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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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Lončar I, van Velsen EFS, Massolt ET, van Kemenade FJ, van Engen-van Grunsven ACH, van Hemel BM, van Nederveen FH, Netea-Maier R, Links TP, Peeters RP, van Ginhoven TM. European experience with the Afirma Gene Expression Classifier for indeterminate thyroid nodules: A clinical utility study in the Netherlands. Head Neck 2023; 45:2227-2236. [PMID: 37490544 DOI: 10.1002/hed.27472] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/30/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND The Gene Expression Classifier (GEC) and Genomic Sequencing Classifier (GSC) were developed to improve risk stratification of indeterminate nodules. Our aim was to assess the clinical utility in a European population with restrictive diagnostic workup. METHODS Clinical utility of the GEC was assessed in a prospective multicenter cohort of 68 indeterminate nodules. Diagnostic surgical rates for Bethesda III and IV nodules were compared to a historical cohort of 171 indeterminate nodules. Samples were post hoc tested with the GSC. RESULTS The GEC classified 26% as benign. Surgical rates between the prospective and historical cohort did not differ (72.1% vs. 76.6%). The GSC classified 59% as benign, but misclassified six malignant lesions as benign. CONCLUSION Implementation of GEC in management of indeterminate nodules in a European country with restrictive diagnostic workup is currently not supported, especially in oncocytic nodules. Prospective studies with the GSC in European countries are needed to determine the clinical utility.
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Affiliation(s)
- Ivona Lončar
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Evert F S van Velsen
- Department of Internal Medicine, Erasmus MC Academic Center for Thyroid Diseases, Rotterdam, the Netherlands
| | - Elske T Massolt
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | | | | | - Bettien M van Hemel
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Romana Netea-Maier
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thera P Links
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus MC Academic Center for Thyroid Diseases, Rotterdam, the Netherlands
| | - Tessa M van Ginhoven
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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Abou Karam G, Malhotra A. PET/CT May Assist in Avoiding Pointless Thyroidectomy in Indeterminate Thyroid Nodules: A Narrative Review. Cancers (Basel) 2023; 15:cancers15051547. [PMID: 36900338 PMCID: PMC10000406 DOI: 10.3390/cancers15051547] [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: 01/21/2023] [Revised: 02/23/2023] [Accepted: 02/26/2023] [Indexed: 03/05/2023] Open
Abstract
Indeterminate thyroid nodules (ITN) are commonly encountered among the general population, with a malignancy rate of 10 to 40%. However, many patients may be overtreated with futile surgery for benign ITN. To avoid unnecessary surgery, PET/CT scan is a possible alternative to help differentiate between benign and malignant ITN. In this narrative review, the major results and limitations of the most recent studies on PET/CT efficacy (from PET/CT visual assessment to quantitative PET parameters and recent radiomic features analysis) and on cost-effectiveness (compared to other alternatives (such as surgery)) are presented. PET/CT can reduce futile surgery with visual assessment (around 40%; if ITN ≥ 10 mm). Moreover, PET/CT conventional parameters and radiomic features extracted from PET/CT imaging can be associated together in a predictive model to rule out malignancy in ITN, with a high NPV (96%) when certain criteria are met. Even though promising results were obtained in these recent PET/CT studies, further studies are needed to enable PET/CT to become the definitive diagnostic tool once a thyroid nodule is identified as indeterminate.
