The Combination of Sonographic Features and the Seven-Gene Panel May be Useful in the Management of Thyroid Nodules With Indeterminate Cytology

• Published in: Frontiers in endocrinology (Lausanne) 2021-02, Vol.12, p.613727
• Main Authors: Capezzone, Marco, Cantara, Silvia, Di Santo, Andrea, Sagnella, Alfonso, Pilli, Tania, Brilli, Lucia, Ciuoli, Cristina, Maino, Fabio, Forleo, Raffaella, Cartocci, Alessandra, Castagna, Maria Grazia
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy, Fine-Needle; Cytodiagnosis; Diagnosis, Differential; Endocrinology; Female; fine needle aspiration cytology (FNAC); Humans; indeterminate nodules; Male; Middle Aged; Molecular Diagnostic Techniques; molecular test; Predictive Value of Tests; Retrospective Studies; Thyroid Gland - diagnostic imaging; Thyroid Gland - metabolism; Thyroid Gland - pathology; Thyroid Nodule - diagnosis; Thyroid Nodule - genetics; Thyroid Nodule - pathology; thyroid nodules; thyroid ultrasound; Transcriptome; Ultrasonography; Young Adult
• ISSN: 1664-2392; 1664-2392
• DOI: 10.3389/fendo.2021.613727

The management of patients with indeterminate thyroid nodules, which account for 10-25% of thyroid fine needle aspiration biopsies (FNABs), is still very challenging. To verify the utility of the seven-gene panel in combination with ultrasound features in the clinical management of indeterminate thyroid nodules. The study group included 188 indeterminate thyroid nodules, divided into TIR3A (56.4%) and TIR3B (43.6%). A significant correlation between US categories and both cytological and molecular results was observed. In detail, TIR3B cytology was more frequent in EU-TIRADS 4 and 5 nodules (54.7 and 50%, respectively) than in EU-TIRADS 2 and 3 nodules (31%, = 0.04). Similarly, the rate of a nodule with a mutation increased with the increase of US risk class (6.0% in EU-TIRADS 2 and 3, 9.3% in EUTIRADS-4 and 27.8% in EUTIRAD-5, = 0.01). Among thyroid nodules submitted to surgery, final histology was benign in 61.4% nodules, while malignancy was diagnosed in 38.6% nodules. Using US score as tool for decision-making in TIR3A subgroup, we correctly classified 64.5% of thyroid nodules. The second tool (seven-gene panel test) was used in the subgroup of US high-risk nodules. By multiple tests with a series approach (US in all cases and US plus seven-gene panel in US high risk nodules) 84% of cases were correctly classified. In TIR3B nodules, using only seven-gene panel as tool for decision making, we correctly classified 61.9% of indeterminate nodules. By multiple tests with series approach (seven-gene panel in all cases and seven-gene panel plus US score in non-mutated nodules) only a slight improvement of thyroid nodule classification (66.6%) was observed. US score seems able to correctly discriminate between TIR3A nodules in which a conservative approach may be used, and those in which additional test, such as molecular test, may be indicated. On the contrary, in TIR3B nodules both US risk stratification and seven-gene panel seem to be of little use, because the risk of thyroid cancer remains high regardless of US score and mutational status.