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Matos MDL, Pinto M, Alves M, Canberk S, Gonçalves A, Bugalho MJ, Papoila AL, Soares P. Comparative Cyto-Histological Genetic Profile in a Series of Differentiated Thyroid Carcinomas. Diagnostics (Basel) 2024; 14:278. [PMID: 38337794 PMCID: PMC10855767 DOI: 10.3390/diagnostics14030278] [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: 12/25/2023] [Revised: 01/25/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Molecular tests can contribute to improve the preoperative diagnosis of thyroid nodules. Tests available are expensive and not adapted to different populations. AIM This study aimed to compare the cyto-histological genetic profile and to evaluate the reliability of molecular tests using ultrasound-guided fine needle aspiration cytology (US-FNAC) in accurately diagnosing differentiated thyroid carcinomas (DTCs) and predicting biologic behavior of papillary thyroid carcinomas (PTCs). MATERIALS AND METHODS The series included 259 patients with paired cyto-histological samples totaling 518 samples. The genetic alterations were analyzed via PCR/Sanger sequencing. The association with clinicopathologic features was evaluated in PTCs. RESULTS/DISCUSSION From the 259 patients included, histologies were 50 (19.3%) benign controls and 209 (80.7%) DTC cases, from which 182 were PTCs; cytologies were 5.8% non-diagnostic, 18.2% benign, 39% indeterminate, and 37.1% malignant. In histology, indeterminate nodules (n = 101) were 22.8% benign and 77.2% malignant. Mutation frequencies in cytology and histology specimens were, respectively, TERTp: 3.7% vs. 7.9%; BRAF: 19.5% vs. 25.1%; and RAS: 11% vs. 17.5%. The overall cyto-histological agreement of the genetic mutations was 94.9%, with Cohen's k = 0.67, and in indeterminate nodules agreement was 95.7%, k = 0.64. The identified mutations exhibited a discriminative ability in diagnosing DTC with a specificity of 100% for TERTp and BRAF, and of 94% for RAS, albeit with low sensitivity. TERTp and BRAF mutations were associated with aggressive clinicopathological features and tumor progression in PTCs (p < 0.001). The obtained good cyto-histological agreement suggests that molecular analysis via US-FNAC may anticipate the genetic profile and the behavior of thyroid tumors, confirming malignancy and contributing to referring patients to surgery.
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Affiliation(s)
- Maria de Lurdes Matos
- Department of Endocrinology, Diabetes and Metabolismo, Centro Hospitalar Universitário de Lisboa Central, Hospital Curry Cabral, 1050-099 Lisbon, Portugal
| | - Mafalda Pinto
- Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), i3S—Institute for Research & Innovation in Health, 4200-135 Porto, Portugal; (M.P.); (S.C.)
| | - Marta Alves
- Gabinete de Estatística do Centro de Investigação do Centro Hospitalar Universitário de Lisboa Central, EPE, Nova Medical School, 1169-045 Lisbon, Portugal; (M.A.); (A.L.P.)
- Centro de Estatística e Aplicações da Universidade de Lisboa (CEAUL), 1749-016 Lisbon, Portugal
| | - Sule Canberk
- Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), i3S—Institute for Research & Innovation in Health, 4200-135 Porto, Portugal; (M.P.); (S.C.)
| | - Ana Gonçalves
- Department of Pathology, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal;
| | - Maria João Bugalho
- Department of Endocrinology, Centro Hospitalar Universitário de Lisboa Norte, Hospital de Santa Maria, 1649-028 Lisboa, Portugal;
- Medical Faculty, University of Lisbon, 1649-028 Lisboa, Portugal
| | - Ana Luísa Papoila
- Gabinete de Estatística do Centro de Investigação do Centro Hospitalar Universitário de Lisboa Central, EPE, Nova Medical School, 1169-045 Lisbon, Portugal; (M.A.); (A.L.P.)
- Centro de Estatística e Aplicações da Universidade de Lisboa (CEAUL), 1749-016 Lisbon, Portugal
| | - Paula Soares
- Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), i3S—Institute for Research & Innovation in Health, 4200-135 Porto, Portugal; (M.P.); (S.C.)
