甲状腺细针抽吸不确定甲状腺结节中 ThyroSeq 的应用。
The utility of ThyroSeq in the management of indeterminate thyroid nodules by fine-needle aspiration.
机构信息
Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
出版信息
Cytopathology. 2021 Jul;32(4):505-512. doi: 10.1111/cyt.12981. Epub 2021 Apr 29.
OBJECTIVE
We aim to evaluate the impact of ThyroSeq in the management of indeterminate thyroid nodules (ITN), including Bethesda III and IV nodules.
METHODS
ITNs that underwent ThyroSeq testing between 2016 and 2019 were retrospectively reviewed. A control cohort included ITNs without molecular testing. Cytological, molecular, and histological data were collected.
RESULTS
We identified 202 ITNs that underwent molecular testing (128 in Bethesda III and 74 in Bethesda IV). Mutations were found in 58 nodules with mutation rates of 21.9% in Bethesda III and 40.5% in Bethesda IV. In this cohort, 49 cases had surgical resection with a resection rate of 24.3% (49/202, 15.6% in Bethesda III and 39.2% in Bethesda IV). Among the resected cases, 42 cases had positive molecular results. Thyroid cancer was diagnosed in 21 nodules with a malignancy detection rate of 10.4%. In the other cohort, we identified 236 ITNs (158 in Bethesda III and 78 in Bethesda IV). Surgical resection was performed in 127 cases, with a resection rate of 53.8% (127/236, 46.2% in Bethesda III and 69.2% in Bethesda IV). Thyroid cancer was diagnosed in 21 nodules, with a malignancy detection rate of 8.9%. The risk of malignancy (ROM) recalculated based on positive ThyroSeq results was significantly higher (21.4%-35.5% in Bethesda III and 50%-60% in Bethesda IV) than that without molecular testing (4.4%-9.6% in Bethesda III and 17.9%-25.9% in Bethesda IV).
CONCLUSION
We concluded that ThyroSeq significantly decreased the surgical resection rate (from 53.8% to 24.3%) without significantly affecting the malignancy detection rate in ITNs. Furthermore, positive molecular testing significantly increased ROM in ITNs. We believe that the recalculated ROM should be incorporated into the management of ITNs.
目的
评估 ThyroSeq 对不确定甲状腺结节（ITN）管理的影响，包括 Bethesda III 和 IV 类结节。
方法
回顾性分析了 2016 年至 2019 年期间接受 ThyroSeq 检测的 ITN。对照组包括未进行分子检测的 ITN。收集细胞学、分子和组织学数据。
结果
我们共鉴定了 202 例接受分子检测的 ITN（Bethesda III 类 128 例，Bethesda IV 类 74 例）。在这些结节中，有 58 例发现了突变，突变率在 Bethesda III 类中为 21.9%，在 Bethesda IV 类中为 40.5%。在该队列中，49 例进行了手术切除，切除率为 24.3%（202 例中有 49 例，Bethesda III 类中为 15.6%，Bethesda IV 类中为 39.2%）。在切除的病例中，42 例分子检测结果阳性。21 例诊断为甲状腺癌，恶性肿瘤检出率为 10.4%。在另一组中，我们共鉴定了 236 例 ITN（Bethesda III 类 158 例，Bethesda IV 类 78 例）。127 例进行了手术切除，切除率为 53.8%（236 例中有 127 例，Bethesda III 类中为 46.2%，Bethesda IV 类中为 69.2%）。21 例诊断为甲状腺癌，恶性肿瘤检出率为 8.9%。根据阳性 ThyroSeq 结果重新计算的恶性肿瘤风险（ROM）显著更高（Bethesda III 类为 21.4%-35.5%，Bethesda IV 类为 50%-60%），高于无分子检测（Bethesda III 类为 4.4%-9.6%，Bethesda IV 类为 17.9%-25.9%）。
结论
我们得出结论，ThyroSeq 显著降低了手术切除率（从 53.8%降至 24.3%），但对 ITN 中的恶性肿瘤检出率无显著影响。此外，阳性分子检测显著增加了 ITN 的 ROM。我们认为，应将重新计算的 ROM 纳入 ITN 的管理中。
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