1
|
Skaugen JM, Taneja C, Liu JB, Wald AI, Nikitski AV, Chiosea SI, Seethala RR, Ohori NP, Karslioglu-French E, Carty SE, Nikiforova MN, Yip L, Nikiforov YE. Performance of a Multigene Genomic Classifier in Thyroid Nodules with Suspicious for Malignancy Cytology. Thyroid 2022; 32:1500-1508. [PMID: 35864811 PMCID: PMC9807251 DOI: 10.1089/thy.2022.0282] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background: Molecular testing is increasingly used to refine the probability of cancer and assess recurrence risk in thyroid nodules with Bethesda III/IV fine needle aspiration (FNA) cytology. However, limited data exist for Bethesda V (suspicious for malignancy [SFM]) samples. This study evaluated the performance of ThyroSeq v3 (TSv3) in thyroid nodules with SFM cytology. Methods: In this single-institution retrospective cohort study, consecutive thyroid FNA samples diagnosed as SFM with TSv3 testing and known surgical outcome were identified. Clinical, pathology, and molecular findings were reviewed. The TSv3 Cancer Risk Classifier was used to determine molecular risk groups (MRGs). For test-negative cases diagnosed as cancer/noninvasive follicular thyroid neoplasm with papillary-like nuclear features, TSv3 was performed on the resected tumors. Results: Among 128 SFM samples studied, 100 (78.1%) were TSv3 positive, and 28 (21.9%) were negative. The cancer prevalence on surgery was 82.8%. Among test-positive samples, 95% were malignant and 5% benign. Among test-negative samples, 17 (60.7%) were benign and 11 (39.3%) malignant. Overall, TSv3 had a sensitivity of 89.6% (confidence interval; CI 82.4-94.1) and a specificity of 77.3% (CI 56.6-89.9). For a cancer prevalence of 50-75% expected in SFM cytology by the Bethesda system, the negative predictive value was expected to range from 71.2% to 88.1% and the positive predictive value from 79.8% to 92.2%. Among test-positive nodules, 20% were MRG-Low (mostly RAS-like alterations), 66% MRG-Intermediate (mostly BRAF-like alterations), and 14% MRG-High. Among patients with cancer, 65 (61.3%) were American Thyroid Association low risk, 25 (23.6%) intermediate risk, and 6 (5.7%) high risk. During the mean follow-up of 51.2 months (range: <1 to 470 months), 12 (13.0%) patients had disease recurrence, which was more common in MRG-High (54.6%) compared with MRG-Intermediate (9.5%) and MRG-Low (0%) cancers (p < 0.001). Upon reexamining tumors with false-negative results, half of evaluable cases had alterations likely missed due to limiting FNA sampling, and the remainder represented low-risk tumors. Potentially targetable alterations were identified in 10 samples. Conclusions: In this large series of SFM thyroid nodules, TSv3 further improved cancer prediction and detected RAS-like, BRAF-like, high-risk, and potentially targetable alterations, all of which may inform more optimal patient management. MRGs were associated with recurrence-free survival, offering potential preoperative cancer risk stratification.
Collapse
Affiliation(s)
- John M. Skaugen
- Division of Molecular and Genomic Pathology, Department of Pathology; Department of Pathology; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Address correspondence to: John M. Skaugen, MD, Department of Pathology, University of Pittsburgh School of Medicine, 3477 Euler Way, Room 7028, Pittsburgh, PA 15213, USA
| | - Charit Taneja
- Division of Endocrinology, Department of Medicine; Department of Pathology; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jason B. Liu
- Division of Endocrine Surgery, Department of Surgery; and Department of Pathology; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Abigail I. Wald
- Division of Molecular and Genomic Pathology, Department of Pathology; Department of Pathology; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Alyaksandr V. Nikitski
- Division of Molecular and Genomic Pathology, Department of Pathology; Department of Pathology; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Simion I. Chiosea
- Division of Molecular and Genomic Pathology, Department of Pathology; Department of Pathology; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Division of Anatomic Pathology, Department of Pathology; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Raja R. Seethala
- Division of Anatomic Pathology, Department of Pathology; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - N. Paul Ohori
- Division of Anatomic Pathology, Department of Pathology; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Esra Karslioglu-French
- Division of Endocrinology, Department of Medicine; Department of Pathology; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sally E. Carty
- Division of Endocrine Surgery, Department of Surgery; and Department of Pathology; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Marina N. Nikiforova
- Division of Molecular and Genomic Pathology, Department of Pathology; Department of Pathology; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Linwah Yip
- Division of Endocrine Surgery, Department of Surgery; and Department of Pathology; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yuri E. Nikiforov
- Division of Molecular and Genomic Pathology, Department of Pathology; Department of Pathology; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
2
|
Higgins S, James BC, Sacks B, Mowschenson P, Nishino M, Hasselgren PO. Can Cytologic and Sonographic Features Help Prevent Overtreatment of Bethesda V Thyroid Nodules? J Surg Res 2021; 268:112-118. [PMID: 34298210 DOI: 10.1016/j.jss.2021.05.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/21/2020] [Revised: 05/10/2021] [Accepted: 05/26/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although nearly half of thyroid nodules with Bethesda V cytology (suspicious for malignancy) may be benign or harbor low-grade neoplasms that can be sufficiently treated with lobectomy, many patients with Bethesda V cytology continue to be treated with total thyroidectomy. The objectives of this study were to establish whether cytomorphologic and ultrasonographic features can determine appropriate surgery for thyroid nodules with Bethesda V cytology and how often patients are overtreated with total instead of partial thyroidectomy. METHODS Utilizing a 10-y prospective database starting January 1, 2004, cytomorphologic and ultrasonographic features of thyroid nodules with Bethesda V cytology were reviewed. Overtreatment was defined as total thyroidectomy when histopathology revealed benign nodule, noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) or a unilateral < 4 cm low risk cancer. RESULTS Sixty-three patients were included in the study. Seventeen (27%) had benign, 14 (22%) NIFTP, and 32 (51%) malignant nodules. On cytology, nuclear pseudoinclusions, and on ultrasound, taller-than-wide configuration, were more common in malignant than benign or NIFTP nodules. Among 56 patients who underwent total thyroidectomy, 14 and 11 had a benign or NIFTP nodule, respectively, and 13 had a unilateral < 4 cm low risk cancer, suggesting that 68% (38/56) were overtreated. CONCLUSIONS Total thyroidectomy for Bethesda V thyroid nodules may result in overtreatment in more than half of the patients. Although certain cytomorphologic and ultarsonographic features may be helpful in determining appropriate surgery for Bethesda V thyroid nodules, additional characteristics are needed to reduce overtreatment of these nodules.
Collapse
Affiliation(s)
- Sara Higgins
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Benjamin C James
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Barry Sacks
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Peter Mowschenson
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Michiya Nishino
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| | - Per-Olof Hasselgren
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|