Use of Molecular Markers for Cytologically Indeterminate Thyroid Nodules to Optimize Surgical Management

Yip, Linwah

doi:10.1007/s40137-013-0035-9

Cited by 2 publications

(3 citation statements)

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“…5 The high performance of a similar molecular panel was also validated by Cantara et al 16 In a subsequent cohort study, we observed that a clinical algorithm that used molecular testing results to guide extent of thyroidectomy led to a 30% increase in appropriate total thyroidectomy for a clinically significant TC while also resulting in a 33% increase in lobectomy alone for either papillary thyroid microcarcinoma or benign histology. 6 …”

Section: Discussionmentioning

confidence: 99%

“…4,13 Thyroidectomy was performed algorithmically for clinical, radiographical, cytological, and molecular results as previously described. 6 Extent of lymphadenectomy was determined by assessment of malignancy potential on preoperative ultrasonography and by intraoperative findings. Lateral compartment (levels 2–5) lymph nodes with suspicious ultrasound features including rounded appearance, cystic changes, loss of fatty hilum, and/or microcalcifications were biopsied preoperatively.…”

Section: Methodsmentioning

confidence: 99%

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Tumor Genotype Determines Phenotype and Disease-related Outcomes in Thyroid Cancer

et al. 2015

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Objectives To correlate thyroid cancer genotype with histology and outcomes. Background The prognostic significance of molecular signature in thyroid cancer (TC) is undefined but can potentially change surgical management. Methods We reviewed a consecutive series of 1510 patients who had initial thyroidectomy for TC with routine testing for BRAF, RAS, RET/PTC, and PAX8/PPARG alterations. Histologic metastatic or recurrent TC was tracked for 6 or more months after oncologic thyroidectomy. Results Papillary thyroid cancer (PTC) was diagnosed in 97% of patients and poorly differentiated/anaplastic TC in 1.1%. Genetic alterations were detected in 1039 (70%); the most common mutations were BRAFV600E (644/1039, 62%), and RAS isoforms (323/1039, 31%). BRAFV600E-positive PTC was often conventional or tall cell variant (58%), with frequent extrathyroidal extension (51%) and lymph node metastasis (46%). Conversely, RAS-positive PTC was commonly follicular variant (87%), with infrequent extrathyroidal extension (4.6%) and lymph node metastasis (5.6%). BRAFV600E and RET/PTC-positive PTCs were histologically similar. Analogously, RAS and PAX8/PPARG-positive PTCs were histologically similar. Compared with RAS or PAX8/PPARG-positive TCs, BRAFV600E or RET/PTC-positive TCs were more often associated with stage III/IV disease (40% vs 15%, P < 0.001) and recurrence (10% vs 0.7%, P < 0.001; mean follow-up 33 ± 21 mo). Distant metastasis was highest in patients with RET/PTC-positive TC (10.8%, P = 0.02). Conclusions In this large study of prospective mutation testing in unselected patients with TC, molecular signature was associated with distinctive phenotypes including cancers, with higher risks of both distant metastasis and early recurrence. Preoperative genotype provides valuable prognostic data to appropriately inform surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Tumor Genotype Determines Phenotype and Disease-related Outcomes in Thyroid Cancer

et al. 2015

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“…Two of twenty seven conventional PTC had coexistent BRAF V600E with p53 and/or PIK3CA mutations which are typically more characteristic of aggressive thyroid cancers. The identification of more than one driver mutation may provide preoperative prognostic information that may beneficially guide surgical management .…”

Section: Genetic Mutations and Rearrangementsmentioning

confidence: 99%