indeterminate thyroid biopsy

So that although the previous test seemed like there was a little bit of a difference in the positive predictive value, the current test versions are very similar. New test helps avoid repeat thyroid biopsies. http://thyroid.about...d-surgeries.htm. Block, MD, La Jolla, California George E. Dailey, MD, La Jolla, California James A. Robb, MD, La Jolla, California Needle biopsy of thyroid nodules has been demon- strated to be of definitive value in selecting patients for operation [1-6]. So ultimately, we found that the diagnostic performance of the two tests were very similar. Get the whole picture with molecular testing. The other approach to molecular diagnosis of thyroid cancer is the measurement of oncogenes such as BRAF on FNA to make a positive diagnosis of thyroid cancer in cytologically indeterminate FNA biopsies. This approach is being marked by several laborartories and was reviewed in the December 2011 issue of Clinical Thyroidology. Video: Drs. So knowing that, we maybe more likely to observe the patients in certain cases or to just do a thyroid lobectomy. Nodules in this grey area have a 5-30% chance of containing a thyroid cancer. So, every month we would either do one molecular test and next month switch to the next molecular test. And we have the opportunities to discover that and perhaps manage those patients in a different way, to a little bit more aggressive with surgery, or perhaps additional treatments Radiative Iodine Ablation. My doctor said if this had happened to me even five years ago, I would have had to have surgery to determine if the nodule (3.6cm) was cancer. Data were extracted to calculate sensitivity, specificity, and positive/negative predictive values of any HRAS, KRAS, or NRAS mutation. [Michael Yeh] Great. Your study had a unique design with block randomization. The role of repeat fine needle aspiration in the management of indeterminate thyroid nodules. Jooya A, Saliba J, Blackburn A, Tamilia M, Hier MP, Mlynarek A, Forest VI, Rochon L, Florea A, Wang H, Payne RJ. This study sought to determine the potential effects of GEP for indeterminate thyroid FNA results on thyroidectomy volume. You're welcome, Andros. That’s one of the strengths of our study with a lot of thyroid FNAs performed every year, over 1,000 annually. So ultimately that will tell us what is the risk of malignancy, looking at the wide expression of mRNA. Please re-enable javascript to access full functionality. Thank you so much for sharing your insights with us today. I - Nondiagnostic: Sometimes the material obtained during the FNA is not enough and the doctor reading the slides (cytopathologist) will say it is insufficient. Now, molecular tests can help us predict whether an indeterminate nodule will be benign or cancerous. [Michael Yeh] These are relatively new versions of these two tests, new generations. In some patients we may recommend more extensive surgery or radioactive iodine treatment if high-risk mutations are identified. This is known as an indeterminate or inconclusive result, which occurs in about 35% of the thyroid biopsies performed. In fact, many endocrinologists no longer recommend thyroid suppression because of potential long-term adverse effects, such as osteoporosis and cardiac arrhythmias. For example, thyroid cancers that have a combination of TERT and BRAF V600E mutation. [Michael Yeh] Masha can you summarize the findings of your study? So the first important part of how these tests performed is what is the benign call rate? Additionally, growth of a thyroid nodule during levothyroxine therapy is a strong indication for surgery. Patients with benign solitary thyroid nodules may undergo observation or levothyroxine suppression therapy as the initial treatment modality. Two authors independently searched the data sources. In the past, we would perform surgery on all indeterminate thyroid nodules to avoid missing a cancer diagnosis. Randomizing at the individual patient level was challenging. So the positive predictive value of the two tests were also similar, about 50%-60% for Affrima GSC and Thyroseq V3. The cancer risk in this case is 10-30% and a doctor should either repeat the biopsy, perform further molecular testing, or proceed with a thyroid lobectomy. How does the current test perform to the prior generation test? Thyroid biopsies per- For 11 of the 18 patients, operation was performed with carcinoma identified in two (18 percent). Masha Livhits and Michael Yeh discuss their latest study on molecular testing for indeterminate thyroid nodules. UCLA Endocrine Center physicians Drs. Armour........3 1/2 grains per day. When there is a suspicion for cancer, the tests differ slightly. There is no "Indeterminate" with this particular test. Within papillary thyroid carcinoma and its variants only, indeterminate nodules with nuclear atypia had a 7.6-fold higher malignancy risk compared with the reference group; a similar 7.5-fold association was found in a separate analysis of those with BIII nodules. Some mutations, or combinations of mutations, make the cancer behave more aggressively. We use cookies to improve your experience on this website and so that ads you see online can be tailored to your online browsing interests. [Michael Yeh] Hi. And that information is known with Thyroseq. [Michael Yeh] Great. [Masha Livhits] And Thyroseq