Thyroid No Surgery: Suspicious Nodules with Negative Molecular Markers By Interpace Study Disease Free at 2 Years.

Thyroid No Surgery: Suspicious Nodules with Negative Molecular Markers By Interpace Study Disease Free at 2 Years.

Thyroid No Surgery: Suspicious Nodules with Negative Molecular Markers By Interpace Study Disease Free at 2 Years.

Guttler.Richard is one of the researchers on this important study.

No Surgery for Suspicious Nodules with Negative Molecular Markers in Interpace Study of 140 Patients.

Patients with negative cytology and markers are candidates for alternative therapy with radiofrequency ablation. Call me for details at 310393-8860 or email to [email protected]

Dr.G.

Clinical performance of multiplatform mutation panel microRNA risk classifier in indeterminate thyroid nodules

Under a Creative Commons license
open access

Highlights

Key Highlights

Our study is the first to report the clinical performance of multiplatform testing when a microRNA risk classifier test is used in combination with an expanded NGS mutation panel (MPTX) to assess risk of malignancy in thyroid nodules with indeterminate cytology.

Patients with negative MPTX test status had a high probability (94%) of remaining cancer-free at 2 years follow-up, supporting the ability of MPTX to effectively rule-out malignancy.

Patients with positive MPTX test status had a high probability of malignancy (53%), even at the low rate of malignancy (13%) encountered when clinically managing patients with indeterminate thyroid nodules.

microRNA results of patients who lacked mutational change and those who had weak driver mutations, such as RAS, enabled accurate risk stratification of patients into low, moderate, or high risk clinical risk categories.

Patients with low risk MPTX results had a high probability (94%) of remaining cancer-free, while those with moderate risk results and those with high risk results had a 53% and 70% probability of malignancy, respectively.

Abstract

Introduction

We evaluated the clinical performance of an expanded mutation panel in combination with microRNA classification (MPTX) for the management of indeterminate thyroid nodules.

Methods

MPTX included testing of fine needle aspirates from multiple centers with a combination of ThyGeNEXT® mutation panel for strong and weak driver oncogenic changes and ThyraMIR® microRNA risk classifier. MPTX test status (positive or negative) and MPTX clinical risk classifications (low, moderate, or high risk) were determined blind to patient outcomes. Surgical pathology and clinical follow-up records of patients from multiple centers were used to determine patient outcomes. MPTX performance was assessed by Kaplan Meier analysis for cancer-free survival of patients, with risk of malignancy determined by hazard ratios (HR).

Results

Our study included 140 patients with AUS/FLUS or FN/SFN nodules, of which 13% had malignancy. MPTX negative test status and MPTX low risk results conferred a high probability (94%) that patients would remain cancer free. MPTX positive test status (HR 11.2, P<0.001) and MPTX moderate risk results (HR 8.5, P=0.001) were significant risk factors for malignancy, each conferring a 53% probability of malignancy. MPTX high risk results elevated risk of malignancy even more so, conferring a 70% probability of malignancy (HR 38.5, P<0.001).

Conclusions

MPTX test status accurately stratifies patients for risk of malignancy. Further classification using MPTX clinical risk categories enhances utility by accurately identifying patients at low, moderate, or high risk of malignancy at the low rate of malignancy encountered when clinically managing patients with indeterminate thyroid nodules.

2 Comments
  • Barbara October 2, 2020 9:49 am

    I have a 2cm nodule on the isthmus….What does it mean if the test comes back undetermined but with some weak mutation cells 25%-40% malignant chance and the microRNA came back negative … Recommended to do 6 month follow up..just worried what to do wait or do surgery

    • Dr Guttler October 5, 2020 12:06 pm

      Barbara
      Does the nodule stick out and is easily seen by others?
      Does it give you neck symptoms?
      Has it grown over time?
      RFA may be right for you rather than waiting until it grows or surgery.
      Recent advances in RFA for the thyroid have now extended treatmentoptions to small
      cancers and indeterminate nodules.
      Call Alicia and discuss you coming for evaluation for thyroid RFA.
      310-393-8860
      or secure email to [email protected]
      Now is the time to get it treated before it grows.
      Dr.G.

      Call Alicia for details.

Add Your Comment

Contact Info
1328 16th Street, Santa Monica, CA 90404
Monday – Friday
9:00 AM to 5:00 PM
(310) 393-8860