A Diagnostic Predictor Model for Indeterminate or Suspicious Thyroid FNA Samples

Banks, Nia D.; Kowalski, Jeanne; Tsai, Hua Ling; Somervell, Helina; Tufano, Ralph P.; Dackiw, Alan P.B.; Marohn, Michael R.; Clark, Douglas P.; Umbricht, Christopher B.; Zeiger, Martha A.

doi:10.1089/thy.2008.0108

Cited by 101 publications

(108 citation statements)

References 26 publications

(58 reference statements)

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“…We must note that some studies have shown a significant linear dose-response relationship over a relatively broad range of doses and a higher risk after exposure in childhood (55). Although some studies have reported a higher risk of thyroid carcinoma for TNs occurring in young people and older people with a bimodal distribution (31,45,56,57), our analysis did not show these findings. However, limitations are present in our meta-analysis for age because it is a continuous variable, and most studies presented non-uniform, aggregate data on age.…”

Section: Clinical Tn Featurescontrasting

confidence: 79%

DIAGNOSIS IN ENDOCRINOLOGY: Quantification of cancer risk of each clinical and ultrasonographic suspicious feature of thyroid nodules: a systematic review and meta-analysis

Campanella

Ianni

Rota

et al. 2014

European Journal of Endocrinology

106

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Objective: In order to quantify the risk of malignancy of clinical and ultrasonographic features of thyroid nodules (TNs), we did a systematic review and meta-analysis of published studies. Methods: We did a literature search in MEDLINE for studies published from 1st January 1989 until 31st December 2012. Studies were considered eligible if they investigated the association between at least one clinical/ultrasonographic feature and the risk of malignancy, did not have exclusion criteria for the detected nodules, had histologically confirmed the diagnoses of malignancy, and had a univariable analysis available. Two reviewers independently extracted data on study characteristics and outcomes. Results: The meta-analysis included 41 studies, for a total of 29 678 TN. A higher risk of malignancy expressed in odds ratio (OR) was found for the following: nodule height greater than width (OR: 10.15), absent halo sign (OR: 7.14), microcalcifications (OR: 6.76), irregular margins (OR: 6.12), hypoechogenicity (OR: 5.07), solid nodule structure (OR: 4.69), intranodular vascularization (OR: 3.76), family history of thyroid carcinoma (OR: 2.29), nodule size R4 cm (OR: 1.63), single nodule (OR: 1.43), history of head/neck irradiation (OR: 1.29), and male gender (OR: 1.22). Interestingly, meta-regression analysis showed a higher risk of malignancy for hypoechoic nodules in iodine-sufficient than in iodine-deficient geographical areas. Conclusions: The current meta-analysis verified and weighed out each suspicious clinical and ultrasonographic TN feature. The highest risk was found for nodule height greater than width, absent halo sign, and microcalcifications for ultrasonographic features and family history of thyroid carcinoma for clinical features. A meta-analysis-derived grading system of TN malignancy risk, validated on a large prospective cohort, could be a useful tool in TN diagnostic work-up.

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Section: Clinical Tn Featurescontrasting

confidence: 79%

DIAGNOSIS IN ENDOCRINOLOGY: Quantification of cancer risk of each clinical and ultrasonographic suspicious feature of thyroid nodules: a systematic review and meta-analysis

Campanella

Ianni

Rota

et al. 2014

European Journal of Endocrinology

106

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“…The limited value of FNA and frozen section examination as the diagnosis was deferred in 76 (58.9%) patients in our study, several clinical factors have been investigated for their potential value in predicting carcinoma and determining the extent of thyroid surgery. While certain clinical features such as male gender and nodule size (≥4 cm), older patient age, or cytologic features such as presence of atypia can improve the diagnostic accuracy for malignancy in patients with indeterminate cytology, (18)(19)(20)(21) overall predictive values are still low and even has been reported conflicting results. (17) Recently, many potential immunohistochemical and molecular markers such as galectin-3, cytokeratin-19 (CK19), HBME-1, thyroid transcription factor 1 (TTF-1), RET/PTC gene rearrangements, and B-raf mutations have been studied to improve diagnostic accuracy for indeterminate nodules.…”

Section: Discussionmentioning

confidence: 99%

“…(16,18,19,25,26) According to the ATA guideline, initial total thyroidectomy is recommended in patients with indeterminate nodules who have large tumors (＞4 cm) due to an increased risk for malignancy. Taneri et al (26) found in HCN that there was no malignancy among the tumors less than 1 cm diameter.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors of Malignancy in Thyroid Nodules Diagnosed as Follicular Neoplasm or Hürthle Cell Neoplasm on FNA

