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UTILITY OF AFIRMA GENE EXPRESSION CLASSIFIER FOR EVALUATION OF INDETERMINATE THYROID NODULES AND CORRELATION WITH ULTRASOUND RISK ASSESSMENT: SINGLE INSTITUTIONAL EXPERIENCE.
AFIRMA 基因表达分类器用于评估不确定甲状腺结节的效用及与超声风险评估的相关性: 单一机构经验。
- 影响因子:3.02
- DOI:10.4158/EP-2019-0350
- 作者列表:"Sultan R","Levy S","Sulanc E","Honasoge M","Rao SD
- 发表时间:2020-01-22
Abstract
:Objective: We assessed our experience with Afirma gene expression classifier (GEC) combined with sonographic risk assessment, using both the ATA and TI-RADS in evaluating indeterminate thyroid nodules. Methods: We identified 98 patients with 101 nodules who had a second fine needle aspiration biopsy (FNA) between 01/01/2014 and 09/30/2017 and sent to Veracyte for cytopathology and subsequent Afirma GEC testing. A second FNA biopsy was performed if the initial cytopathology was either Bethesda III or IV (n= 94) or non-diagnostic (n= 7). We correlated cytopathology, histopathology, and Afirma GEC results with sonographic risk assessment using both the ATA system and TI-RADS. Results: The mean age of the cohort was 57.4 ± 12.3 years; 84% women and 60% white. Repeat FNA was benign in 51 of 101 nodules, and of the remaining 50 nodules, 18 (36%) were GEC-benign and 32 (64%) GEC-suspicious. Eighteen of the 32 GEC-suspicious nodules underwent surgery with the following results: 7 benign (39%), 1 follicular thyroid carcinoma (6%), 6 follicular variant of papillary thyroid cancer (33%), and 4 non-invasive follicular tumor with papillary-like nuclear features (22%). The malignancy rate among the surgical cohort was 39% (without NIFTP) and 61% (with NIFTP) and about 50% and 20% of this group scored in the high suspicion category by ATA and TR5 by TI-RADS respectively. Conclusion: Afirma GEC was useful in avoiding surgery in one-third of indeterminate nodules and performed similarly to ATA and TI-RADS. However, use of echogenicity in scoring may underestimate the risk of malignancy in patients with indeterminate nodules.
摘要
: 目的: 我们评估了我们使用 Afirma 基因表达分类器 (GEC) 结合超声风险评估的经验,同时使用 ATA 和 TI-RADS 评估不确定甲状腺结节。方法: 我们确定了 98 例 101 个结节的患者,他们在 01/01/2014 至 09/30/2017 期间进行了第二次细针穿刺活检 (FNA),并将其送至 Veracyte 进行细胞病理学和随后的 Afirma GEC 检测。如果初始细胞病理学为 Bethesda III 或 IV (n = 94) 或非诊断性 (n = 7),则进行第二次 FNA 活检。我们将细胞病理学、组织病理学和 Afirma GEC 结果与使用 ATA 系统和 TI-RADS 的超声风险评估相关联。结果: 队列的平均年龄为 57.4 ± 12.3 岁; 84% 为女性,60% 为白人。101 个结节中有 51 个重复 FNA 为良性,其余 50 个结节中,18 个 (36%) 为 GEC 良性,32 个 (64%) 为 GEC 可疑。32 个 GEC 可疑结节中 18 个接受了手术,结果如下: 良性 7 个 (39%),滤泡状甲状腺癌 1 个 (6% ), 6 个滤泡状乳头状甲状腺癌变异型 (33%), 4 例非浸润性滤泡性肿瘤伴乳头状核样特征 (22%)。外科队列的恶性率为 39% (无 NIFTP) 和 61% (有 NIFTP) 这一组中 ATA 和 TI-RADS 的 TR5 得分分别为 50% 和 20%。结论: Afirma GEC 可避免 3分之1 不确定结节的手术,其操作与 ATA 和 TI-RADS 相似。然而,在评分中使用回声可能低估了不确定结节患者的恶性风险。
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METHODS:OBJECTIVES:To assess the prevalence of Hashimoto thyroiditis (HT) in primary thyroid lymphoma (PTL) and whether it differs between mucosa-associated lymphoid tissue (MALT) lymphoma and diffuse large B-cell lymphoma (DLBCL). METHODS:Electronic databases were searched for studies assessing HT prevalence in PTL, based on antithyroid antibodies, clinical history, or pathology. Pooled prevalence of HT and its association with histotype (MALT or DLBCL) were calculated. RESULTS:Thirty-eight studies with 1,346 PTLs were included. Pooled prevalence results were 78.9% (any HT evidence), 65.3% (antithyroid antibodies), 41.7% (clinical history), and 64% (pathology). HT prevalence was significantly higher in MALT lymphoma than in DLBCL (P = .007) and in mixed DLBCL/MALT than in pure DLBCL (P = .002). CONCLUSIONS:Overall, 78.9% of patients with PTL have any HT evidence, but only half of these had been clinically followed. The difference in HT prevalence suggests that a subset of DLBCL may not derive from MALT lymphoma.
