Evaluation of 167 Gene Expression Classifier (GEC) and ThyroSeq v2 Diagnostic Accuracy in the Preoperative Assessment of Indeterminate Thyroid Nodules: Bivariate/HROC Meta-analysis

Borowczyk, Martyna; Szczepanek‐Parulska, Ewelina; Olejarz, Michał; Więckowska, Barbara; Verburg, Frederik A.; Dębicki, Szymon; Budny, Bartłomiej; Janicka‐Jedyńska, Małgorzata; Ziemnicka, Katarzyna; Ruchała, Marek

doi:10.1007/s12022-018-9560-5

Cited by 32 publications

(28 citation statements)

References 34 publications

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“…There are some genetic studies for presurgical differentiation of Bethesda classes III and IV to avoid the need for diagnostic surgery [26][27][28]. Due to the high sensitivity and accuracy, genetic analysis may be helpful in ruling out malignancy in cases of indeterminate nodules.…”

Section: Discussionmentioning

confidence: 99%

Malignancy rates for Bethesda III and IV thyroid nodules: a retrospective study of the correlation between fine-needle aspiration cytology and histopathology

Bayrak

Eruyar

2020

BMC Endocr Disord

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Background: Fine-needle aspiration cytology (FNAC) has become a well-established modality in the diagnosis, staging and follow-up of thyroid nodules. FNAC outcomes are routinely classified using the Bethesda System for Reporting Thyroid Cytopathology (BSRTC), facilitating appropriate clinical management. Bethesda categories III and IV encompass varying risks of malignancy. This retrospective study established a possible association between these cytological categories and malignancy rates in patients treated at a single institution. Methods: Over a 6-year period, 11,627 FNAC procedures were performed on thyroid nodules. Of these, 814 (59.63%) patients were submitted to thyroidectomy. The nodules of 108 patients were classified as Bethesda category III and 47 patients as Bethesda category IV. Patient data were reviewed to establish a correlation between the FNAC results and the final histopathological analyses. Results: The rates of malignancy among patients who underwent surgery were 25% for category III and 27.6% for category IV, with no significant differences between categories (p = 0.67). The pathological parameters of malignant nodules, namely tumour type, size, encapsulation, invasion into the thyroid capsule, extrathyroidal extension and lymphovascular invasion did not significantly differ between the groups (p > 0.05). Conclusions: This paper provides a more precise correlation of malignancy rates with thyroid nodules classified as Bethesda categories III and IV, as our findings are comparable to the literature, giving malignancy rates ranging from 10 to 30% for category III and 25-40% for category IV. Use of the BSRTC is heterogeneous across institutions, and there is some degree of subjectivity in the distinction between categories III and IV; therefore, it is crucial to estimate the rates of malignancy at each institution. Molecular assays are of increasing importance in determining the need for surgical intervention for thyroid lesions. Gene expression assays using FNAC material may demonstrate a high predictive value for cytologically indeterminate thyroid nodules diagnosed as Bethesda classes III and IV.

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Section: Discussionmentioning

confidence: 99%

Malignancy rates for Bethesda III and IV thyroid nodules: a retrospective study of the correlation between fine-needle aspiration cytology and histopathology

Bayrak

Eruyar

2020

BMC Endocr Disord

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“…20 A recent meta-analysis reported a pooled Se of 98%, NPV of 91%, Sp of 12% and PPV of 45% for GEC in indeterminate nodules (including class III and IV nodules). 21 A "Rule In" test based on gene sequencing assay, the ThyroSeq has also been evaluated for this purpose. The clinical validation study showed that ThyroSeq v2.1 had a Se, Sp, PPV and NPV of 90.9%, 92.1%, 76.9% and 97.2%, respectively, in nodules with cytological categorization as AUS/FLUS and with known histologic outcome.…”

