Molecular Test Effectively Guides Extent of Initial Thyroidectomy
By HospiMedica International staff writers Posted on 05 Aug 2014 |
Image: Papillary thyroid cancer showing grey lobulated tumor with central scar (Photo courtesy of Dr. Shahidul Islam).
The routine use of a molecular testing panel increases the likelihood of performing the correct initial surgery for patients with thyroid nodules and cancer.
A clinical algorithm using routine cytological molecular testing (MT) promotes initial total thyroidectomy (TT) for clinically significant thyroid cancer (sTC) and/or correctly limits surgery to lobectomy when appropriate. Either TT or lobectomy is often needed to diagnose differentiated thyroid cancer and determining the correct extent of initial thyroidectomy is challenging.
Scientists at the University of Pittsburgh Medical Center (Pittsburgh, PA, USA) conducted a single-institution cohort study of 671 patients with nonmalignant cytology who had thyroidectomy between October 2010 and March 2012. Cytological diagnosis was made using the 2008 Bethesda criteria, and one or more indications for thyroidectomy. The patients who received biopsies all had suspicious thyroid nodes.
Approximately half the biopsy samples were run through the molecular panel, and the other half were not. Patients whose tissue samples were not tested with the panel had a 2.5-fold higher statistically significant likelihood of having an initial lobectomy and then requiring a second operation. Using a routine algorithm for prospective MT, the team demonstrated that the likelihood of optimal initial thyroid surgery is increased by the reflexive use of testing a molecular marker panel of proto-oncogene B-Raf (BRAF), Rat sarcoma (RAS), Paired box gene 8- peroxisome proliferator-activated receptor γ 1 (PAX8-PPARγ), and Rearranged in Transformation/Papillary Thyroid Carcinomas (RET-PTC) on fine needle aspiration biopsy (FNAB) specimens.
By analyzing new data from a single institution that has been prospectively and routinely using FNAB-MT since 2007, the investigators observed that, overall, FNAB-MT facilitated a 30% increase in the appropriate use of initial TT for sTC histology and a 33% increase in the appropriate use of initial lobectomy for non-sTC histology. Yuri Nikiforov, MD, PhD, a professor of pathology and coauthor of the study said, “We're currently refining the panel by adding tests for more genetic mutations, thereby making it even more accurate. Thyroid cancer is usually very curable, and we are getting closer to quickly and efficiently identifying and treating all cases of thyroid cancer.” The study was published in July 2014 issue of the Annals of Surgery.
Related Links:
University of Pittsburgh Medical Center
A clinical algorithm using routine cytological molecular testing (MT) promotes initial total thyroidectomy (TT) for clinically significant thyroid cancer (sTC) and/or correctly limits surgery to lobectomy when appropriate. Either TT or lobectomy is often needed to diagnose differentiated thyroid cancer and determining the correct extent of initial thyroidectomy is challenging.
Scientists at the University of Pittsburgh Medical Center (Pittsburgh, PA, USA) conducted a single-institution cohort study of 671 patients with nonmalignant cytology who had thyroidectomy between October 2010 and March 2012. Cytological diagnosis was made using the 2008 Bethesda criteria, and one or more indications for thyroidectomy. The patients who received biopsies all had suspicious thyroid nodes.
Approximately half the biopsy samples were run through the molecular panel, and the other half were not. Patients whose tissue samples were not tested with the panel had a 2.5-fold higher statistically significant likelihood of having an initial lobectomy and then requiring a second operation. Using a routine algorithm for prospective MT, the team demonstrated that the likelihood of optimal initial thyroid surgery is increased by the reflexive use of testing a molecular marker panel of proto-oncogene B-Raf (BRAF), Rat sarcoma (RAS), Paired box gene 8- peroxisome proliferator-activated receptor γ 1 (PAX8-PPARγ), and Rearranged in Transformation/Papillary Thyroid Carcinomas (RET-PTC) on fine needle aspiration biopsy (FNAB) specimens.
By analyzing new data from a single institution that has been prospectively and routinely using FNAB-MT since 2007, the investigators observed that, overall, FNAB-MT facilitated a 30% increase in the appropriate use of initial TT for sTC histology and a 33% increase in the appropriate use of initial lobectomy for non-sTC histology. Yuri Nikiforov, MD, PhD, a professor of pathology and coauthor of the study said, “We're currently refining the panel by adding tests for more genetic mutations, thereby making it even more accurate. Thyroid cancer is usually very curable, and we are getting closer to quickly and efficiently identifying and treating all cases of thyroid cancer.” The study was published in July 2014 issue of the Annals of Surgery.
Related Links:
University of Pittsburgh Medical Center
Latest Surgical Techniques News
- Miniaturized Implantable Multi-Sensors Device to Monitor Vessels Health
- Tiny Robots Made Out Of Carbon Could Conduct Colonoscopy, Pelvic Exam or Blood Test
- Miniaturized Ultrasonic Scalpel Enables Faster and Safer Robotic-Assisted Surgery
- AI Assisted Reading Tool for Small Bowel Video Capsule Endoscopy Detects More Lesions
- First-Ever Contact Force Pulsed Field Ablation System to Transform Treatment of Ventricular Arrhythmias
- Caterpillar Robot with Built-In Steering System Crawls Easily Through Loops and Bends
- Tiny Wraparound Electronic Implants to Revolutionize Treatment of Spinal Cord Injuries
- Small, Implantable Cardiac Pump to Help Children Awaiting Heart Transplant
- Gastrointestinal Imaging Capsule a Game-Changer in Esophagus Surveillance and Treatment
- World’s Smallest Laser Probe for Brain Procedures Facilitates Ablation of Full Range of Targets
- Artificial Intelligence Broadens Diagnostic Abilities of Conventional Coronary Angiography
- AI-Powered Surgical Visualization Tool Supports Surgeons' Visual Recognition in Real Time
- Cutting-Edge Robotic Bronchial Endoscopic System Provides Prompt Intervention during Emergencies
- Handheld Device for Fluorescence-Guided Surgery a Game Changer for Removal of High-Grade Glioma Brain Tumors
- Porous Gel Sponge Facilitates Rapid Hemostasis and Wound Healing
- Novel Rigid Endoscope System Enables Deep Tissue Imaging During Surgery