Cargando…

Qualifiers of atypia in the cytologic diagnosis of thyroid nodules are associated with different Afirma gene expression classifier results and clinical outcomes

BACKGROUND: Thyroid nodules with atypia of undetermined significance (AUS) on fine‐needle aspiration (FNA) have a low risk of malignancy that appears to vary based on specific features described in the AUS diagnosis. The Afirma gene expression classifier (GEC) is a molecular test designed to improve...

Descripción completa

Detalles Bibliográficos
Autores principales: Baca, Sylvan C., Wong, Kristine S., Strickland, Kyle C., Heller, Howard T., Kim, Matthew I., Barletta, Justine A., Cibas, Edmund S., Krane, Jeffrey F., Marqusee, Ellen, Angell, Trevor E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5484344/
https://www.ncbi.nlm.nih.gov/pubmed/28152275
http://dx.doi.org/10.1002/cncy.21827
_version_ 1783245868317540352
author Baca, Sylvan C.
Wong, Kristine S.
Strickland, Kyle C.
Heller, Howard T.
Kim, Matthew I.
Barletta, Justine A.
Cibas, Edmund S.
Krane, Jeffrey F.
Marqusee, Ellen
Angell, Trevor E.
author_facet Baca, Sylvan C.
Wong, Kristine S.
Strickland, Kyle C.
Heller, Howard T.
Kim, Matthew I.
Barletta, Justine A.
Cibas, Edmund S.
Krane, Jeffrey F.
Marqusee, Ellen
Angell, Trevor E.
author_sort Baca, Sylvan C.
collection PubMed
description BACKGROUND: Thyroid nodules with atypia of undetermined significance (AUS) on fine‐needle aspiration (FNA) have a low risk of malignancy that appears to vary based on specific features described in the AUS diagnosis. The Afirma gene expression classifier (GEC) is a molecular test designed to improve preoperative risk stratification of thyroid nodules, but its performance for different patterns of AUS has not been defined. The objective of this study was to assess GEC results and clinical outcomes in AUS nodules with architectural atypia (AUS‐A), cytologic atypia (AUS‐C) or both (AUS‐C/A). METHODS: This was a retrospective review of all thyroid nodules with AUS cytopathology that underwent GEC testing at the authors' institution over a period of >4 years. RESULTS: In 227 nodules that had AUS cytology results and Afirma GEC testing, the rate of benign GEC results was higher in AUS‐A nodules (70 of 107; 65%) than in AUS‐C/A nodules (25 of 65; 38%; P = .0008), and AUS‐C nodules exhibited an intermediate rate of benign results (27 of 55 nodules; 59%). The risk of cancer among patients who had GEC‐suspicious nodules, 86% of whom underwent resection, was 19% (6 of 25) for AUS‐A nodules compared with 57% (21 of 37) for AUS‐C/A nodules (P = .003) and 45% (10 of 22) for AUS‐C nodules (P = .07). In nodules that had an indeterminate repeat cytology result, no difference was observed in the rate of benign GEC results or in the malignancy rate compared with nodules that had a single cytology result. CONCLUSIONS: The performance characteristics of Afirma GEC testing vary, depending on qualifiers of cytologic atypia. Recognition of these differences may enable clinicians to provide improved counseling and treatment recommendations to patients. Cancer Cytopathol 2017;125:313–322. © 2017 American Cancer Society.
format Online
Article
Text
id pubmed-5484344
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-54843442017-07-10 Qualifiers of atypia in the cytologic diagnosis of thyroid nodules are associated with different Afirma gene expression classifier results and clinical outcomes Baca, Sylvan C. Wong, Kristine S. Strickland, Kyle C. Heller, Howard T. Kim, Matthew I. Barletta, Justine A. Cibas, Edmund S. Krane, Jeffrey F. Marqusee, Ellen Angell, Trevor E. Cancer Cytopathol Original Articles BACKGROUND: Thyroid nodules with atypia of undetermined significance (AUS) on fine‐needle aspiration (FNA) have a low risk of malignancy that appears to vary based on specific features described in the AUS diagnosis. The Afirma gene expression classifier (GEC) is a molecular test designed to improve preoperative risk stratification of thyroid nodules, but its performance for different patterns of AUS has not been defined. The objective of this study was to assess GEC results and clinical outcomes in AUS nodules with architectural atypia (AUS‐A), cytologic atypia (AUS‐C) or both (AUS‐C/A). METHODS: This was a retrospective review of all thyroid nodules with AUS cytopathology that underwent GEC testing at the authors' institution over a period of >4 years. RESULTS: In 227 nodules that had AUS cytology results and Afirma