyroid cancer. The assay was able to correctly identify 25 of the 28 malignant nodules, showing sensitivity of 89.3% and specificity of 66.7%. The positive predictive value for the assay was 71.4%, whereas the negative predictive value was 87.0%. CONCLUSION An epigenetic assay of peripheral blood shows high sensitivity in detecting thyroid cancer and provides an additional method for its diagnosis.
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Affiliation(s)
- Huan Yan
- NorthShore University HealthSystem, Evanston, Illinois.
| | | | | | - Patricia Park
- NorthShore University HealthSystem, Evanston, Illinois
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Piga I, Casano S, Smith A, Tettamanti S, Leni D, Capitoli G, Pincelli AI, Scardilli M, Galimberti S, Magni F, Pagni F. Update on: proteome analysis in thyroid pathology - part II: overview of technical and clinical enhancement of proteomic investigation of the thyroid lesions. Expert Rev Proteomics 2018; 15:937-948. [PMID: 30290700 DOI: 10.1080/14789450.2018.1532793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION An accurate diagnostic classification of thyroid lesions remains an important clinical aspect that needs to be addressed in order to avoid 'diagnostic' thyroidectomies. Among the several 'omics' techniques, proteomics is playing a pivotal role in the search for diagnostic markers. In recent years, different approaches have been used, taking advantage of the technical improvements related to mass spectrometry that have occurred. Areas covered: The review provides an update of the recent findings in diagnostic classification, in genetic definition and in the investigation of thyroid lesions based on different proteomics approaches and on different type of specimens: cytological, surgical and biofluid samples. A brief section will discuss how these findings can be integrated with those obtained by metabolomics investigations. Expert commentary: Among the several proteomics approaches able to deepen our knowledge of the molecular alterations of the different thyroid lesions, MALDI-MSI is strongly emerging above all. In fact, MS-imaging has also been demonstrated to be capable of distinguishing thyroid lesions, based on their different molecular signatures, using cytological specimens. The possibility to use the material obtained by the fine needle aspiration makes MALDI-MSI a highly promising technology that could be implemented into the clinical and pathological units.
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Affiliation(s)
- Isabella Piga
- a Department of Medicine and Surgery , University of Milano-Bicocca, Clinical Proteomics and Metabolomics Unit , Vedano al Lambro , Italy.,b Department of Medicine and Surgery , University of Milano-Bicocca, Section of Pathology , Monza , Italy
| | - Stefano Casano
- b Department of Medicine and Surgery , University of Milano-Bicocca, Section of Pathology , Monza , Italy
| | - Andrew Smith
- a Department of Medicine and Surgery , University of Milano-Bicocca, Clinical Proteomics and Metabolomics Unit , Vedano al Lambro , Italy
| | - Silvia Tettamanti
- a Department of Medicine and Surgery , University of Milano-Bicocca, Clinical Proteomics and Metabolomics Unit , Vedano al Lambro , Italy
| | - Davide Leni
- c Department of Radiology , San Gerardo Hospital , Monza , Italy
| | - Giulia Capitoli
- d Department of Medicine and Surgery , University of Milano-Bicocca, Centre of Biostatistics for Clinical Epidemiology , Monza , Italy
| | | | | | - Stefania Galimberti
- d Department of Medicine and Surgery , University of Milano-Bicocca, Centre of Biostatistics for Clinical Epidemiology , Monza , Italy
| | - Fulvio Magni
- a Department of Medicine and Surgery , University of Milano-Bicocca, Clinical Proteomics and Metabolomics Unit , Vedano al Lambro , Italy
| | - Fabio Pagni
- b Department of Medicine and Surgery , University of Milano-Bicocca, Section of Pathology , Monza , Italy
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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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48
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Utilidad del estudio molecular de nódulos tiroideos con citología indeterminada. Cir Esp 2018; 96:395-400. [DOI: 10.1016/j.ciresp.2018.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 01/07/2023]
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49