- Medical Faculty, University of Porto, 4200-135 Porto, Portugal
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Huang HH, Ji P, Peng SK. Unmasking the Silent Invader: A Rare Case of Follicular Thyroid Carcinoma With Skull Metastasis and an Uncommon KRAS Q61R Mutation. Cureus 2023; 15:e47641. [PMID: 38021925 PMCID: PMC10668626 DOI: 10.7759/cureus.47641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Follicular thyroid carcinoma (FTC) is a noteworthy subtype of thyroid cancer known for its tendency to metastasize through the bloodstream, usually to the lungs and bones. This case report examines an exceptionally rare instance involving an 81-year-old female presenting with an unusual metastatic scalp lesion. Remarkably, this aggressive metastasis originated from a thyroid lesion as small as 0.7 cm. Lab findings, including suppressed TSH and elevated T3 levels, revealed subclinical hyperthyroidism, adding another layer of rarity to this FTC case. Molecular profiling identified a rare KRAS Q61R mutation, providing potential insight into the case's aggressive behavior and underscoring the importance of genetic assessment in FTC. This report emphasizes the critical role of comprehensive diagnostic evaluations, including histopathological assessments, in properly diagnosing and managing FTC, especially when clinical presentations defy conventional paradigms.
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Affiliation(s)
- Hehua Hannah Huang
- Pathology and Laboratory Medicine, Harbor University of California Los Angeles Medical Center, Torrance, USA
| | - Ping Ji
- Pathology and Laboratory Medicine, Harbor University of California Los Angeles Medical Center, Torrance, USA
| | - Shi-Kaung Peng
- Pathology and Laboratory Medicine, Harbor University of California Los Angeles Medical Center, Torrance, USA
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Lubin DJ, Sadow PM. Development and validation of an RNA sequencing-based classifier for medullary thyroid carcinoma on thyroid FNA. Cancer Cytopathol 2023; 131:154-157. [PMID: 36047747 PMCID: PMC10294123 DOI: 10.1002/cncy.22643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 01/11/2023]
Abstract
This commentary describes the development and validation of the Afirma RNA sequencing–based classifier for medullary thyroid carcinoma (MTC). The importance of the early diagnosis of MTC is discussed along with the limitations of cytomorphology alone.
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Affiliation(s)
- Daniel J. Lubin
- Department of Pathology, Emory University Hospital Midtown,
Atlanta, GA, USA
| | - Peter M. Sadow
- Department of Pathology, Massachusetts General Hospital,
Boston, MA, USA
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McMurtry V, Canberk S, Deftereos G. Molecular testing in fine-needle aspiration of thyroid nodules. Diagn Cytopathol 2023; 51:36-50. [PMID: 36480743 DOI: 10.1002/dc.25035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Thyroid nodules are commonly faced by clinicians as palpable nodules or incidentally identified on imaging. Nodules that are found to be suspicious by imaging can be biopsied by fine needle aspiration, which can yield material for molecular testing to refine the diagnosis. METHODS The current literature concerning molecular testing in thyroid nodules including available commercial assays was reviewed and summarized. RESULTS/CONCLUSIONS Commonly encountered alterations include mutations in RAS, BRAF, TERT promoter, PTEN, and DICER1 as well as fusions of RET, ALK, PAX8-PPARγ, and NTRK. This article provides a summary of these molecular alterations, commercially available molecular assays, and general considerations for thyroid epithelial malignancies and benign thyroid nodules.
