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Sirotnikov S, Griffith CC, Lubin D, Zhang C, Saba NF, Li D, Kornfield A, Chen A, Shi Q. ThyroSeq overview on indeterminate thyroid nodules: An institutional experience. Diagn Cytopathol 2024. [PMID: 38554032 DOI: 10.1002/dc.25311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/31/2024] [Accepted: 03/20/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND Molecular triage of indeterminate thyroid aspirates offers the opportunity to stratify the risk of malignancy (ROM) more accurately. Here we examine our experience with ThyroSeq v3 testing. METHODS We analyzed 276 of 658 (42%) fine needle aspiration samples classified as indeterminate thyroid nodules using ThyroSeq v3 (Sept 2017-Dec 2019). The test provides a ROM and detects specific mutations. Surgical diagnoses were reviewed. RESULTS Of 276 ThyroSeq-tested cases, 42% (n = 116) harbored genetic alterations, whereas 64% (n = 74) had surgical follow-up. Notably, 79% cases within intermediate to higher risk mutations were highly associated with surgical intervention, resulting in a 77.5% ROM when including both cancer and noninvasive follicular thyroid neoplasia with papillary-like features (cancer+NIFTP) and 68% malignant diagnosis when excluding NIFTP. RAS-like alterations were most common (66%), exhibiting a 73.4% ROM and a 59% malignant diagnosis. Interestingly, this group included 24 encapsulated follicular variant papillary thyroid carcinomas (EFVPTCs), 1 infiltrative FVPTC, 9 follicular carcinomas, and 7 NIFTP. Additionally, three high-risk mutations and eight BRAF/V600E mutations had a 100% ROM, all diagnosed as classic-type papillary thyroid carcinoma (cPTC). Combined analysis of thyroid nodules from Bethesda III and IV categories revealed a 78.2% positive predictive value (PPV) and a 75.9% negative predictive value (NPV). CONCLUSION ThyroSeq v3 effectively stratifies the ROM in indeterminate thyroid nodules based on specific genetic alterations, guiding appropriate surgical management. Notably, the BRAFV600E/high-risk group and RAS-like groups exhibited ROM of 100% and 77.5%, respectively, with promising predictive accuracy (PPV of 78.2% and NPV of 75.9%).
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Affiliation(s)
- Sam Sirotnikov
- Department of Pathology, Emory University, Atlanta, Georgia, USA
| | | | - Daniel Lubin
- Department of Pathology, Emory University, Atlanta, Georgia, USA
| | - Chao Zhang
- Biostatistics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Nabil F Saba
- Department of Hematology & Medical Oncology and Otolaryngology, Emory University, Atlanta, Georgia, USA
| | - Dehong Li
- Center for the Cancer Research and Therapeutic Development (CCRTD), Clark Atlanta University, Atlanta, Georgia, USA
| | - Amanda Kornfield
- Department of Pathology, Emory University, Atlanta, Georgia, USA
| | - Amy Chen
- Department of Otolaryngology, Emory University, Atlanta, Georgia, USA
| | - Qiuying Shi
- Department of Pathology, Emory University, Atlanta, Georgia, USA
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Lengyel K, Lubin DJ, Hsiao WY, Sirotnikov S, Luo G, Roberts JW, Shi Q, Magliocca K, Lewis MM, Sears DL, Ilyas G, Rogers BB, Viswanathan K. Comprehensive evaluation of cytomorphologic, histologic, and molecular features of DICER1-altered thyroid lesions on FNA: A multipractice experience. Cancer Cytopathol 2024. [PMID: 38520219 DOI: 10.1002/cncy.22805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND DICER1 mutations, though infrequent, are encountered on preoperative molecular testing of indeterminate adult and pediatric thyroid fine-needle aspiration (FNA) specimens. Yet, published cytomorphologic features of DICER1-altered thyroid lesions are limited. Cytomorphological features of DICER1-altered thyroid lesions were examined in a multipractice FNA cohort with clinical, radiological, and histologic data. METHODS The cohort comprised 18 DICER1-altered thyroid FNAs, with 14 having slides available and eight having corresponding surgical resections. Smears, ThinPrep, and formalin-fixed cell block slides were reviewed and correlated with histology, when available. Clinical and radiologic data were obtained from the medical record. RESULTS Most DICER1-altered FNAs were classified as atypia of undetermined significance (94.4%). DICER1 mutations occurred in codons 1709 (50%), 1810 (27.8%), and 1813 (22.2%). One patient had an additional DICER1 p.D1822N variant in both of their FNAs. Lesions were often hypoechoic (35.3%) and solid (47.1%) on ultrasound. Notable cytomorphologic features include mixed but prominent microfollicular or crowded component, variable colloid, and insignificant nuclear atypia. On resection (n = 10), histologic diagnoses ranged from benign follicular adenoma and low-risk follicular thyroid carcinoma to high-grade follicular-derived nonanaplastic thyroid carcinoma. Subcapsular infarct-type change was the most common histologic change. There was no evidence of recurrence or metastasis in eight patients on limited follow-up. CONCLUSION DICER1-altered thyroid lesions occurred frequently in young females and FNAs show RAS-like cytomorphology including crowded, mixed macro-/microfollicular pattern, and bland nuclear features. On resection, DICER1-altered thyroid lesions include benign (50%), low-risk lesions (30%), or high-risk malignancies (20%).