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Mu N, Juhlin CC, Tani E, Sofiadis A, Reihnér E, Zedenius J, Larsson C, Nilsson IL. High Ki-67 index in fine needle aspiration cytology of follicular thyroid tumors is associated with increased risk of carcinoma. Endocrine 2018; 61:293-302. [PMID: 29796987 PMCID: PMC6061212 DOI: 10.1007/s12020-018-1627-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/05/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE Preoperative distinction of follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA) is a diagnostic challenge. Our aim was to investigate whether the Ki-67 proliferation index in fine needle aspiration material can contribute to the diagnosis of FTC. METHODS We analyzed retrospectively cytological Ki-67 index determined in routine clinical setting and clinical data for 61 patients with FTC, 158 patients with FTA and 15 patients with follicular tumor of uncertain malignant potential (FT-UMP) surgically treated and diagnosed by histopathology at Karolinska University Hospital 2006-2017 (Cohort A). A previously published cohort of 109 patients with follicular tumors was re-analyzed as well (Cohort B). RESULTS In Cohort A, patients with FTC had a higher Ki-67 index (p < 0.001), larger tumor size (p < 0.001) and higher age at diagnosis (p = 0.036) compared to patients with FTA or FT-UMP. Hürthle cell differentiation, present in 50 FTA, 20 FTC and 8 FT-UMP, was associated with higher Ki-67 index (p = 0.009). Multivariate analysis of Cohort A identified a high Ki-67 index (odds ratio [OR]: 1.215, p < 0.001) and large tumor size (OR: 1.038, p < 0.001) as independent predictors of FTC. Results remained consistent after exclusion of Hürthle cell tumors and in pooled analysis of Cohort A + B. The area under curve of the Ki-67 index for predicting FTC was 0.722 and a cut-off for Ki-67 index at above 5% resulted in a specificity at 93% and sensitivity at 31%. Subgroup analysis of FTCs in Cohort A showed an association of higher Ki-67 index to extrathyroidal extension (p = 0.001) as well as widely invasive subtype (p = 0.019) based on the WHO 2017 classification. CONCLUSIONS Pre-operative Ki-67 index may add diagnostic information for a subset of patients with follicular thyroid tumors.
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Affiliation(s)
- Ninni Mu
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
- Cancer Center Karolinska, Karolinska University Hospital, Stockholm, Sweden.
- Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden.
| | - C Christofer Juhlin
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Cancer Center Karolinska, Karolinska University Hospital, Stockholm, Sweden
- Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Edneia Tani
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Anastasios Sofiadis
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Cancer Center Karolinska, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Reihnér
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jan Zedenius
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Breast, Endocrine Tumours and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
| | - Catharina Larsson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Cancer Center Karolinska, Karolinska University Hospital, Stockholm, Sweden
- Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Inga-Lena Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Breast, Endocrine Tumours and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
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PET/CT and prediction of thyroid cancer in patients with follicular neoplasm or atypia. Eur Arch Otorhinolaryngol 2018; 275:2109-2117. [PMID: 29909471 DOI: 10.1007/s00405-018-5030-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/05/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE To examine whether addition of 18F-fluoro-deoxy-glucose positron emission tomography/computed tomography (FDG-PET/CT) to fine needle aspiration biopsy (FNAB) would improve prediction of thyroid cancer in patients with FNAB-derived follicular neoplasm or atypia, classified according to focal, multifocal, diffuse, or no FDG uptake. MATERIALS AND METHODS Consecutive patients with FNAB-derived follicular neoplasm or atypia planned for surgery from September 2013 to March 2016 were prospectively included and considered for analysis. All patients underwent preoperative PET/CT and a clinical head and neck examination, including ultrasound of the neck and the thyroid gland. Patients with obvious signs of thyroid malignancy were excluded from the study. Histology of the surgical specimen was used as reference standard for statistical analysis. RESULTS Of the 108 patients included (85 women, median age 53.4 years), 31 (29%) had a thyroid nodule that was histologically verified as malignant. Sensitivity and specificity for PET/CT in detection of thyroid cancer was 79 and 32%, respectively, including a derived positive predictive value (PPV) of 31%, and a negative predictive value (NPV) of 79%. Univariate and multivariate analyses showed no significant increase in the risk of thyroid cancer among patients with focal or multifocal FDG uptake compared to patients with no FDG uptake. CONCLUSION Addition of PET/CT to FNAB did not improve prediction of thyroid cancer in patients with FNAB-derived follicular neoplasm or atypia.
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