Outcomes of Indeterminate Thyroid Nodules Managed Nonoperatively after Molecular Testing
| Autor: | Dalena T Nguyen, Michael W. Yeh, Deepashree Gupta, Ines Donangelo, Joana E. Ochoa, Catherine Y. Zhu, Masha J. Livhits |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Thyroid nodules medicine.medical_specialty Endocrinology Diabetes and Metabolism Clinical Biochemistry 030209 endocrinology & metabolism Context (language use) Malignancy medicine.disease_cause Biochemistry California 03 medical and health sciences 0302 clinical medicine Endocrinology Internal medicine medicine Humans Thyroid Nodule Watchful Waiting Thyroid cancer Thyroid neoplasm Aged Retrospective Studies business.industry Gene Expression Profiling Biochemistry (medical) Thyroid High-Throughput Nucleotide Sequencing Nodule (medicine) Middle Aged Prognosis medicine.disease Tumor Burden Treatment Outcome medicine.anatomical_structure Molecular Diagnostic Techniques 030220 oncology & carcinogenesis Female Radiology medicine.symptom business Indeterminate Follow-Up Studies |
| Zdroj: | The Journal of Clinical Endocrinology & Metabolism. 106:e1240-e1247 |
| ISSN: | 1945-7197 0021-972X |
| DOI: | 10.1210/clinem/dgaa887 |
| Popis: | Context Molecular testing to refine the diagnosis of cytologically indeterminate thyroid nodules has become increasingly popular, but data on long-term durability of test results and the rate of delayed operation are limited. Objective Determine the delayed rate of surgical resection in indeterminate nodules with benign/negative molecular testing and the risk of false-negative molecular test results. Design Prospective follow-up of the Gene Expression Classifier vs Targeted Next-Generation Sequencing in the Management of Indeterminate Thyroid Nodules randomized controlled trial comparing the diagnostic test performance of Afirma Gene Expression Classifier and ThyroSeq v2. Setting University of California, Los Angeles. Participants Patients who underwent thyroid biopsy with indeterminate (Bethesda III/IV) cytology (April 2016 to July 2017). Intervention Ultrasound surveillance. Main Outcome Measure False-negative rate of molecular testing. Results Of 95 indeterminate nodules with negative/benign molecular test results, 12 nodules underwent immediate resection (11 benign nodules, 1 noninvasive follicular thyroid neoplasm nodule with papillary-like nuclear features). Nonoperative management was pursued for 83 (87.4%) nodules. The median surveillance was 26.7 months. Ten nodules were resected during surveillance and malignancy was identified in 4 nodules (overall false-negative rate of 5.8%). In the 4 malignant nodules that underwent delayed operation, surgery was prompted by sonographic changes during surveillance. Conclusions The majority of indeterminate nodules with negative molecular testing have a stable clinical course over 3 years of follow-up, but our finding of a 6% false-negative rate highlights the importance of continuing sonographic surveillance. Long-term studies are needed to determine the optimal length of follow-up. |
| Databáze: | OpenAIRE |
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