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Affiliation(s)
- Valarie McMurtry
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA.,ARUP Institute for Experimental Pathology, Salt Lake City, Utah, USA
| | - Sule Canberk
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup), Porto, Portugal.,Abel Salazar Biomedical Sciences Institute (ICBAS), University of Porto, Porto, Portugal
| | - Georgios Deftereos
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA.,ARUP Institute for Experimental Pathology, Salt Lake City, Utah, USA
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Patel J, Klopper J, Cottrill EE. Molecular diagnostics in the evaluation of thyroid nodules: Current use and prospective opportunities. Front Endocrinol (Lausanne) 2023; 14:1101410. [PMID: 36909304 PMCID: PMC9999006 DOI: 10.3389/fendo.2023.1101410] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/06/2023] [Indexed: 03/14/2023] Open
Abstract
Thyroid cancer is the most common endocrine malignancy with an estimated 43,800 new cases to be diagnosed in 2022 and representing the 7th most common cancer in women. While thyroid nodules are very common, being identified in over 60% of randomly selected adults, only 5-15% of thyroid nodules harbor thyroid malignancy. Therefore, it is incumbent upon physicians to detect and treat thyroid malignancies as is clinically appropriate and avoid unnecessary invasive procedures in patients with benign asymptomatic lesions. Over the last 15-20 years, rapid advances have been made in cytomolecular testing to aid in thyroid nodule management. Initially, indeterminate thyroid nodules, those with Bethesda III or IV cytology and approximately a 10-40% risk of malignancy, were studied to assess benignity or malignancy. More recently, next generation sequencing and micro-RNA technology platforms have refined the diagnostic capacity of thyroid nodule molecular testing and have introduced opportunities to glean prognostic information from both cytologically indeterminate and malignant thyroid nodules. Therefore, clinicians can move beyond determination of malignancy, and utilize contemporary molecular information to aid in decisions such as extent of surgery and post-therapy monitoring plans. Future opportunities include molecularly derived information about tumor behavior, neo-adjuvant treatment opportunities and response to thyroid cancer therapies.
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Affiliation(s)
- Jena Patel
- Department of Otolaryngology – Head & Neck Surgery, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia, PA, United States
| | - Joshua Klopper
- Department of Medical Affairs, Veracyte, San Francisco, CA, United States
| | - Elizabeth E. Cottrill
- Department of Otolaryngology – Head & Neck Surgery, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia, PA, United States
- *Correspondence: Elizabeth E. Cottrill,
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Nasr CE, Andrioli M, Endo M, Harrell RM, Livhits MJ, Osakwe I, Polavarapu P, Siperstein A, Wei S, Zheng X, Jiang R, Hao Y, Huang JI, Klopper JP, Kloos RT, Kennedy G, Angell TE. Real World Performance of The Afirma Genomic Sequencing Classifier (GSC) - A Meta-analysis. J Clin Endocrinol Metab 2022; 108:1526-1532. [PMID: 36470585 DOI: 10.1210/clinem/dgac688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
CONTEXT The Afirma® GSC aids in risk stratifying indeterminate thyroid nodule cytology (ITN). The 2018 GSC validation study (VS) reported a sensitivity (SN) of 91%, specificity (SP) of 68%, positive predictive value (PPV) of 47%, and negative predictive value (NPV) of 96%. Since then, 13 independent real world (RW) post-validation studies have been published. OBJECTIVE This study's objective is to compare the RW GSC performance to the VS metrics. METHODS Rules and assumptions applying to this analysis include: 1. At least one patient with molecular benign results must have surgery for that study to be included in SN, SP and NPV analyses. 2. Molecular benign results without surgical histology are considered true negatives (TN) (as are the molecular benign results with benign surgical histology) 3. Unoperated patients with suspicious results are either excluded from the analysis (observed PPV (oPPV) and observed SP (oSP)) or assumed as histology negatives (false positives - conservative PPV (cPPV) and conservative SP (cSP)) 4. NIFTP is considered malignant. RESULTS In RW studies, the GSC demonstrates a SN, oSP, oPPV and NPV of 97%, 88%, 65%, 99% respectively, and conservative RW performance showed cSP of 80% and cPPV of 49%, all significantly higher than the VS save for SN and cPPV. There was also a higher benign call rate (BCR) of 67% in RW studies compared to 54% in the VS (p < 0.05). CONCLUSION RW data for the Afirma GSC demonstrates significantly better oSP and oPPV performance compared to the VS, indicating an increased yield of cancers for resected GSC suspicious nodules. The higher BCR likely increases the overall rate of clinical observation in lieu of surgery.