V3 replies on DNA and RNA based testing. I promised myself I would leave a post about it once I received my results. HERE IS WHERE IT GETS INTERESTING. He performed another FNA but sent the results to a lab that performs RNA testing on the sample. About five percent of the population has such bumps, 90 percent of which are harmless. I recently got some good news, and what I hope is some valuable information to others out there, so I want to share my experience. [Masha Livhits] Yes, so we want to compare the diagnostic performance of these two tests, using the same study population, the same institution, the same centralized site of pathology, and the same prevalence of malignancy. The evaluation and management of thyroid nodules with indeterminate cytology will be reviewed here. So instead we randomized patient blocks by months. In August 2014 US showed that the nodule had gotten larger. So we don’t have a lot of data yet about how we use that for prognosis. It was 3.5 cm. UCLA Endocrine Surgeons Featured in National Comprehensive Cancer Network Video on Molecular Testing for Thyroid … We are just people sharing our experiences with others. Cancer Cytopathology. If you have a nodule on your thyroid gland, you are in good company. The above is opinion only, not medical advice. On the basis of an analysis of 1150 thyroid FNAs in 2000, this institution modified the reporting of thyroid biopsy results into 6 categories, including unsatisfactory. Patients with benign test results can avoid unnecessary thyroid surgery. Doctors now have better options to assess indeterminate thyroid nodules using molecular testing. Unfortunately, many patients found out after surgery that their thyroid nodule was actually benign. These are the Indeterminate Nodules. You currently have javascript disabled. Indeterminate thyroid biopsy: this happens a few atypical cells are seen but not enough to be abnormal (atypia of unknown significance (AUS) or follicular lesion of unknown significance (FLUS)) or when the diagnosis is a follicular or hurthle cell lesion. 'atypical' cells. We aimed to determine the malignancy rate in indeterminate lesions with negative mutation analysis. BACKGROUND Mutation analysis is potentially a powerful tool to enhance the diagnostic accuracy of thyroid fine-needle aspiration (FNA) biopsy specimens. Try this link. Back to Thyroid Disease General Discussion Forum. Several functions may not work. Indeterminate thyroid lesions are diagnosed in up to 30% of fine needle aspirations. The majority (98%) of thyroid nodules are benign. I am very thankful that the results were benign. On the other hand, we know that thyroid nodules that have Ras mutations are often fairly indolent. And it gives us a specific mutational information via which mutation was identified in that nodule. [Masha Livhits] Yes. Still others maintain a thyroid-stimulating hormone (TSH) level ranging from 0.1-0.3 mU/L rather than suppressing to the lowest limits of detectability to avoid immediate toxicity and long-term side effects. These nodules harbor malignancy in more than 25% of cases, and hemithyroidectomy or … About 25% of indeterminate thyroid nodules are ultimately found to be cancers. However, approximately 15% to 25% of the cases are classified as indeterminate, posing dilemmas in decision-making. Thanks, Masha, for joining us today. [Masha Livhits] I think this is one of the most exciting parts of this type of technology, which is “can we used it for prognosis?” And now Thyroseq, as I have mentioned gives the specific mutation that is identified within the thyroid nodule, which is really important for prognosis. While Thyroseq remained fairly similar. BACKGROUND: Ultrasound guided fine-needle aspiration (USFNA) biopsy of thyroid nodules often gives a result of indeterminate pathology, placing thyroid specialists in difficult management situations. Graves' Disease, Lupus (Systemic & Discoid), Sjogren's and old age. Thyroid nodules may be found to be benign (non-cancerous), cancerous or indeterminate on fine needle aspiration biopsy. Got Questions About Indeterminate Thyroid Nodules? In our experience with 121 patients 18 (15 percent) thyroid nodules studied by needle biopsy were considered indeterminate relative to the presence of a low-grade, well-differentiated carcinoma. Following a comprehensive medical history and thorough physical examination, fine-needle aspiration biopsy (FNAB) should be considered the initial step in the evaluation of the solitary thyroid nodule. Background Increasing utilization of genetic expression profiling (GEP) for thyroid nodules with indeterminate fine needle aspiration (FNA) results will potentially decrease the number of patients requiring diagnostic thyroidectomy. About 25% of indeterminate thyroid nodules are ultimately found to be cancers. This is not recommended for shared computers. Her best friend has two nodules and also had an inconclusive FNA many years ago at University of Penn,she then went to another top place in NY,and got another inconclusive result. Can you tell us a little bit about that? How many more biopsies must one have in order for a determination of the … The remaining patients get a “suspicious” result. None of the information on this ThyroidBoards.com is intended to diagnose, treat, cure or prevent any disease. So, as you mentioned, about 25% of thyroid nodules