Thyroid Diseases Unit - Division of Endocrinology, Department of Medicine, Faculty of Medical Sciences/Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.
Division of Head and Neck Surgery, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.
Front Endocrinol (Lausanne). 2024 Jul 5;15:1390743. doi: 10.3389/fendo.2024.1390743. eCollection 2024.
Samples classified as indeterminate correspond to 10-20% of cytologies obtained by fine needle biopsy of thyroid nodules, preventing an adequate distinction between benign and malignant lesions and leading to diagnostic thyroidectomies that often prove unnecessary, as most cases are benign. Furthermore, although the vast majority of patients with differentiated thyroid cancer (DTC) have such a good prognosis that active surveillance is permitted as an initial therapeutic option, relapses are not rare, and a non-negligible number of patients experience poor outcomes. MicroRNAs (miR) emerge as potential biomarkers capable of helping to define more precise management of patients in all these situations.
Aiming to investigate the clinical utility of miR-146b-5p in the diagnostic of thyroid nodules and evaluating its prognostic potential in a realworld setting, we studied 89 thyroid nodule samples, correlating miR-146b-5p expression with clinical tools such as the 8th edition from the American Joint Committee on Cancer (AJCC/UICC) and the American Thyroid Association Guideline Stratification Systems for the rate of recurrence (RR).
miR-146b-5p expression levels distinguished benign from malignant thyroid FNA samples (p< 0.0001). For indeterminate nodules, overexpression of miR-146b-5p with a cut-off of 0.497 was able to diagnose malignancy with a 90% accuracy; specificity=87.5%; sensitivity=100%. An increased expression of miR-146b-5p was associated with greater RR (p=0.015). A cut-off of 2.21 identified cases with more vascular involvement (p=0.013) and a cut-off of 2.420 was associated with a more advanced TNM stage (p-value=0.047).
We demonstrated that miR-146b5p expression in FNA samples is able to differentiate benign from malignant indeterminate nodules and is associated with an increased risk of recurrence and mortality, suggesting that this single miRNA may be a useful diagnostic and prognostic marker in the personalized management of DTC patients.
通过细针穿刺活检获得的甲状腺结节细胞学样本中，约有 10-20%被归类为不确定，这使得难以区分良性和恶性病变，导致诊断性甲状腺切除术，而大多数情况下这些手术是不必要的，因为大多数病例为良性。此外，尽管绝大多数分化型甲状腺癌（DTC）患者的预后良好，允许作为初始治疗选择进行积极监测，但复发并不罕见，而且相当数量的患者预后不佳。微小 RNA（miR）作为潜在的生物标志物出现，能够帮助在所有这些情况下更精确地管理患者。
为了研究 miR-146b-5p 在甲状腺结节诊断中的临床应用，并评估其在真实环境中的预后潜力，我们研究了 89 个甲状腺结节样本，将 miR-146b-5p 的表达与临床工具（如第 8 版美国联合癌症委员会（AJCC/UICC）和美国甲状腺协会指南分层系统）和复发率（RR）相关联。
miR-146b-5p 的表达水平可区分甲状腺细针穿刺样本中的良性和恶性（p<0.0001）。对于不确定的结节，miR-146b-5p 表达的截断值为 0.497 时，能够以 90%的准确率诊断恶性肿瘤；特异性=87.5%；敏感性=100%。miR-146b-5p 的表达增加与更高的 RR 相关（p=0.015）。截断值为 2.21 可识别出血管受累更多的病例（p=0.013），截断值为 2.420 与更晚期的 TNM 分期相关（p 值=0.047）。
我们证明，FNA 样本中 miR-146b5p 的表达能够区分良性和恶性不确定结节，并且与复发和死亡风险增加相关，这表明这种单个 miRNA 可能是 DTC 患者个性化管理中有用的诊断和预后标志物。