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Affiliation(s)
- Gaby Abou Karam
- Section of Neuroradiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St., New Haven, CT 06510, USA
| | - Ajay Malhotra
- Section of Neuroradiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St., New Haven, CT 06510, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 789 Howard Ave, New Haven, CT 06519, USA
- Correspondence: ; Tel.: +1-(203)-785-5102; Fax: +1-(203)-737-1077
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Kotecka-Blicharz A, Krzempek M, Cortez AJ, Oczko-Wojciechowska M, Czarniecka A, Nożyńska E, Chmielik E, Jarząb B, Krajewska J. The role of thyroid sonographic malignancy risk features when the fine needle aspiration biopsy result is indeterminate. Endokrynol Pol 2022; 73:316-324. [PMID: 35593681 DOI: 10.5603/ep.a2022.0027] [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] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Although the role of the thyroid ultrasound is well established in the initial thyroid nodule work up, it is still equivocal whether the thyroid ultrasound pattern could have an impact on refining malignancy risk after an indeterminate cytopathology result. We aim to assess the possible supportive role of the thyroid nodule ultrasound malignancy risk features listed in the Polish guidelines when a biopsy result is indeterminate. MATERIAL AND METHODS We retrospectively reviewed thyroid ultrasound scans from 175 adult patients with thyroid nodules and indeterminate cytopathology results, who underwent thyroid surgery. Sonographic malignancy risk features were reported in accordance with the guidelines of the Polish National Societies Diagnostics and Treatment of Thyroid Carcinoma and included the following: solid structure, hypoechogenicity, microcalcifications, taller than wide shape, irregular margins, features of extrathyroidal expansion, suspicious cervical lymph nodes. RESULTS The malignancy risk in relevant cytological categories, estimated on the basis of histological verification, was 10.9% for Bethesda III category, 12.1% for Bethesda IV, and 71.4% for Bethesda V. The predominant type of thyroid malignancy was papillary thyroid carcinoma (79%). Thyroid nodules sonographic malignancy risk features provided high specificity but low sensitivity in selected groups of indeterminate thyroid nodules. Microcalcifications was the only characteristic that solely had a clinically relevant positive likelihood ratio (> 10) to suggest malignancy in the analysed cohort, but it was not observed in thyroid nodules eventually verified as follicular thyroid carcinoma. An accumulation of more than one sonographic risk feature yielded significant increase in malignancy risk only in Bethesda V category thyroid nodules. CONCLUSIONS The impact of sonographic malignancy risk features on refining post-biopsy probability of thyroid cancer in thyroid nodule with indeterminate cytopathology, may be inadequate to sort patients (without any doubt) between those who require thyroid surgery and those who only require surveillance. There is an urgent need to search for new tools in the diagnostics of indeterminate thyroid nodules and to standardize thyroid ultrasound reports.
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Affiliation(s)
- Agnieszka Kotecka-Blicharz
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland.
| | - Marcela Krzempek
- Department of Biostatistics and Bioinformatics, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Alexander Jorge Cortez
- Department of Biostatistics and Bioinformatics, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Małgorzata Oczko-Wojciechowska
- Department of Genetic and Molecular Diagnostics of Cancer, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Agnieszka Czarniecka
- The Oncologic and Reconstructive Surgery Clinic, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Ewa Nożyńska
- Tumor Pathology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Ewa Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Barbara Jarząb
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Jolanta Krajewska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
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Canu GL, Medas F, Cappellacci F, Giordano ABF, Gurrado A, Gambardella C, Docimo G, Feroci F, Conzo G, Testini M, Calò PG. Risk of Complications in Patients Undergoing Completion Thyroidectomy after Hemithyroidectomy for Thyroid Nodule with Indeterminate Cytology: An Italian Multicentre Retrospective Study. Cancers (Basel) 2022; 14:cancers14102472. [PMID: 35626075 PMCID: PMC9139447 DOI: 10.3390/cancers14102472] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/09/2022] [Accepted: 05/14/2022] [Indexed: 12/19/2022] Open
Abstract
Simple Summary The increasing use of high-quality imaging techniques together with improved access to healthcare has led to an increase in the detection of thyroid nodules. Fine-needle aspiration cytology (FNAC) is currently considered the most accurate examination for the assessment of thyroid nodular disease. However, in about 25% of cases, FNAC leads to the diagnosis of an indeterminate thyroid nodule, which represents a problem because malignancy, although relatively low (up to 30%), cannot be excluded with certainty. According to the 2015 American Thyroid Association guidelines, patients with thyroid nodular disease with an indeterminate cytology can undergo, based on established factors, a total thyroidectomy or a hemithyroidectomy. However, if an intermediate or high-risk differentiated thyroid carcinoma is detected after the hemithyroidectomy, through histological examination, the above-mentioned guidelines recommend performing a completion thyroidectomy. The main aim of this study was to assess the rate of complications in patients undergoing a completion thyroidectomy after a hemithyroidectomy for a thyroid nodule with an indeterminate cytology. Abstract There is still controversy as to whether patients undergoing a completion thyroidectomy after a hemithyroidectomy for a thyroid nodule with an indeterminate cytology have a comparable, increased or decreased risk of complications compared to those submitted to primary thyroid surgery. The main aim of this study was to investigate this topic. Patients undergoing a thyroidectomy for thyroid nodular disease with an indeterminate cytology in four high-volume thyroid surgery centres in Italy, between January 2017 and December 2020, were retrospectively analysed. Based on the surgical procedure performed, four groups were identified: the TT Group (total thyroidectomy), HT Group (hemithyroidectomy), CT Group (completion thyroidectomy) and HT + CT Group (hemithyroidectomy with subsequent completion thyroidectomy). A total of 751 patients were included. As for the initial surgery, 506 (67.38%) patients underwent a total thyroidectomy and 245 (32.62%) a hemithyroidectomy. Among all patients submitted to a hemithyroidectomy, 66 (26.94%) were subsequently submitted to a completion thyroidectomy. No statistically significant difference was found in terms of complications comparing both the TT Group with the HT + CT Group and the HT Group with the CT Group. The risk of complications in patients undergoing a completion thyroidectomy after a hemithyroidectomy for a thyroid nodule with an indeterminate cytology was comparable to that of patients submitted to primary thyroid surgery (both a total thyroidectomy and hemithyroidectomy).