have indeterminant cytology. Although both tests work in different ways, their accuracy and performance were roughly the same. Thyroid biopsy is an important component of the evaluation of a thyroid nodule ( algorithm 1 ). Article Google Scholar 5. In other words, if it is a cancer, do these molecular tests tell you how bad of a cancer, how aggressive this could have been? Recently, core-needle biopsy (CNB) was introduced as a safe and effective tool in diagnosing indeterminate thyroid nodules in order to prevent unnecessary surgery (16,17). Welcome all members! However, if a benign solitary thyroid nodule increases in size, a repeat trial of levothyroxine and repeat FNAB may be indicated. This means the diagnosis was uncertain, or indeterminate. My doc said the afirma test was a possibility since I've had 2 inconclusive FNAs, but there is a 30% false negative rate, and you still need to recheck with a sonogram and FNA in 6 months. We had performed a similar randomization study using the same study design. We talked a lot about the diagnosis of the thyroid nodules that tare indeterminant. Based on epidemiological data, a baseline 20–30% cancer risk is … Indeterminate thyroid biopsy: this happens usually when the diagnosis of a benign nodule or cancer cannot be made with certainty. So, the findings were that the benign call rate of Affrima GSC and Thyroseq V3 were similar. I did tons of reading on the internet and didn't find many other people who said they have had the RNA biopsy. A repeat FNA was done by a different pathologist. It is the most accurate method for evaluating thyroid nodules and selecting patients for thyroid surgery. Levothyroxine is typically administered for 6-12 months to determine if the solitary thyroid nodule decreases in size. [Michael Yeh] Great. Watch Video: Molecular Markers for Thyroid Cancer - Masha Livhits, MD & Michael Yeh, MD >. When you get a thyroid biopsy, your doctor will take a little bit of your thyroid or lumps (known as nodules) growing on it to test in a lab. So now when we repeated with the new test versions, which are the ones clinically used in practice, we found that the positive predictive value of affirma increased a little bit from GEC to GSC. [Masha Livhits] Great question. Modification of cancer risk in thyroid nodules larger than 1 cm in diameter with indeterminate FNA cytology based on the presence or absence of clinical, radiological, or molecular variables. Thyroid biopsies are performed in interventional radiol-ogy (approximately 63%) with on-site evaluation by cytopathology and the majority of the remainder by 3 en-docrine and ear-nose-throat surgeons. Can you tell us a little bit about your study why did you perform an orient test with two molecular test you used? Depending on the interpretation of the FNAB cytologic specimen, management consists of observation, levothyroxine suppression therapy, or surgery. Another FNA was done with another indeterminate result. Researchers think that much of this rise is due to the increased use of imaging procedures in the head and neck area to diagnose other conditions. However, even within the indeterminant cytology nodules, some of them will have these more aggressive mutations. Next was the sonogram and then a FNA biopsy with indertiminate results. Researchers in Vancouver, British Columbia, Canada, published a study on this indeterminate cytology on FNA issue. We use data about you for a number of purposes explained in the links below. I had my first indeterminate biopsy in 2010. So Thyroseq V3 has that information, which I think is already in useful for prognosis and will be increasingly more so in the future. This topic will review the techniques, utility, limitations, and complications of percutaneous thyroid biopsies. This is my first post. About 25% of the time when we biopsy a thyroid nodule, we will diagnose it as an “indeterminate thyroid nodule.” This is when the cells do not look completely benign but also do not look absolutely cancerous. My PCP referred me to an endocronologist. We compare new genetic tests that help us tell the difference between benign and possibly cancerous thyroid nodules. [Masha Livhits] Sure. So, they don’t even get necessarily sent off for molecular testing. About 50-60% of the patients we test get a benign result. In this study we compared the newest version of the two most prominent molecular tests, Thyroseq V3 and Afirma Gene Sequencing Classifier. I didn't want to be taken as being negative. in a hypothetical group of patients evaluated for a thyroid nodule according to the current ATA guidelines with the addition of molecular marker testing. Long story short...a month ago my PCP found a lump in my throat. No doctor degrees here. So, we had the opportunity to study the prior test versions, which are affirma GEC and Thyroseq V2. RosettaGX Reveal reevaluates indeterminate thyroid nodules using cells collected during the original biopsy. The indeterminate thyroid fine-needle aspiration. Thyroid biopsies are sometimes inconclusive. In assessing a lump or nodule in your neck, one of your doctor's main goals is to rule out the possibility of cancer. Now Affirma GSC has expression atlas, which has the potential to provide a lot of the similar type of information. Those are known to really have an increased chance of even mortality related to the thyroid