METHODS:Background Whether chronic lymphocytic thyroiditis (CLT) influences the risk of development and the progression of papillary thyroid cancer (PTC) remains uncertain. We investigated the effects of CLT on the clinicopathologic features and prognosis of PTC. Methods Two thousand nine hundred twenty-eight consecutive patients with PTC treated between 2009 and 2017 were divided into two groups: one with chronic lymphocytic thyroiditis and one without; 1174 (40%) of the patients had coincident CLT. Results In univariate analysis, CLT correlated positively with small tumor size, frequent extrathyroidal extension, multifocal diseases, and p53 but negatively with central lymph node (LN) metastasis and BRAF mutation. In multivariate analysis, CLT was associated with extrathyroidal extension and multifocal disease; however, it was not a prognostic factor for recurrence even though it was associated with two aggressive factors. Compared with patients with PTC alone, there were more retrieved central LNs in the PTC + CLT group, and these patients also underwent more invasive diagnostic tests such as fine needle aspiration cytology and frozen biopsy of LN. Conclusions The CLT patients with PTC had better behavior features and prognoses than did those with PTC alone despite frequent multifocality and extrathyroidal extension. However, precaution may be necessary to avoid performing invasive diagnostic procedures for lateral LN metastasis and to manage the patients appropriately.
METHODS::PTPN2 is one of the members of the protein Tyrosine Phosphatases (PTPs) family. To explore the promotive effect of upregulated PTPN2 induced by inflammatory response or oxidative stress on the progression of thyroid cancer. PTPN2 level in thyroid cancer tissues and cell lines was detected. Kaplan-Meier method was applied for evaluating the prognostic value of PTPN2 in thyroid cancer patients. After stimulation of inflammatory response (treatment of IFN-γ and TNF-α), or oxidative stress (treatment of H2O2), protein level of PTPN2 in K1 cells was measured by Western blot. Regulatory effects of PTPN2 on EdU-positive staining and Ki-67 positive cell ratio in K1 cells either with H2O2 stimulation or not were determined. PTPN2 was upregulated in thyroid cancer tissues and cell lines. Its level was higher in metastatic thyroid cancer patients than those of non-metastatic ones. High level of PTPN2 predicted worse prognosis of thyroid cancer. Treatment of either IFN-γ or TNF-α upregulated protein level of PTPN2 in K1 cells. Meanwhile, H2O2 stimulation upregulated PTPN2, which was reversed by NAC administration. With the stimulation of increased doses of H2O2, EdU-positive staining and Ki-67 positive cell ratio were dose-dependently elevated. Silence of PTPN2 attenuated proliferative ability and Ki-67 expression in K1 cells either with H2O2 stimulation or not. Inflammatory response or oxidative stress induces upregulation of PTPN2, thus promoting the progression of thyroid cancer.