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A clinical algorithm for fine-needle aspiration molecular testing effectively guides the appropriate extent of initial thyroidectomy.

Publication ,  Journal Article
Yip, L; Wharry, LI; Armstrong, MJ; Silbermann, A; McCoy, KL; Stang, MT; Ohori, NP; LeBeau, SO; Coyne, C; Nikiforova, MN; Bauman, JE; Hodak, SP ...
Published in: Ann Surg
July 2014

OBJECTIVE: To test whether a clinical algorithm using routine cytological molecular testing (MT) promotes initial total thyroidectomy (TT) for clinically significant thyroid cancer (sTC) and/or correctly limits surgery to lobectomy when appropriate. BACKGROUND: Either TT or lobectomy is often needed to diagnose differentiated thyroid cancer. Determining the correct extent of initial thyroidectomy is challenging. METHODS: After implementing an algorithm for prospective MT of in-house fine-needle aspiration biopsy specimens, we conducted a single-institution cohort study of all patients (N = 671) with nonmalignant cytology who had thyroidectomy between October 2010 and March 2012, cytological diagnosis using 2008 Bethesda criteria, and 1 or more indications for thyroidectomy by 2009 American Thyroid Association guidelines. sTC was defined by histological differentiated thyroid cancer of 1 cm or more and/or lymph node metastasis. Cohort 2 patients did not have MT or had unevaluable results. In cohort 1, MT for a multigene mutation panel was performed for nonbenign cytology, and positive MT results indicated initial TT. RESULTS: MT guidance was associated with a higher incidence of sTC after TT (P = 0.006) and a lower rate of sTC after lobectomy (P = 0.03). Without MT results, patients with indeterminate (follicular lesion of undetermined significance/follicular or oncocytic neoplasm) cytology who received initial lobectomy were 2.5 times more likely to require 2-stage surgery for histological sTC (P < 0.001). In the 501 patients with non-sTC for whom lobectomy was the appropriate extent of surgery, lobectomy was correctly performed more often with routine preoperative MT (P = 0.001). CONCLUSIONS: Fine-needle aspiration biopsy MT for BRAF, RAS, PAX8-PPARγ, and RET-PTC expedites optimal initial surgery for differentiated thyroid cancer, facilitating succinct definitive management for patients with thyroid nodules.

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Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

July 2014

Volume

260

Issue

1

Start / End Page

163 / 168

Location

United States

Related Subject Headings

  • Thyroidectomy
  • Thyroid Nodule
  • Thyroid Neoplasms
  • Thyroid Gland
  • Surgery
  • Retrospective Studies
  • Reproducibility of Results
  • Practice Guidelines as Topic
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Yip, L., Wharry, L. I., Armstrong, M. J., Silbermann, A., McCoy, K. L., Stang, M. T., … Carty, S. E. (2014). A clinical algorithm for fine-needle aspiration molecular testing effectively guides the appropriate extent of initial thyroidectomy. Ann Surg, 260(1), 163–168. https://doi.org/10.1097/SLA.0000000000000215
Yip, Linwah, Laura I. Wharry, Michaele J. Armstrong, Ari Silbermann, Kelly L. McCoy, Michael T. Stang, Nobuyuki P. Ohori, et al. “A clinical algorithm for fine-needle aspiration molecular testing effectively guides the appropriate extent of initial thyroidectomy.Ann Surg 260, no. 1 (July 2014): 163–68. https://doi.org/10.1097/SLA.0000000000000215.
Yip L, Wharry LI, Armstrong MJ, Silbermann A, McCoy KL, Stang MT, et al. A clinical algorithm for fine-needle aspiration molecular testing effectively guides the appropriate extent of initial thyroidectomy. Ann Surg. 2014 Jul;260(1):163–8.
Yip, Linwah, et al. “A clinical algorithm for fine-needle aspiration molecular testing effectively guides the appropriate extent of initial thyroidectomy.Ann Surg, vol. 260, no. 1, July 2014, pp. 163–68. Pubmed, doi:10.1097/SLA.0000000000000215.
Yip L, Wharry LI, Armstrong MJ, Silbermann A, McCoy KL, Stang MT, Ohori NP, LeBeau SO, Coyne C, Nikiforova MN, Bauman JE, Johnson JT, Tublin ME, Hodak SP, Nikiforov YE, Carty SE. A clinical algorithm for fine-needle aspiration molecular testing effectively guides the appropriate extent of initial thyroidectomy. Ann Surg. 2014 Jul;260(1):163–168.

Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

July 2014

Volume

260

Issue

1

Start / End Page

163 / 168

Location

United States

Related Subject Headings

  • Thyroidectomy
  • Thyroid Nodule
  • Thyroid Neoplasms
  • Thyroid Gland
  • Surgery
  • Retrospective Studies
  • Reproducibility of Results
  • Practice Guidelines as Topic
  • Middle Aged
  • Male