You

Jung

Chae

et al. 2012

Korean J Endocr Surg

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Purpose:The rate of malignancy in the follicular neoplasm (FN) or Hürthle cell neoplasm (HCN) of the thyroid gland is estimated as approximately 20∼30%. Fine-needle aspiration biopsy (FNAB) and frozen section examination are restricted in differentiating between benign and malignant. The aims of this study are to compare the differences of clinicopathologic features and to determine the risk factors for malignancy in patients with FN or HCN. Methods: A retrospective study was conducted of patients with FN or HCN who were diagnosed by FNAB, and underwent surgery at our institution between Jan. 2005 to Jun. 2010. We analyzed the risk factors for malignancy and the differences of clinicopathologic features in patients with FN or HCN. Results: A total of 290 patients were enrolledin this study; 160 (55.2%) patients underwent thyroidectomy, 97 (60.6%) patients had FN, and 63 (39.4%) had HCN. Forty one (25.6%) patients were diagnosed as malignancy of these, 22 (22.7%) patients were FN and 19 (30.2%) were HCN (P=0.29). Two (2.1%) patients with FN and 10 (15.9%) with HCN (P=0.002) comcomitant papillary thyroid carcinoma were indentified by FNAB. Classification of nodules according to ultrasonographic findings in both neoplasms (P＜0.05) and galectin-3 in FN (P＜0.05) were predictive factors for malignancy. In addition, galectin-3 was a predictive factor for malignancy in indeterminate nodules on ultrasonography (USG) (P=0.028). Conclusion: Classification of nodules according to ultrasonographic findings and galectin-3 expression is helpful in predicting carcinoma of patients with FN or HCN.

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“…Preoperative distinction of benign and malignant thyroid nodules is often difficult and frequently inaccurate. The nodules that can be challenging diagnostically include the following histological subtypes: benign (follicular adenoma, adenomatoid nodule, lymphocytic thyroiditis nodule, and Hü rthle cell adenoma) and malignant (Hü rthle cell carcinoma, follicular carcinoma, follicular variant of papillary thyroid carcinoma, and papillary thyroid carcinoma) (5). Although fine needle aspiration (FNA) cytology evaluation is the most accurate means of diagnosing thyroid nodules, even experienced cytopathologists encounter problems with FNA samples for which cytological features neither confirm nor rule out malignancy.…”

Section: Introductionmentioning

confidence: 99%

“…Over the past decade, studies by others and our group have revealed differences in gene expression between benign and malignant thyroid tumors (10)(11)(12)(13)(14)(15)(16)(17)(18). However, no study has included all of the thyroid tumor types that have associated suspicious FNA cytology (5), nor successfully implemented them as a diagnostic adjunct to FNA in a large cohort of patients with suspicious thyroid lesions. Relevant to this, by utilizing microarray analysis, we have previously identified 75 molecular markers that are differentially expressed between benign and malignant thyroid tumors (19).…”

Section: Introductionmentioning

confidence: 99%

Three-Gene Molecular Diagnostic Model for Thyroid Cancer

Prasad

Kowalski

Tsai

et al. 2012

Thyroid

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Background: The preoperative diagnosis of thyroid nodules primarily depends upon fine needle aspiration (FNA) cytology. However, up to 25% of FNA samples have associated ''suspicious or indeterminate'', but not diagnostic cytologic reports, resulting in difficulty deciding appropriate clinical management for these patients. We hypothesize that the use of molecular markers as an adjunct to FNA cytology can improve the distinction of benign from malignant nodules that have associated suspicious or indeterminate cytology. Methods: Using microarray analysis, we previously identified and reported on 75 genes useful in the distinction of benign versus malignant thyroid nodules. In the present study, we have further validated the expression of 14 of these markers in a large number of thyroid samples by immunohistochemistry (IHC) analysis of 154 thyroid tumors and quantitative real-time RT-PCR (QRT-PCR) analysis of 95 FNA samples. Of the 154 tumors analyzed by IHC, 44 samples (29%) had associated suspicious or indeterminate FNA cytology. Results: Receiver operating characteristic using three-gene model, (HMGA2, MRC2, and SFN) analysis for the detection of malignant nodules resulted in areas under the curve (AUCs) of ‡ 0.95 (80% sensitivity; 100% specificity) and ‡ 0.84 (71% sensitivity; 84% specificity) for the IHC data in tumors, and QRT-PCR data in FNA samples, respectively. Conclusions: Our results suggest that a three-gene model for the cytological diagnosis of indeterminate thyroid nodules is both feasible and promising. Implementation of this as an adjunct to thyroid cytology may significantly impact the clinical management of patients with suspicious or indeterminate thyroid FNA nodules.

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A Diagnostic Predictor Model for Indeterminate or Suspicious Thyroid FNA Samples

Abstract: A predictor model was created using the variables age, nodule size, and FNA cytology to predict thyroid malignancy.

Cited by 101 publications

References 26 publications

DIAGNOSIS IN ENDOCRINOLOGY: Quantification of cancer risk of each clinical and ultrasonographic suspicious feature of thyroid nodules: a systematic review and meta-analysis

DIAGNOSIS IN ENDOCRINOLOGY: Quantification of cancer risk of each clinical and ultrasonographic suspicious feature of thyroid nodules: a systematic review and meta-analysis

Predictive Factors of Malignancy in Thyroid Nodules Diagnosed as Follicular Neoplasm or Hürthle Cell Neoplasm on FNA

Three-Gene Molecular Diagnostic Model for Thyroid Cancer

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