Details

Autor(en) / Beteiligte

• Yang, Samantha Peiling
• Nga, Min En
• Bundele, Manish Mahadeorao
• Chiosea, Simion I.
• Tan, Sze Hwa
• Lum, Jeffrey H. Y.
• Parameswaran, Rajeev
• Lim, Ming Yann
• Li, Hao
• Cheah, Wei Keat
• Sek, Kathleen Su‐Yen
• Tan, Andre Teck Huat
• Loh, Thomas Kwok Seng
• Ngiam, Kee Yuan
• Tan, Wee Boon
• Huang, Xinyong
• Ho, Thomas Wai Thong
• Lim, Keng Hua
• Lim, Chwee Ming
• Singaporewalla, Reyaz M.
• Rao, Anil Dinkar
• Rao, Nandini C. L.
• Chua, Dennis Yu Kim
• Chin, David Chao‐Wu
• Wald, Abigail I.
• LiVolsi, Virginia A.
• Nikiforov, Yuri E.
• Tai, E. Shyong

Titel

Performance of a multigene genomic classifier and clinical parameters in predicting malignancy in a Southeast Asian cohort of patients with cytologically indeterminate thyroid nodules

Ist Teil von

• Cancer cytopathology, 2024-05, Vol.132 (5), p.309-319

Ort / Verlag

United States: Wiley Subscription Services, Inc

Erscheinungsjahr

2024

Quelle

MEDLINE

Beschreibungen/Notizen

• Background Most thyroid nodules are benign. It is important to determine the likelihood of malignancy in such nodules to avoid unnecessary surgery. The primary objective of this study was to characterize the genetic landscape and the performance of a multigene genomic classifier in fine‐needle aspiration (FNA) biopsies of cytologically indeterminate thyroid nodules in a Southeast Asian cohort. The secondary objective was to assess the predictive contribution of clinical characteristics to thyroid malignancy. Methods This prospective, multicenter, blinded study included 132 patients with 134 nodules. Molecular testing (MT) with ThyroSeq v3 was performed on clinical or ex‐vivo FNA samples. Centralized pathology review also was performed. Results Of 134 nodules, consisting of 61% Bethesda category III, 20% category IV, and 19% category V cytology, and 56% were histologically malignant. ThyroSeq yielded negative results in 37.3% of all FNA samples and in 42% of Bethesda category III–IV cytology nodules. Most positive samples had RAS‐like (41.7%), followed by BRAF‐like (22.6%), and high‐risk (17.9%) alterations. Compared with North American patients, the authors observed a higher proportion of RAS‐like mutations, specifically NRAS, in Bethesda categories III and IV and more BRAF‐like mutations in Bethesda category III. The test had sensitivity, specificity, negative predictive value, and positive predictive value of 89.6%, 73.7%, 84.0%, and 82.1%, respectively. The risk of malignancy was predicted by positive MT and high‐suspicion ultrasound characteristics according to American Thyroid Association criteria. Conclusions Even in the current Southeast Asian cohort with nodules that had a high pretest cancer probability, MT could lead to potential avoidance of diagnostic surgery in 42% of patients with Bethesda category III–IV nodules. MT positivity was a stronger predictor of malignancy than clinical parameters. In this Southeast Asian cohort, ThyroSeq provided diagnostic value, avoiding unnecessary thyroid surgery in 42% of patients with Bethesda category III–IV cytology nodules. The risk of malignancy was mainly predicted by a positive ThyroSeq test and the presence of high‐suspicion ultrasound characteristics according to American Thyroid Association criteria.