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Affiliation(s)
- Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, 09042 Monserrato, CA, Italy; (F.M.); (F.C.); (P.G.C.)
- Correspondence:
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, 09042 Monserrato, CA, Italy; (F.M.); (F.C.); (P.G.C.)
| | - Federico Cappellacci
- Department of Surgical Sciences, University of Cagliari, 09042 Monserrato, CA, Italy; (F.M.); (F.C.); (P.G.C.)
| | | | - Angela Gurrado
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, BA, Italy; (A.G.); (M.T.)
| | - Claudio Gambardella
- Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, NA, Italy; (C.G.); (G.D.)
| | - Giovanni Docimo
- Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, NA, Italy; (C.G.); (G.D.)
| | - Francesco Feroci
- Department of General and Oncologic Surgery, Santo Stefano Hospital, 59100 Prato, PO, Italy; (A.B.F.G.); (F.F.)
| | - Giovanni Conzo
- Department of Traslational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, NA, Italy;
| | - Mario Testini
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, BA, Italy; (A.G.); (M.T.)
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, 09042 Monserrato, CA, Italy; (F.M.); (F.C.); (P.G.C.)
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Keutgen XM, Li H, Memeh K, Conn Busch J, Williams J, Lan L, Sarne D, Finnerty B, Angelos P, Fahey TJ, Giger ML. A machine-learning algorithm for distinguishing malignant from benign indeterminate thyroid nodules using ultrasound radiomic features. J Med Imaging (Bellingham) 2022; 9:034501. [PMID: 35692282 PMCID: PMC9133922 DOI: 10.1117/1.jmi.9.3.034501] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/11/2022] [Indexed: 11/02/2023] Open
Abstract
Background: Ultrasound (US)-guided fine needle aspiration (FNA) cytology is the gold standard for the evaluation of thyroid nodules. However, up to 30% of FNA results are indeterminate, requiring further testing. In this study, we present a machine-learning analysis of indeterminate thyroid nodules on ultrasound with the aim to improve cancer diagnosis. Methods: Ultrasound images were collected from two institutions and labeled according to their FNA (F) and surgical pathology (S) diagnoses [malignant (M), benign (B), and indeterminate (I)]. Subgroup breakdown (FS) included: 90 BB, 83 IB, 70 MM, and 59 IM thyroid nodules. Margins of thyroid nodules were manually annotated, and computerized radiomic texture analysis was conducted within tumor contours. Initial investigation was conducted using five-fold cross-validation paradigm with a two-class Bayesian artificial neural networks classifier, including stepwise feature selection. Testing was conducted on an independent set and compared with a commercial molecular testing platform. Performance was evaluated using receiver operating characteristic analysis in the task of distinguishing between malignant and benign nodules. Results: About 1052 ultrasound images from 302 thyroid nodules were used for radiomic feature extraction and analysis. On the training/validation set comprising 263 nodules, five-fold cross-validation yielded area under curves (AUCs) of 0.75 [Standard Error (SE) = 0.04; P < 0.001 ] and 0.67 (SE = 0.05; P = 0.0012 ) for the classification tasks of MM versus BB, and IM versus IB, respectively. On an independent test set of 19 IM/IB cases, the algorithm for distinguishing indeterminate nodules yielded an AUC value of 0.88 (SE = 0.09; P < 0.001 ), which was higher than the AUC of a commercially available molecular testing platform (AUC = 0.81, SE = 0.11; P < 0.005 ). Conclusion: Machine learning of computer-extracted texture features on gray-scale ultrasound images showed promising results classifying indeterminate thyroid nodules according to their surgical pathology.