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Affiliation(s)
- Krisztina Lengyel
- Department of Pathology and Laboratory Medicine, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Daniel J Lubin
- Department of Pathology and Laboratory Medicine, Emory University Hospital Midtown, Atlanta, Georgia, USA
- Winship Cancer Institute of Emory University, Decatur, Georgia, USA
| | - Wen-Yu Hsiao
- Department of Pathology and Laboratory Medicine, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Sam Sirotnikov
- Department of Pathology and Laboratory Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Guangju Luo
- Department of Pathology and Laboratory Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - James W Roberts
- Department of Pathology and Laboratory Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Qiuying Shi
- Department of Pathology and Laboratory Medicine, Emory University Hospital Midtown, Atlanta, Georgia, USA
- Winship Cancer Institute of Emory University, Decatur, Georgia, USA
| | - Kelly Magliocca
- Department of Pathology and Laboratory Medicine, Emory University Hospital Midtown, Atlanta, Georgia, USA
- Winship Cancer Institute of Emory University, Decatur, Georgia, USA
| | - Melinda M Lewis
- Department of Pathology and Laboratory Medicine, Emory University Hospital Midtown, Atlanta, Georgia, USA
- Winship Cancer Institute of Emory University, Decatur, Georgia, USA
| | | | - Ghulam Ilyas
- Emory Johns Creek Hospital, Johns Creek, Georgia, USA
| | - Beverly B Rogers
- Department of Pathology and Laboratory Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Kartik Viswanathan
- Department of Pathology and Laboratory Medicine, Emory University Hospital Midtown, Atlanta, Georgia, USA
- Winship Cancer Institute of Emory University, Decatur, Georgia, USA
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Tantillo TJ, Chang K, Tan S, Sirotnikov S, Goodman HJ. An Unusual Pathologic Ulna Fracture Induced by Intraosseous Tumoral Calcium Pyrophosphate Dihydrate Crystal Deposition Disease. Journal of Hand Surgery Global Online 2022; 4:233-238. [PMID: 35880153 PMCID: PMC9308157 DOI: 10.1016/j.jhsg.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/25/2022] [Indexed: 11/27/2022] Open
Abstract
In this case report, we describe a novel occurrence of tumoral calcium pyrophosphate dihydrate crystal deposition disease (TCPPDCD) in a 76-year-old man that presented as an unusual, intraosseous, metadiaphyseal lesion of a long bone causing a pathologic fracture. A routine intralesional biopsy was performed, demonstrating granular deposits composed of polarizing, overlapping rhomboid crystals consistent with TCPPDCD. With limited numbers of reported cases of TCPPDCD, and the atypical intraosseous origin seen in this case, it is paramount to thoroughly evaluate all cases of TCPPDCD to clearly differentiate key findings that are essential in diagnosing and managing TCPPDCD.
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Affiliation(s)
- Tyler J. Tantillo
- Department of Orthopaedic Surgery, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Huntington Hospital, Huntington, NY
- Corresponding author: Tyler J. Tantillo, DO, Department of Orthopaedic Surgery, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Huntington Hospital, 270 Park Ave, Huntington, NY 11743.
| | - Kevin Chang
- Department of Orthopaedic Surgery, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Huntington Hospital, Huntington, NY
| | - Sean Tan
- New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, NY
| | - Sam Sirotnikov
- Department of Pathology, Emory University Hospital, Atlanta, GA
| | - Howard J. Goodman
- Department of Oncologic Orthopaedic Surgery, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Hospital, Queens, NY
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