Faculty of Medicine, McGill University, 845 Rue Sherbrooke West, Montreal, QC, Canada.
Department of Otolaryngology Head and Neck Surgery, Hillel Yaffe Medical Centre, Technion University, Hadera, Israel.
J Otolaryngol Head Neck Surg. 2021 Apr 28;50(1):29. doi: 10.1186/s40463-021-00500-6.
Molecular testing has been used for cytologically indeterminate thyroid nodules (Bethesda III and IV), where the risk of malignancy is 10-40%. However, to date, the role of molecular testing in cytologically suspicious or positive for malignancy (Bethesda V and VI) thyroid nodules has been controversial. The aim of this study was to determine whether patients who had molecular testing in Bethesda V and VI thyroid nodules had the optimal extent of surgery performed more often than patients who did not have molecular testing performed.
A retrospective chart review of 122 cases was performed: 101 patients from the McGill University teaching hospitals and 21 patients from the Hillel Yaffe Medical center, Technion University. Patients included in the study were those with Bethesda V or VI thyroid nodules who underwent molecular testing (ThyGenext® or ThyroseqV3®) (McGill n = 72, Hillel Yaffe n = 14). Patients with Bethesda V or VI thyroid nodules who did not undergo molecular testing were used as controls (McGill n = 29, Hillel Yaffe n = 7). Each case was reviewed in order to determine whether the patient had optimal surgery. This was defined as total thyroidectomy in the presence of either a positive lymph node, extrathyroidal extension, or an aggressive pathological variant of papillary thyroid carcinoma (tall cell, hobnail, columnar cell, diffuse sclerosing, and solid/trabecular) documented on the final pathology report. In all other cases, a lobectomy/hemi/subtotal thyroidectomy was considered as optimal surgery. Chi-squared testing was performed to compare groups.
When molecular testing was done, 91.86% (79/86) of surgeries in the molecular testing group were optimal, compared to 61.11% (22/36) in the control group. At McGill University teaching hospitals and at Hillel Yaffe, 91.67% (66/72) and 92.86% (13/14) of surgeries in the intervention group were considered as optimal, respectively. This compares to 58.62% (17/29) at McGill and 71.43% (5/7) at Hillel Yaffe when molecular testing was not performed (p = .001, p = .186).
In this study, molecular testing in Bethesda V and VI thyroid tumors significantly improved the likelihood of optimal surgery. Therefore, molecular testing may have an important role in optimizing surgical procedures performed in the setting of Bethesda V and VI thyroid nodules. Prospective studies with larger sample sizes are required to further investigate this finding.
分子检测已被用于细胞学不确定的甲状腺结节（Bethesda III 和 IV 级），其恶性肿瘤风险为 10-40%。然而，迄今为止，分子检测在细胞学可疑或恶性肿瘤阳性（Bethesda V 和 VI 级）的甲状腺结节中的作用仍存在争议。本研究旨在确定在 Bethesda V 和 VI 级甲状腺结节中进行分子检测的患者是否比未进行分子检测的患者更常接受最佳手术范围。
对 122 例病例进行回顾性图表审查：101 例来自麦吉尔大学教学医院，21 例来自海利尔雅法医疗中心，技术大学。纳入研究的患者为经分子检测（ThyGenext®或 ThyroseqV3®）的 Bethesda V 或 VI 级甲状腺结节患者（麦吉尔大学 n=72，海利尔雅法 n=14）。Bethesda V 或 VI 级甲状腺结节未行分子检测的患者作为对照组（麦吉尔大学 n=29，海利尔雅法 n=7）。对每个病例进行审查，以确定患者是否接受了最佳手术。这被定义为在最终病理报告中存在阳性淋巴结、甲状腺外延伸或侵袭性乳头状甲状腺癌的病理变异（高细胞、钉突状、柱状细胞、弥漫性硬化和实性/小梁）时行全甲状腺切除术。在所有其他情况下，行甲状腺叶切除术/半甲状腺切除术/次全甲状腺切除术被认为是最佳手术。采用卡方检验比较各组。
当进行分子检测时，检测组中 91.86%（79/86）的手术为最佳手术，而对照组为 61.11%（22/36）。在麦吉尔大学教学医院和海利尔雅法，干预组中分别有 91.67%（66/72）和 92.86%（13/14）的手术被认为是最佳手术，而在麦吉尔大学未进行分子检测的手术中，这一比例为 58.62%（17/29），在海利尔雅法未进行分子检测的手术中为 71.43%（5/7）（p=0.001，p=0.186）。
在这项研究中，Bethesda V 和 VI 级甲状腺肿瘤的分子检测显著提高了最佳手术的可能性。因此，分子检测可能在优化 Bethesda V 和 VI 级甲状腺结节的手术程序中具有重要作用。需要更大样本量的前瞻性研究来进一步研究这一发现。