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Affiliation(s)
- Xavier M. Keutgen
- The University of Chicago Medicine, Endocrine Surgery Research Program, Division of General Surgery and Surgical Oncology, Department of Surgery, Chicago, Illinois, United States
| | - Hui Li
- The University of Chicago, Department of Radiology, Chicago, Illinois, United States
| | - Kelvin Memeh
- The University of Chicago Medicine, Endocrine Surgery Research Program, Division of General Surgery and Surgical Oncology, Department of Surgery, Chicago, Illinois, United States
| | - Julian Conn Busch
- The University of Chicago Medicine, Endocrine Surgery Research Program, Division of General Surgery and Surgical Oncology, Department of Surgery, Chicago, Illinois, United States
| | - Jelani Williams
- The University of Chicago Medicine, Endocrine Surgery Research Program, Division of General Surgery and Surgical Oncology, Department of Surgery, Chicago, Illinois, United States
| | - Li Lan
- The University of Chicago, Department of Radiology, Chicago, Illinois, United States
| | - David Sarne
- The University of Chicago Medicine, Division of Endocrinology, Department of Medicine, Chicago, Illinois, United States
| | - Brendan Finnerty
- New York Presbyterian Hospital—Weill Cornell Medicine, Endocrine Oncology Research Program, Division of Endocrine Surgery, Department of Surgery, New York, United States
| | - Peter Angelos
- The University of Chicago Medicine, Endocrine Surgery Research Program, Division of General Surgery and Surgical Oncology, Department of Surgery, Chicago, Illinois, United States
| | - Thomas J. Fahey
- New York Presbyterian Hospital—Weill Cornell Medicine, Endocrine Oncology Research Program, Division of Endocrine Surgery, Department of Surgery, New York, United States
| | - Maryellen L. Giger
- The University of Chicago, Department of Radiology, Chicago, Illinois, United States
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Gild ML, Chan M, Gajera J, Lurie B, Gandomkar Z, Clifton-Bligh RJ. Risk stratification of indeterminate thyroid nodules using ultrasound and machine learning algorithms. Clin Endocrinol (Oxf) 2022; 96:646-652. [PMID: 34642976 DOI: 10.1111/cen.14612] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/02/2021] [Accepted: 09/21/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Indeterminate thyroid nodules (Bethesda III) are challenging to characterize without diagnostic surgery. Auxiliary strategies including molecular analysis, machine learning models, and ultrasound grading with Thyroid Imaging, Reporting and Data System (TI-RADS) can help to triage accordingly, but further refinement is needed to prevent unnecessary surgeries and increase positive predictive values. DESIGN Retrospective review of 88 patients with Bethesda III nodules who had diagnostic surgery with final pathological diagnosis. MEASUREMENTS Each nodule was retrospectively scored through TI-RADS. Two deep learning models were tested, one previously developed and trained on another data set, mainly containing determinate cases and then validated on our data set while the other one trained and tested on our data set (indeterminate cases). RESULTS The mean TI-RADS score was 3 for benign and 4 for malignant nodules (p = .0022). Radiological high risk (TI-RADS 4,5) and low risk (TI-RADS 2,3) categories were established. The PPV for the high radiological risk category in those with >10 mm nodules was 85% (CI: 70%-93%). The NPV for low radiological risk in patients >60 years (mean age was 100% (CI: 83%-100%). The area under the curve (AUC) value of our novel classifier was 0.75 (CI: 0.62-0.84) and differed significantly from the chance-level (p < .00001). CONCLUSIONS Novel radiomic and radiologic strategies can be employed to assist with preoperative diagnosis of indeterminate thyroid nodules.