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Affiliation(s)
| | | | | | | | | | - Ibitoro Osakwe
- Umass Chan Medical School, Baystate, Springfield, MA, USA.
| | | | | | | | | | | | | | - JIng Huang
- Veracyte, Inc, South San Francisco, CA, USA.
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Randolph GW, Sosa JA, Hao Y, Angell TE, Shonka DC, LiVolsi VA, Ladenson PW, Blevins TC, Duh QY, Ghossein R, Harrell M, Patel KN, Shanik MH, Traweek ST, Walsh PS, Yeh MW, Abdelhamid Ahmed AH, Ho AS, Wong RJ, Klopper JP, Huang J, Kennedy GC, Kloos RT, Sadow PM. Preoperative Identification of Medullary Thyroid Carcinoma (MTC): Clinical Validation of the Afirma MTC RNA-Sequencing Classifier. Thyroid 2022; 32:1069-1076. [PMID: 35793115 PMCID: PMC9526471 DOI: 10.1089/thy.2022.0189] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Cytopathological evaluation of thyroid fine-needle aspiration biopsy (FNAB) specimens can fail to raise preoperative suspicion of medullary thyroid carcinoma (MTC). The Afirma RNA-sequencing MTC classifier identifies MTC among FNA samples that are cytologically indeterminate, suspicious, or malignant (Bethesda categories III-VI). In this study we report the development and clinical performance of this MTC classifier. Methods: Algorithm training was performed with a set of 483 FNAB specimens (21 MTC and 462 non-MTC). A support vector machine classifier was developed using 108 differentially expressed genes, which includes the 5 genes in the prior Afirma microarray-based MTC cassette. Results: The final MTC classifier was blindly tested on 211 preoperative FNAB specimens with subsequent surgical pathology, including 21 MTC and 190 non-MTC specimens from benign and malignant thyroid nodules independent from those used in training. The classifier had 100% sensitivity (21/21 MTC FNAB specimens correctly called positive; 95% confidence interval [CI] = 83.9-100%) and 100% specificity (190/190 non-MTC FNAs correctly called negative; CI = 98.1-100%). All positive samples had pathological confirmation of MTC, while all negative samples were negative for MTC on surgical pathology. Conclusions: The RNA-sequencing MTC classifier accurately identified MTC from preoperative thyroid nodule FNAB specimens in an independent validation cohort. This identification may facilitate an MTC-specific preoperative evaluation and resulting treatment.
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Affiliation(s)
- Gregory W. Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Julie Ann Sosa
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Yangyang Hao
- Department of Research and Development, Veracyte, Inc., South San Francisco, California, USA
| | - Trevor E. Angell
- Division of Endocrinology and Diabetes, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - David C. Shonka
- Department of Otolaryngology—Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Virginia A. LiVolsi
- Anatomic Pathology Division, Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Paul W. Ladenson
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Quan-Yang Duh
- Section of Endocrine Surgery, Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Ronald Ghossein
- Department of Pathology and Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Mack Harrell
- The Memorial Center for Integrative Endocrine Surgery, Hollywood, Weston and Boca Raton, Florida, USA
| | - Kepal Narendra Patel
- Division of Endocrine Surgery, Department of Surgery, NYU Langone Medical Center, New York, New York, USA
| | | | | | - P. Sean Walsh
- Department of Research and Development, Veracyte, Inc., South San Francisco, California, USA
| | - Michael W. Yeh
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Amr H. Abdelhamid Ahmed
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Allen S. Ho
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Richard J. Wong
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Joshua P. Klopper
- Department of Medical Affairs, Veracyte, Inc., South San Francisco, California, USA
| | - Jing Huang
- Department of Research and Development, Veracyte, Inc., South San Francisco, California, USA
| | - Giulia C. Kennedy
- Department of Research and Development, Veracyte, Inc., South San Francisco, California, USA
- Department of Medical Affairs, Veracyte, Inc., South San Francisco, California, USA
| | - Richard T. Kloos
- Department of Medical Affairs, Veracyte, Inc., South San Francisco, California, USA
| | - Peter M. Sadow
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Address correspondence to: Peter M. Sadow, MD, PhD, Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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