Thyroid nodule other diagnostic studies
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Other Diagnostic Studies
Fine needle aspiration
The most important diagnostic test to differentiate thyroid nodules from each other is fine needle aspiration (FNA). As FNA is considered as an aggressive procedure, the American Thyroid Association developed the following criteria for FNA indication:
- Nodules ≥ 1 cm with intermediate or high suspicion US pattern
- Nodules ≥ 1.5 cm with low suspicion US pattern
- Nodules ≥ 2 cm with very low suspicion US pattern (e.g., spongiform). Observation an alternate option
- For nodules that do not meet the above criteria, FNA is not required, including nodules < 1 cm (with some exceptions) and purely cystic nodules 26462967
- Criteria for US-guided FNA:
- A higher likelihood of either a nondiagnostic cytology (>25–50% cystic component)
- A higher likelihood of sampling error
- Difficult to palpate nodules
- Posteriorly located nodules
FNA biopsy is sensitive and specific in the diagnosis of childhood thyroid nodules. [1][2]
Molecular marker evaluation
The molecular marker evaluation tests are performed based on samples that are collected during fine needle aspiration using needle washing. The most important indications of the molecular markers study include:
- Indeterminate cytological diagnosis
- To assist narrowing disease management options (medical treatment versus surgical treatment)
The molecular tests which have the most available data are: Afirma Gene-expression Classifier, seven-gene panel of genetic mutations and rearrangements and galectin-3 immunohistochemistry.[3][4]
Genetic Evaluation
Gene-expression classifier Afirma
A highly sensitive (92%) gene-expression classifier called Afirma evaluates the presence of related gene expression profiles. The low specificity of this technique (a negative predictive of 93 %, positive predictive value and specificity of 48–53 %) lead to major usage of this technique as a rule out test to identify benign nodules. A benign gene expression classifier result predicts low risk of malignancy but there is still an up to 5% chance of malignancy in the nodules classified as benign.
Gene mutation and rearrangement panel [5]
The seven gene mutation and rearrangement analysis panel evaluates the following genetic mutations:
- Point mutations
- BRAF gene
- NRAS gene
- HRAS gene
- KRAS gene
- Common rearrangements
- RET/PTC
- PAX8/PPARγ
This technique has a high specificity (86–100 %) and positive predictive value (84–100 %) but poor a sensitivity (reported from 44 to 100 %), thus it is being used to rule in thyroid malignancies, mainly as the second line after gene expression classifier Afirma test.
Galectin-3 immunohistochemistry [6]
Immunohistochemistry evaluation of the marker galectin-3 should be performed on representative histologic sections of the thyroid neoplasms that are obtained based on FNA or direct surgical biopsy. The samples should then be stained and then the staining can be graded. Specific cytoplasmic staining of more than 5% of the tumour cells, regardless of the intensity, is scored as positive for Gal-3. It has a high sensitivity especially for papillary thyroid carcinoma.
References
- ↑ Chang SH, Joo M, Kim H (2006). "Fine needle aspiration biopsy of thyroid nodules in children and adolescents". J. Korean Med. Sci. 21 (3): 469–73. doi:10.3346/jkms.2006.21.3.469. PMC 2729953. PMID 16778391.
- ↑ Hung W (1999). "Solitary thyroid nodules in 93 children and adolescents. a 35-years experience". Horm. Res. 52 (1): 15–8. doi:23426 Check
|doi=value (help). PMID 10640894. - ↑ Bartolazzi A, Orlandi F, Saggiorato E, Volante M, Arecco F, Rossetto R, Palestini N, Ghigo E, Papotti M, Bussolati G, Martegani MP, Pantellini F, Carpi A, Giovagnoli MR, Monti S, Toscano V, Sciacchitano S, Pennelli GM, Mian C, Pelizzo MR, Rugge M, Troncone G, Palombini L, Chiappetta G, Botti G, Vecchione A, Bellocco R (2008). "Galectin-3-expression analysis in the surgical selection of follicular thyroid nodules with indeterminate fine-needle aspiration cytology: a prospective multicentre study". Lancet Oncol. 9 (6): 543–9. doi:10.1016/S1470-2045(08)70132-3. PMID 18495537.
- ↑ Sapio MR, Posca D, Raggioli A, Guerra A, Marotta V, Deandrea M, Motta M, Limone PP, Troncone G, Caleo A, Rossi G, Fenzi G, Vitale M (2007). "Detection of RET/PTC, TRK and BRAF mutations in preoperative diagnosis of thyroid nodules with indeterminate cytological findings". Clin. Endocrinol. (Oxf). 66 (5): 678–83. doi:10.1111/j.1365-2265.2007.02800.x. PMID 17381488.
- ↑ Nikiforova MN, Wald AI, Roy S, Durso MB, Nikiforov YE (2013). "Targeted next-generation sequencing panel (ThyroSeq) for detection of mutations in thyroid cancer". J. Clin. Endocrinol. Metab. 98 (11): E1852–60. doi:10.1210/jc.2013-2292. PMC 3816258. PMID 23979959.
- ↑ Sumana BS, Shashidhar S, Shivarudrappa AS (2015). "Galectin-3 Immunohistochemical Expression in Thyroid Neoplasms". J Clin Diagn Res. 9 (11): EC07–11. doi:10.7860/JCDR/2015/16277.6760. PMC 4668414. PMID 26673516.