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Transl Res. 2017 Oct;188:58-66.e1. doi: 10.1016/j.trsl.2017.07.005. Epub 2017 Jul 22.

Predicting thyroid nodule malignancy at several prevalence values with a combined Bethesda-molecular test.

Author information

1
Fédération d'Endocrinologie, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France; Université Lyon 1, Lyon, France; Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; CNRS UMR5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France. Electronic address: helene.lasolle@chu-lyon.fr.
2
Université Lyon 1, Lyon, France; Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; CNRS UMR5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France.
3
Université Lyon 1, Lyon, France; Service d'anatomie-pathologique, Hospices Civils de Lyon, Pierre-Bénite, France.
4
Service de Radiologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.
5
Université Lyon 1, Lyon, France; INSERM, CIC1407, Bron, France; Service de Pharmacologie Clinique, Hospices Civils de Lyon, Bron, France.
6
Université Lyon 1, Lyon, France; Centre de Recherche en Cancérologie de Lyon, INSERM, U 1052, Lyon, France; ProfileXpert, SFR santé Lyon Est, UMS 3453 CNRS - US7 INSERM, Lyon, France.
7
Université Lyon 1, Lyon, France; Service de Chirurgie Digestive et Endocrinienne, Hôpital Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.
8
Fédération d'Endocrinologie, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France; Centre de Recherche en Cancérologie de Lyon, INSERM, U 1052, Lyon, France; University of Medicine and Pharmacy, Tirgu Mures, Romania.
9
Université Lyon 1, Lyon, France; Centre de Recherche en Cancérologie de Lyon, INSERM, U 1052, Lyon, France.
10
Fédération d'Endocrinologie, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France; Université Lyon 1, Lyon, France; Centre de Recherche en Cancérologie de Lyon, INSERM, U 1052, Lyon, France.

Abstract

Investigation of thyroid nodules using fine-needle aspiration cytology (FNAC) gives indeterminate results in up to 30% of samples using the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). We present a combined Bethesda-molecular predictor of nodule malignancy to improve the accuracy of the preoperative diagnosis of thyroid nodules. To detect a molecular signature of thyroid nodule malignancy, a molecular test was performed on FNACs from 128 thyroid nodules from prospectively included patients, collected in a tertiary center. The test relied on a transcriptomic array of 20 genes selected from a previous study. An optimal set of seven genes was identified using a logistic regression model. Comparison between the combined predictor (TBSRTC + molecular) and TBSRTC alone used the area under the ROC curve (AUC). Performance of the combined predictor was calculated according to various malignancy prevalence values and benefit-to-harm ratios (B/Hr) (favoring sensitivity or specificity). In our population (36% malignancy prevalence) and with a B/Hr of 1, the combined predictor achieved 95% specificity and 76% sensitivity. The AUC was 93.5%; higher than that of TBSRTC (P = 0.004). Among indeterminate nodules (30% malignancy prevalence), sensitivity and specificity were 52.2% and 96.2%, respectively, with a B/Hr of 1, or 95.7% and 64.2% with a B/Hr of 4 (favoring sensitivity), allowing avoidance of 64% of unnecessary surgeries at the cost of only one false-positive result. In conclusion, this predictor could improve the detection of thyroid nodule malignancy, taking into account malignancy prevalence and B/Hr, and reduce the number of unnecessary thyroidectomies.

PMID:
28797549
DOI:
10.1016/j.trsl.2017.07.005
[Indexed for MEDLINE]

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