Kay-Rivest Emily, Tibbo Jamie, Bouhabel Sarah, Tamilia Michael, Leboeuf Rebecca, Forest Veronique-Isabelle, Hier Michael P, Savoury Loren, Payne Richard J
Department of Otolaryngology - Head and Neck Surgery, McGill University, Jewish General Hospital, 3755 Côte-Sainte-Catherine Road, Montréal, QC, H3T 1E2, Canada.
Department of Otolaryngology - Head and Neck Surgery, Memorial University, St. Clare's Mercy Hospital, St. John's, NF, Canada.
J Otolaryngol Head Neck Surg. 2017 Apr 4;46(1):25. doi: 10.1186/s40463-017-0201-7.
Thyroid nodules are common and often benign, although prove to be malignant upon surgical pathology in 5-15% of cases. When assessed with ultrasound-guided fine-needle aspiration (USFNA), 15-30% of the nodules yield an indeterminate result. The Afirma® gene expression classifier (AGEC) was developed to improve management of indeterminate thyroid nodules (ITNs) by classifying them as "benign" or "suspicious." Objectives were (1) to assess the performance of the AGEC in two Canadian academic medical centres (2), to search for inter-institutional variation and (3) to compare AGEC performance in Canadian versus American institutions.
We undertook a retrospective cohort study of patients with indeterminate cytopathology (Bethesda Class III or IV) as per USFNA who underwent AGEC testing. We reviewed patient demographics, cytopathological results, AGEC data and, if the patient underwent surgery, results from their final pathology.
In total, we included 172 patients with Bethesda Class III or IV thyroid nodules underwent AGEC testing, 109 in Montreal, Quebec and 63 in St. John's, Newfoundland, in this study. Among the nodules sent for testing, 55% (60/109) in Montreal and 46% (29/63) in St. John's returned as "benign." None of these patients underwent surgery. On the other hand, 45% (49/109) nodules in Montreal and 54% (34/63) in St. John's were found to be "suspicious," for a total of 83 specimens. Seventy seven of these patients underwent surgery. Both in Montreal and St. John's, the final pathology yielded malignant thyroid disease in approximately 50% of the specimens categorized as "suspicious." Since 2013, no patient diagnosed with a benign nodule as per AGEC testing was found to harbor a malignant thyroid nodule on follow-up.
Molecular analysis is increasingly used in the management of indeterminate thyroid nodules. This study highlights the experience of two Canadian centres with AGEC testing. We found inter-institutional variability in the rate of nodules returning as "benign," however we found similar rates of confirmed malignancy in nodules returning as "suspicious." According the literature, results for AGEC testing in two Canadian institutions align with results reported in American centres.
甲状腺结节很常见，通常为良性，但在5%-15%的病例中经手术病理检查证实为恶性。在超声引导下细针穿刺活检（USFNA）评估时，15%-30%的结节结果不确定。开发Afirma®基因表达分类器（AGEC）是为了通过将不确定的甲状腺结节（ITN）分类为“良性”或“可疑”来改善其管理。目标是：（1）评估AGEC在两个加拿大学术医疗中心的性能；（2）寻找机构间差异；（3）比较AGEC在加拿大和美国机构中的性能。
我们对接受AGEC检测的USFNA结果为不确定细胞病理学（贝塞斯达III或IV类）的患者进行了一项回顾性队列研究。我们回顾了患者的人口统计学资料、细胞病理学结果、AGEC数据，以及如果患者接受了手术，其最终病理结果。
在本研究中，我们共纳入了172例贝塞斯达III或IV类甲状腺结节患者进行AGEC检测，其中109例在魁北克省蒙特利尔，63例在纽芬兰圣约翰斯。在送去检测的结节中，蒙特利尔的55%（60/109）和圣约翰斯的46%（29/63）检测结果为“良性”。这些患者均未接受手术。另一方面，蒙特利尔45%（49/109）的结节和圣约翰斯54%（34/63）的结节被发现为“可疑”，共计83个样本。其中77例患者接受了手术。在蒙特利尔和圣约翰斯，最终病理检查发现，在分类为“可疑”的样本中，约50%为甲状腺恶性疾病。自2013年以来，经AGEC检测诊断为良性结节的患者在随访中均未发现甲状腺恶性结节。
分子分析在不确定甲状腺结节的管理中应用越来越广泛。本研究突出了两个加拿大中心使用AGEC检测的经验。我们发现机构间“良性”结节的检出率存在差异，但“可疑”结节的确诊恶性率相似。根据文献，两个加拿大机构的AGEC检测结果与美国中心报告的结果一致。
