Molecular testing for cytologically suspicious and malignant (Bethesda V and VI) thyroid nodules to optimize the extent of surgical intervention: a retrospective chart review
Abstract Background Molecular testing has been used for cytologically indeterminate thyroid nodules (Bethesda III and IV), where the risk of malignancy is 10–40%. However, to date, the role of molecular testing in cytologically suspicious or positive for malignancy (Bethesda V and VI) thyroid nodule...
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SAGE Publishing
2021-04-01
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| Series: | Journal of Otolaryngology - Head and Neck Surgery |
| Online Access: | https://doi.org/10.1186/s40463-021-00500-6 |
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| author | Jessica Hier Galit Avior Marc Pusztaszeri Joshua R. Krasner Noura Alyouha Veronique-Isabelle Forest Michael P. Hier Alex Mlynarek Keith Richardson Nader Sadeghi Michael Tamilia Richard J. Payne |
| author_facet | Jessica Hier Galit Avior Marc Pusztaszeri Joshua R. Krasner Noura Alyouha Veronique-Isabelle Forest Michael P. Hier Alex Mlynarek Keith Richardson Nader Sadeghi Michael Tamilia Richard J. Payne |
| author_sort | Jessica Hier |
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| description | Abstract Background Molecular testing has been used for cytologically indeterminate thyroid nodules (Bethesda III and IV), where the risk of malignancy is 10–40%. However, to date, the role of molecular testing in cytologically suspicious or positive for malignancy (Bethesda V and VI) thyroid nodules has been controversial. The aim of this study was to determine whether patients who had molecular testing in Bethesda V and VI thyroid nodules had the optimal extent of surgery performed more often than patients who did not have molecular testing performed. Methods A retrospective chart review of 122 cases was performed: 101 patients from the McGill University teaching hospitals and 21 patients from the Hillel Yaffe Medical center, Technion University. Patients included in the study were those with Bethesda V or VI thyroid nodules who underwent molecular testing (ThyGenext® or ThyroseqV3®) (McGill n = 72, Hillel Yaffe n = 14). Patients with Bethesda V or VI thyroid nodules who did not undergo molecular testing were used as controls (McGill n = 29, Hillel Yaffe n = 7). Each case was reviewed in order to determine whether the patient had optimal surgery. This was defined as total thyroidectomy in the presence of either a positive lymph node, extrathyroidal extension, or an aggressive pathological variant of papillary thyroid carcinoma (tall cell, hobnail, columnar cell, diffuse sclerosing, and solid/trabecular) documented on the final pathology report. In all other cases, a lobectomy/hemi/subtotal thyroidectomy was considered as optimal surgery. Chi-squared testing was performed to compare groups. Results When molecular testing was done, 91.86% (79/86) of surgeries in the molecular testing group were optimal, compared to 61.11% (22/36) in the control group. At McGill University teaching hospitals and at Hillel Yaffe, 91.67% (66/72) and 92.86% (13/14) of surgeries in the intervention group were considered as optimal, respectively. This compares to 58.62% (17/29) at McGill and 71.43% (5/7) at Hillel Yaffe when molecular testing was not performed (p = .001, p = .186). Conclusions In this study, molecular testing in Bethesda V and VI thyroid tumors significantly improved the likelihood of optimal surgery. Therefore, molecular testing may have an important role in optimizing surgical procedures performed in the setting of Bethesda V and VI thyroid nodules. Prospective studies with larger sample sizes are required to further investigate this finding. Graphical abstract |
| format | Article |
| id | doaj-art-a205c7ab5a20401a9143d9457fdfdf77 |
| institution | Kabale University |
| issn | 1916-0216 |
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| spelling | doaj-art-a205c7ab5a20401a9143d9457fdfdf772025-01-03T01:45:57ZengSAGE PublishingJournal of Otolaryngology - Head and Neck Surgery1916-02162021-04-015011710.1186/s40463-021-00500-6Molecular testing for cytologically suspicious and malignant (Bethesda V and VI) thyroid nodules to optimize the extent of surgical intervention: a retrospective chart reviewJessica Hier0Galit Avior1Marc Pusztaszeri2Joshua R. Krasner3Noura Alyouha4Veronique-Isabelle Forest5Michael P. Hier6Alex Mlynarek7Keith Richardson8Nader Sadeghi9Michael Tamilia10Richard J. Payne11Faculty of Medicine, McGill UniversityDepartment of Otolaryngology Head and Neck Surgery, Hillel Yaffe Medical Centre, Technion UniversityDepartment of Pathology, Sir Mortimer B. Davis-Jewish General Hospital, McGill UniversityFaculty of PharmacologyDepartment of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill UniversityDepartment of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill UniversityDepartment of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill UniversityDepartment of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill UniversityDepartment of Otolaryngology Head and Neck Surgery, McGill University Health Centre, McGill UniversityDepartment of Otolaryngology Head and Neck Surgery, McGill University Health Centre, McGill UniversityDivision of Endocrinology & Metabolism, Sir Mortimer B. David-Jewish General Hospital, McGill UniversityDepartment of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill UniversityAbstract Background Molecular testing has been used for cytologically indeterminate thyroid nodules (Bethesda III and IV), where the risk of malignancy is 10–40%. However, to date, the role of molecular testing in cytologically suspicious or positive for malignancy (Bethesda V and VI) thyroid nodules has been controversial. The aim of this study was to determine whether patients who had molecular testing in Bethesda V and VI thyroid nodules had the optimal extent of surgery performed more often than patients who did not have molecular testing performed. Methods A retrospective chart review of 122 cases was performed: 101 patients from the McGill University teaching hospitals and 21 patients from the Hillel Yaffe Medical center, Technion University. Patients included in the study were those with Bethesda V or VI thyroid nodules who underwent molecular testing (ThyGenext® or ThyroseqV3®) (McGill n = 72, Hillel Yaffe n = 14). Patients with Bethesda V or VI thyroid nodules who did not undergo molecular testing were used as controls (McGill n = 29, Hillel Yaffe n = 7). Each case was reviewed in order to determine whether the patient had optimal surgery. This was defined as total thyroidectomy in the presence of either a positive lymph node, extrathyroidal extension, or an aggressive pathological variant of papillary thyroid carcinoma (tall cell, hobnail, columnar cell, diffuse sclerosing, and solid/trabecular) documented on the final pathology report. In all other cases, a lobectomy/hemi/subtotal thyroidectomy was considered as optimal surgery. Chi-squared testing was performed to compare groups. Results When molecular testing was done, 91.86% (79/86) of surgeries in the molecular testing group were optimal, compared to 61.11% (22/36) in the control group. At McGill University teaching hospitals and at Hillel Yaffe, 91.67% (66/72) and 92.86% (13/14) of surgeries in the intervention group were considered as optimal, respectively. This compares to 58.62% (17/29) at McGill and 71.43% (5/7) at Hillel Yaffe when molecular testing was not performed (p = .001, p = .186). Conclusions In this study, molecular testing in Bethesda V and VI thyroid tumors significantly improved the likelihood of optimal surgery. Therefore, molecular testing may have an important role in optimizing surgical procedures performed in the setting of Bethesda V and VI thyroid nodules. Prospective studies with larger sample sizes are required to further investigate this finding. Graphical abstracthttps://doi.org/10.1186/s40463-021-00500-6 |
| spellingShingle | Jessica Hier Galit Avior Marc Pusztaszeri Joshua R. Krasner Noura Alyouha Veronique-Isabelle Forest Michael P. Hier Alex Mlynarek Keith Richardson Nader Sadeghi Michael Tamilia Richard J. Payne Molecular testing for cytologically suspicious and malignant (Bethesda V and VI) thyroid nodules to optimize the extent of surgical intervention: a retrospective chart review Journal of Otolaryngology - Head and Neck Surgery |
| title | Molecular testing for cytologically suspicious and malignant (Bethesda V and VI) thyroid nodules to optimize the extent of surgical intervention: a retrospective chart review |
| title_full | Molecular testing for cytologically suspicious and malignant (Bethesda V and VI) thyroid nodules to optimize the extent of surgical intervention: a retrospective chart review |
| title_fullStr | Molecular testing for cytologically suspicious and malignant (Bethesda V and VI) thyroid nodules to optimize the extent of surgical intervention: a retrospective chart review |
| title_full_unstemmed | Molecular testing for cytologically suspicious and malignant (Bethesda V and VI) thyroid nodules to optimize the extent of surgical intervention: a retrospective chart review |
| title_short | Molecular testing for cytologically suspicious and malignant (Bethesda V and VI) thyroid nodules to optimize the extent of surgical intervention: a retrospective chart review |
| title_sort | molecular testing for cytologically suspicious and malignant bethesda v and vi thyroid nodules to optimize the extent of surgical intervention a retrospective chart review |
| url | https://doi.org/10.1186/s40463-021-00500-6 |
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