GEC testing, the rate of benign GEC results was higher in AUS‐A nodules (70 of 107; 65%) than in AUS‐C/A nodules (25 of 65; 38%; P = .0008), and AUS‐C nodules exhibited an intermediate rate of benign results (27 of 55 nodules; 59%). The risk of cancer among patients who had GEC‐suspicious nodules, 86% of whom underwent resection, was 19% (6 of 25) for AUS‐A nodules compared with 57% (21 of 37) for AUS‐C/A nodules (P = .003) and 45% (10 of 22) for AUS‐C nodules (P = .07). In nodules that had an indeterminate repeat cytology result, no difference was observed in the rate of benign GEC results or in the malignancy rate compared with nodules that had a single cytology result. CONCLUSIONS: The performance characteristics of Afirma GEC testing vary, depending on qualifiers of cytologic atypia. Recognition of these differences may enable clinicians to provide improved counseling and treatment recommendations to patients. Cancer Cytopathol 2017;125:313–322. © 2017 American Cancer Society. John Wiley and Sons Inc. 2017-02-02 2017-05 /pmc/articles/PMC5484344/ /pubmed/28152275 http://dx.doi.org/10.1002/cncy.21827 Text en © 2017 The Authors. Cancer Cytopathology published by Wiley Periodicals, Inc. on behalf of American Cancer Society This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial (http://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Articles
Baca, Sylvan C.
Wong, Kristine S.
Strickland, Kyle C.
Heller, Howard T.
Kim, Matthew I.
Barletta, Justine A.
Cibas, Edmund S.
Krane, Jeffrey F.
Marqusee, Ellen
Angell, Trevor E.
Qualifiers of atypia in the cytologic diagnosis of thyroid nodules are associated with different Afirma gene expression classifier results and clinical outcomes
title Qualifiers of atypia in the cytologic diagnosis of thyroid nodules are associated with different Afirma gene expression classifier results and clinical outcomes
title_full Qualifiers of atypia in the cytologic diagnosis of thyroid nodules are associated with different Afirma gene expression classifier results and clinical outcomes
title_fullStr Qualifiers of atypia in the cytologic diagnosis of thyroid nodules are associated with different Afirma gene expression classifier results and clinical outcomes
title_full_unstemmed Qualifiers of atypia in the cytologic diagnosis of thyroid nodules are associated with different Afirma gene expression classifier results and clinical outcomes
title_short Qualifiers of atypia in the cytologic diagnosis of thyroid nodules are associated with different Afirma gene expression classifier results and clinical outcomes
title_sort qualifiers of atypia in the cytologic diagnosis of thyroid nodules are associated with different afirma gene expression classifier results and clinical outcomes
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5484344/
https://www.ncbi.nlm.nih.gov/pubmed/28152275
http://dx.doi.org/10.1002/cncy.21827
work_keys_str_mv AT bacasylvanc qualifiersofatypiainthecytologicdiagnosisofthyroidnodulesareassociatedwithdifferentafirmageneexpressionclassifierresultsandclinicaloutcomes
AT wongkristines qualifiersofatypiainthecytologicdiagnosisofthyroidnodulesareassociatedwithdifferentafirmageneexpressionclassifierresultsandclinicaloutcomes
AT stricklandkylec qualifiersofatypiainthecytologicdiagnosisofthyroidnodulesareassociatedwithdifferentafirmageneexpressionclassifierresultsandclinicaloutcomes
AT hellerhowardt qualifiersofatypiainthecytologicdiagnosisofthyroidnodulesareassociatedwithdifferentafirmageneexpressionclassifierresultsandclinicaloutcomes
AT kimmatthewi qualifiersofatypiainthecytologicdiagnosisofthyroidnodulesareassociatedwithdifferentafirmageneexpressionclassifierresultsandclinicaloutcomes
AT barlettajustinea qualifiersofatypiainthecytologicdiagnosisofthyroidnodulesareassociatedwithdifferentafirmageneexpressionclassifierresultsandclinicaloutcomes
AT cibasedmunds qualifiersofatypiainthecytologicdiagnosisofthyroidnodulesareassociatedwithdifferentafirmageneexpressionclassifierresultsandclinicaloutcomes
AT kranejeffreyf qualifiersofatypiainthecytologicdiagnosisofthyroidnodulesareassociatedwithdifferentafirmageneexpressionclassifierresultsandclinicaloutcomes
AT marquseeellen qualifiersofatypiainthecytologicdiagnosisofthyroidnodulesareassociatedwithdifferentafirmageneexpressionclassifierresultsandclinicaloutcomes
AT angelltrevore qualifiersofatypiainthecytologicdiagnosisofthyroidnodulesareassociatedwithdifferentafirmageneexpressionclassifierresultsandclinicaloutcomes