Section: Utility Of Molecular Testing In Aus/flus Cytologymentioning

confidence: 99%

“…22 recent meta-analysis comparing ThyroSeq v2 with Afirma GEC demonstrated thatThyroSeq v2had a significantly higher Sp and accuracy then GEC. 21 The current version, ThyroSeq v3, analyzing 112 genes was found to have a Se of 93.9% and NPV of 97% in the validation studies for indeterminate cytology and hence, is now considered as a "Rule Out" test. 23,24 ThyGenX (sequencing of eight genes) coupled with ThyraMIR (analyzing 10 miRNAs) demonstrated a Se of 94%, Sp 85%, PPV of 68% and NPV of 97% in the AUS/FLUS category.…”

Section: Utility Of Molecular Testing In Aus/flus Cytologymentioning

confidence: 99%

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Molecular testing in diagnosis of indeterminate thyroid cytology: Trends and drivers

Kumar

Gupta

2020

Diagnostic Cytopathology

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Fine needle aspiration (FNA), the cornerstone of diagnosis in thyroid swellings, fails to render a definitive diagnosis in about 20% to 30% of cases that are reported as indeterminate on cytology. Since the clinical management in thyroid rests on the risk of malignancy (ROM) in a given nodule, this distinction between "benign" and "possibly malignant" assumes paramount clinical importance. Over the last two decades, tremendous progress has been achieved in our understanding of the molecular basis of thyroid pathologies leading to identification of several genetic alterations that could potentially be exploited for diagnostic, prognostic and therapeutic purposes. An array of molecular tests has hit the markets aiming to predict the ROM in thyroid nodules. A deeper understanding of the strengths and limitations of these tests is imperative to be able to judiciously choose the right molecular test in a given case for maximum clinical benefit. This narrative review provides an overview of current status of molecular testing in the evaluation of thyroid nodules encompassing the current status and applications of these tests in diagnostic, prognostic and therapeutic areas along with a brief insight into the future developments in this field.

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“…The use of a 167 gene expression classifier (GEC) has been proposed as a rule-out test due to relatively high sensitivity (92%) and net present value (93%), as reported in a prospective multicenter study. 19 In addition, relatively low specificity of 167 GEC test (48%-53%) has shown that it could not establish malignancy criteria for indeterminate nodules. Alexander et al 20 reported that the prevalence of 167 GEC benign readings varied among institutions and reached up to 29%, which was not significant.…”

Section: Preoperative Ultrasonographymentioning

confidence: 99%

Comparison of clinicopathological features in the patients with noninvasive follicular thyroid neoplasm with papillary-like nuclear features and follicular variant papillary thyroid cancer

Çelık¹,

Bulbul²,

Can³

et al. 2020

Polish Archives of Internal Medicine

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these patients are unnecessarily followed and treated. The role of clinical and laboratory findings of thyroid nodules in the diagnosis of the infiltrative follicular variant of papillary thyroid carcinoma (FVPTC) and NIFTP is still unknown. In this study, we aimed to evaluate the characteristics of our patients with FVPTC who have NIFTP according to the new classification. Patients and methods Patient selection A total of 460 patients with any PTC variant who had been followed between 2010 and 2016 were introduction Recent studies have shown that about 10% to 20% of all thyroid cancers are noninvasive capsulated papillary follicular variant. 1,2 However, there is no consensus on papillary nuclear changes used in the diagnosis of noninvasive capsulated follicular variant of papillary thyroid cancer. Moreover, instead of noninvasive capsulated follicular variant of papillary thyroid cancer, some authors prefer the term noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). 3 Although NIFTP is less aggressive, there is an ongoing debate on whether

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Evaluation of 167 Gene Expression Classifier (GEC) and ThyroSeq v2 Diagnostic Accuracy in the Preoperative Assessment of Indeterminate Thyroid Nodules: Bivariate/HROC Meta-analysis

Cited by 32 publications

References 34 publications

Malignancy rates for Bethesda III and IV thyroid nodules: a retrospective study of the correlation between fine-needle aspiration cytology and histopathology

Malignancy rates for Bethesda III and IV thyroid nodules: a retrospective study of the correlation between fine-needle aspiration cytology and histopathology

Molecular testing in diagnosis of indeterminate thyroid cytology: Trends and drivers

Comparison of clinicopathological features in the patients with noninvasive follicular thyroid neoplasm with papillary-like nuclear features and follicular variant papillary thyroid cancer

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