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Affiliation(s)
- Matti Lauren Gild
- Northern Clinical School, Faculty of Health and Medicine, University of Sydney, Australia
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, Australia
| | - Mico Chan
- Department of Radiology, Royal North Shore Hospital, Sydney, Australia
| | - Jay Gajera
- Department of Radiology, Royal North Shore Hospital, Sydney, Australia
| | - Brett Lurie
- Department of Radiology, Royal North Shore Hospital, Sydney, Australia
| | - Ziba Gandomkar
- Discipline of Clinical Imaging, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Roderick J Clifton-Bligh
- Northern Clinical School, Faculty of Health and Medicine, University of Sydney, Australia
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, Australia
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Offi C, Romano RM, Cangiano A, Filograna Pignatelli M, Candela G, Docimo G. Evaluation of LMR, NLR and PLR as predictors of malignancy in indeterminate thyroid nodules. Acta Otorhinolaryngol Ital 2021; 41:530-536. [PMID: 34928264 PMCID: PMC8686799 DOI: 10.14639/0392-100x-n1515] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 09/28/2021] [Indexed: 12/22/2022]
Abstract
Objective Thyroid nodules with indeterminate cytology represent 20% of all thyroid nodules. Inflammation plays an important role in cancer. Lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are independent prognostic scores in numerous cancers, although no study has documented their role in cytology indeterminate nodules. The aim of this study is to evaluate the role of LMR, NLR and PLR values as predictors of malignancy in patients with cytology indeterminate nodules. Methods This retrospective study analysed data from 298 patients with indeterminate thyroid nodule. Anatomopathological and haematological data were analysed, dividing the population into two groups. LMR, NLR and PLR values were determined using ROC curve and data were analysed using independent samples t-test, test of proportions, Fisher’s exact test and univariate and multivariate logistic regression. Results We found that a baseline LMR value ≥ 4.09 was indicative of benignity of indeterminate nodule. The probability of malignancy in patients with LMR < 4.09 was 26 times higher than patients with a LMR value ≥ 4.09. Conclusions This study showed that only LMR has shown a concrete probability to find a thyroid cancer in patients with indeterminate nodules. Further studies are necessary to implement tailored treatment.
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Affiliation(s)
- Chiara Offi
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Naples, Italy
| | - Roberto Maria Romano
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Naples, Italy
| | - Angelo Cangiano
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Naples, Italy
| | - Marcello Filograna Pignatelli
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Naples, Italy
| | - Giancarlo Candela
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Naples, Italy
| | - Giovanni Docimo
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Naples, Italy
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Razavi MA, Wong J, Akkera M, Shalaby M, Shalaby H, Sholl A, Haddad A, Behl P, Kandil E, Lee GS. Nuclear morphometry in indeterminate thyroid nodules. Gland Surg 2020; 9:238-244. [PMID: 32420247 DOI: 10.21037/gs.2020.02.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Up to 30% of thyroid nodules undergoing fine needle aspiration (FNA) yield an indeterminate result. Recent research efforts have suggested that nuclear morphometry and morphology may enhance the diagnostic accuracy of FNA as an objective adjunct. We applied nuclear morphometric analysis on a diverse cohort of patients to evaluate the association between nuclear morphometry and malignancy. Methods Forty-five randomly selected patients, who underwent thyroid surgery after an indeterminate FNA result (Bethesda III & IV) between 2012-2015, were reviewed. One hundred representative nuclei per FNA of a thyroid nodule were analyzed using ImageJ. Seven validated morphometric parameters were collected: nuclear area, perimeter, circularity, aspect ratio, roundness, and maximum/minimum Feret's diameter. L/S ratio was subsequently calculated. All 8 nuclear parameters were reported as averages with standard errors of the mean (SEM). A Student's t-test was used to assess the association of nuclear parameters with final surgical pathology. Results The mean age of all patients was 56.31±15.39 years, with female patients comprising 68.9% of the cohort. Twenty-two patients had malignant thyroid nodules. The mean perimeter of nuclei for the cohort was 18.48±0.45 µm, the mean area was 22.19±0.93 µm, and the mean maximum Feret's diameter was 6.67±0.13 µm. No significant differences in the 8 nuclear parameters were observed between the malignant and non-malignant groups. Conclusions In the population examined, our results suggest that nuclear morphometry is not yet a tool of reliable diagnostic value in accessing malignant and non-malignant thyroid nodules. Further investigation is necessary to identify objective parameters that will enhance diagnostic accuracy of indeterminate FNA cytology to minimize the number of diagnostic thyroid surgery.