cancer. Just trying to share info! The incidence of thyroid cancer has been rising steeply over the last few decades, though this rise appears to have tapered off in the last few years. Now logistically this is quite challenging, because we have a large institution with several people doing biopsies. We use smears, both air-dried Diff Quik and alcohol-fixed Papanicolaou stained preparations, for all FNAs. However, some clinicians may rely on a negative mutation panel to exclude malignancy. Follicular and … An indeterminate result of a thyroid nodule biopsy means that doctors cannot be certain whether a thyroid nodule is benign or cancerous. In evaluating thyroid nodules, fine needle aspiration (FNA) biopsy is the critical initial diagnostic test. BACKGROUND: Thyroid fine-needle aspiration (FNA) is used as a screening test of choice for evaluation of thyroid nodules. Hello. What about prognostic value? There is a good deal of information on the web if you research it. We aimed to examine our institutional data to determine whether the 3-month period affects the diagnostic yield of repeat biopsies. And so we randomized patients, to either receiving one or the other molecular test. But it is not yet clinically validated. No consensus exists regarding the degree of thyroid suppression or the efficacy of levothyroxine therapy. Please seek the advice of a qualified physician........ Andros Please consult a physician before trying anything mentioned on this forum. Thyroid Nodules Indeterminate by Needle Biopsy Melvin A. However, 25% of these biopsies render an indeterminate cytology, leaving uncertainty regarding appropriate management. Given that 15% to 48% of thyroid nodule biopsies are indeterminate [ 2 - 7 ], this is not an infrequent situation for thyroid specialists to encounter. BACKGROUND AND PURPOSE: The results of conventional core biopsy for some thyroid nodules with indeterminate cytology have still remained indeterminate. But your doctor will also want to know if your I have been reading these boards for the past month and they have been very helpful. An indeterminate thyroid nodule is a growth within the thyroid gland that could possibly be cancerous. Edited by CindiG, 19 May 2013 - 01:07 AM. And in that case, it difficult for us to know clinically how to manage those patients. Some studies reported that as much as 98% of indeterminate thyroid nodules are able to be classified as malignant or benign when CNB is used for follow-up analysis ( 18 - 22 ). Thyroseq provides a report on DNA mutations present in the tumor. She then went to Dr.Anthony Jennings(who did my first FNA of all three of my small nodules that came back benign in June 2008) and now her results were benign.Tipper Gore the ex-wife of ex vice president Al Gore also had only one nodule with two inconclusive FNA's and had half of her thyroid out in 1999 and it was a benign follicular adenoma. And the Affirma GSC is mRNA based and relies on machine learning algorithms. However, it is still a relatively new process, so that is something to always keep in mind. I had a hard time deciding to post it and wording. Background: In the case of a nondiagnostic thyroid fine-needle aspiration (FNA) biopsy result, recent guidelines from the Bethesda system recommend repeat thyroid FNA after 3 months to prevent false-positive results. We are here to talk about molecular testing for indeterminant thyroid nodules which make up about 25% of all thyroid biopsy results. In accordance with National Guidelines, we currently follow a linear approach to the diagnosis of thyroid nodules, with management decision based primarily on a cytological diagnosis following fine-needle aspiration biopsy. When we have that information, we can tailor the treatment to the disease. Came back benign. If the results are indeterminate, thyroid surgery is often undertaken in order to clear up any suspicion of cancer. By continuing to browse our site you agree to our use of data and cookies. Imaging So, in how many cases will the molecular test return a benign result which is really one of the main utilities of this molecular test, because it allows patients to then avoid diagnostic surgery when the test is benign. abyymom99,Also, my first cousin had only one nodule over ten years ago and Dr.Susan Mandel a top thyroid cancer specialist at university of Penn did her FNA and it came back unfortunately inderminate so she had half of her thyroid out,it turned out it was benign as 90-95% of thyroid nodules are,even many that are suspicious and inconclusive. Biopsy results are often categorised into three main groups: benign, malignant or indeterminate, with an indeterminate USFNA result posing diagnostic and management dilemmas. The results are 99% accurate. An indeterminate thyroid nodule is a growth within the thyroid gland that could possibly be cancerous. The most confusing results are the undetermined category results which are categories III and IV below. 2009;117(3):195–202. Thank you everyone for participating on this board, for helping other posters and for sharing your experiences and wisdom! The aim of this study was to evaluate whether the ultrasonography-guided core needle biopsy technique containing the nodule, capsular portion, and surrounding parenchyma was more effective than a conventional method in …

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