The impact of noninvasive follicular thyroid neoplasm with papillary-like nuclear features on the performance of the Afirma gene expression classifier.
具有乳头状癌核特征的非浸润性滤泡性甲状腺肿瘤对Afirma 基因表达分类的影响。
Abstract
A recent revision in thyroid tumor nomenclature has resulted in a change from a malignant diagnosis (noninvasive follicular variant of papillary thyroid carcinoma) to one that is nonmalignant (noninvasive follicular thyroid neoplasm with papillary-like nuclear features [NIFTP]). The objective of the current study was to evaluate the impact of this change on the performance of the Afirma gene expression classifier (GEC).
The authors retrospectively analyzed consecutive thyroid fine-needle aspiration specimens with indeterminate diagnoses on which GEC was performed. Surgical pathology material was reviewed with the reclassification of nodules into NIFTP.
GEC testing was performed on 384 fine-needle aspiration specimens diagnosed as atypia of undetermined significance (AUS) (304 cases) and suspicious for a follicular neoplasm (SFN) (80 cases) and yielded a suspicious result in 152 of the AUS cases (50%) and 50 of the SFN cases (63%). Thyroidectomy was performed on 177 patients. After reclassifying NIFTP, the positive predictive value of GEC decreased from 42% (95% confidence interval [95% CI], 39%-45%) to 24% (95% CI, 22%-26%) in the AUS group and from 23% (95% CI, 19%-27%) to 13% (95% CI, 9%-18%) in the SFN group. Total thyroidectomy was performed more frequently than a partial thyroidectomy in patients with AUS with a suspicious GEC result compared with pre-GEC controls (68% vs 49%; P = .037).
Reclassification of NIFTP significantly decreases the positive predictive value of GEC in indeterminate thyroid nodules. Nevertheless, the majority of patients with indeterminate thyroid nodules with a suspicious GEC result in the study institution have undergone total thyroidectomy. This finding raises concerns over reliance on a suspicious GEC result by clinicians to justify total thyroidectomy. Cancer Cytopathol 2017;125:683-91. © 2017 American Cancer Society.
The authors retrospectively analyzed consecutive thyroid fine-needle aspiration specimens with indeterminate diagnoses on which GEC was performed. Surgical pathology material was reviewed with the reclassification of nodules into NIFTP.
GEC testing was performed on 384 fine-needle aspiration specimens diagnosed as atypia of undetermined significance (AUS) (304 cases) and suspicious for a follicular neoplasm (SFN) (80 cases) and yielded a suspicious result in 152 of the AUS cases (50%) and 50 of the SFN cases (63%). Thyroidectomy was performed on 177 patients. After reclassifying NIFTP, the positive predictive value of GEC decreased from 42% (95% confidence interval [95% CI], 39%-45%) to 24% (95% CI, 22%-26%) in the AUS group and from 23% (95% CI, 19%-27%) to 13% (95% CI, 9%-18%) in the SFN group. Total thyroidectomy was performed more frequently than a partial thyroidectomy in patients with AUS with a suspicious GEC result compared with pre-GEC controls (68% vs 49%; P = .037).
Reclassification of NIFTP significantly decreases the positive predictive value of GEC in indeterminate thyroid nodules. Nevertheless, the majority of patients with indeterminate thyroid nodules with a suspicious GEC result in the study institution have undergone total thyroidectomy. This finding raises concerns over reliance on a suspicious GEC result by clinicians to justify total thyroidectomy. Cancer Cytopathol 2017;125:683-91. © 2017 American Cancer Society.
摘要
近期修订的甲状腺肿瘤命名中，一个恶性的诊断（非浸润性滤泡型甲状腺乳头状癌）变成了一个非恶性的诊断（具有乳头状癌核特征的非浸润性滤泡性甲状腺肿瘤【NIFTP】）。本研究的目的是评估这种改变对Afirma基因表达分类（GEC）的影响。
作者回顾性分析了已进行GEC检测且不确定诊断的甲状腺细针穿刺标本。对手术病理资料重新评估，依据新分类归入NIFTP的病例则复阅其外科病理相关资料。
384例细针穿刺活检病理中进行GEC检测，具体包括被诊断为意义不明的非典型改变（AUS）（304例）和可疑滤泡性肿瘤（SFN）（80例）的病例。结果152例意义不明的非典型改变病例（50%）和50例可疑滤泡性肿瘤病例（63%）中出现了可疑的结果。其中177例病人进行了甲状腺切除手术。在按NIFTP新分类后，GEC的阳性预测值在AUS组中从42%（95%的可信区间[95%CI]，39%-45%）降到24%（95%CI，22%-26%）；在SFN组中从23%（95%CI，19%-27%）降到13%（95%CI，9%-18%）。与未进行GEC检测相对照（68% vs 49%；P=.037），诊断为AUS并且GEC检测显示可疑阳性结果时，进行甲状腺全切除术的患者比部分切除术的患者多很多。
NIFTP的新分类显著降低了GEC检测在诊断不明确的甲状腺结节病例中的阳性预测值。不过，在本研究机构中，绝大多数诊断不明确的甲状腺结节并且GEC检测结果为可疑阳性的患者，已经进行了甲状腺全切除术。这个发现引起了对于临床医生依靠可疑的GEC结果进行甲状腺全切除术的合理性的担忧。
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