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Affiliation(s)
- Michael A Razavi
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Johnny Wong
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mounika Akkera
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mahmoud Shalaby
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Hosam Shalaby
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Andrew Sholl
- Department of Pathology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Antione Haddad
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Preeti Behl
- Department of Pathology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Grace S Lee
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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10
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dos Santos MT, Buzolin AL, Gama RR, da Silva ECA, Dufloth RM, Figueiredo DLA, Carvalho AL. Molecular Classification of Thyroid Nodules with Indeterminate Cytology: Development and Validation of a Highly Sensitive and Specific New miRNA-Based Classifier Test Using Fine-Needle Aspiration Smear Slides. Thyroid 2018; 28:1618-1626. [PMID: 30319072 PMCID: PMC6308280 DOI: 10.1089/thy.2018.0254] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 12/12/2022]
Abstract
Background: Thyroid nodules can be identified in up to 68% of the population. Fine-needle aspiration (FNA) cytopathology classifies 20%-30% of nodules as indeterminate, and these are often referred for surgery due to the risk of malignancy. However, histological postsurgical reports indicate that up to 84% of cases are benign, highlighting a high rate of unnecessary surgeries. We sought to develop and validate a microRNA (miRNA)-based thyroid molecular classifier for precision endocrinology (mir-THYpe) with both high sensitivity and high specificity, to be performed on the FNA cytology smear slide with no additional FNA. Methods: The expression of 96 miRNA candidates from 39 benign/39 malignant thyroid samples, (indeterminate on FNA) was analyzed to develop and train the mir-THYpe algorithm. For validation, an independent set of 58 benign/37 malignant FNA smear slides (also classified as indeterminate) was used. Results: In the training set, with a 10-fold cross-validation using only 11 miRNAs, the mir-THYpe test reached 89.7% sensitivity, 92.3% specificity, 90.0% negative predictive value and 92.1% positive predictive value. In the FNA smear slide validation set, the mir-THYpe test reached 94.6% sensitivity, 81.0% specificity, 95.9% negative predictive value, and 76.1% positive predictive value. Bayes' theorem shows that the mir-THYpe test performs satisfactorily in a wide range of cancer prevalences. Conclusions: The presented data and comparison with other commercially available tests suggest that the mir-THYpe test can be considered for use in clinical practice to support a more informed clinical decision for patients with indeterminate thyroid nodules and potentially reduce the rates of unnecessary thyroid surgeries.
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Affiliation(s)
- Marcos Tadeu dos Santos
- Department of Research and Development, Onkos Molecular Diagnostics, Ribeirão Preto/SP, Brazil
- Department of Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos/SP, Brazil
- Address correspondence to: Marcos Tadeu dos Santos, PhD, Department of Research and Development, Onkos Molecular Diagnostics, (Startups incubator), 1805 Avenida Doutora Nadir Aguiar, SUPERA Innovation and Technology Park, Ribeirão Preto/SP 14056-680, Brazil
| | - Ana Lígia Buzolin
- Department of Research and Development, Onkos Molecular Diagnostics, Ribeirão Preto/SP, Brazil
| | - Ricardo Ribeiro Gama
- Department of Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos/SP, Brazil
- Department of Head and Neck Surgery, Barretos Cancer Hospital, Barretos/SP, Brazil
| | | | | | | | - André Lopes Carvalho
- Department of Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos/SP, Brazil
- Department of Head and Neck Surgery, Barretos Cancer Hospital, Barretos/SP, Brazil
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11
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Stahl LE, Stewart R, Carr MM, Goldenberg D, Schubart JR. Treatment preferences and decision-making in patients diagnosed with indeterminate thyroid nodules. Psychooncology 2018; 27:2862-2864. [PMID: 30144220 DOI: 10.1002/pon.4865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/09/2018] [Accepted: 08/16/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Lauren E Stahl
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Renee Stewart
- Department of Humanities, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Michele M Carr
- Department of Otolaryngology, West Virginia University, Morgantown, WV, USA
| | - David Goldenberg
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Jane R Schubart
- Department of Surgery, Division of Outcomes, Research and Quality, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
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