New Molecular Test Increases Odds of Correct Surgery for Thyroid Cancer Patients
By The ASCO Post Posted: 7/24/2014 3:21:13 PM Last Updated: 7/24/2014 3:21:13 PM
A new molecular testing panel allows physicians to reduce the likelihood of performing unnecessary surgery for thyroid cancer.
Patients whose tissue samples were not tested with the panel had a 2.5-fold higher likelihood of having an initial lobectomy and then requiring a second operation for their thyroid cancer.
The routine use of a molecular testing panel developed at the University of Pittsburgh Medical Center greatly increases the likelihood of performing the correct initial surgery for patients with thyroid nodules and cancer, reported researchers from theUniversity of Pittsburgh Cancer Institute. The test improved the chances of patients getting the correct initial surgery by 30%, according to the study by Yip et al published in the Annals of Surgery.
“Before this test, about one in five potential thyroid cancer cases couldn’t be diagnosed without an operation to remove a portion of the thyroid,” said lead author Linwah Yip, MD, Assistant Professor of Surgery at the University of Pittsburgh School of Medicine and UPMC surgical oncologist. Previously, “if the portion removed during the first surgery came back positive for cancer, a second surgery was needed to remove the rest of the thyroid. The molecular testing panel now bypasses that initial surgery, allowing us to go right to fully removing the cancer with one initial surgery. This reduces risk and stress to the patient, as well as recovery time and costs.”
Thyroid cancer is the fifth most common cancer diagnosed in women. The 5-year survival rate is 97%, but it is also one of the few cancers that continues to increase in incidence.
Previously, the most accurate form of testing for thyroid cancer was a fine-needle aspiration biopsy. However, in 20% of these biopsies, cancer cannot be ruled out. A lobectomy is then needed to diagnose or rule out thyroid cancer. In the case of a postoperative cancer diagnosis, a second surgery is required to remove the rest of the thyroid.
Researchers have identified certain gene mutations that are indicative of an increased likelihood of thyroid cancer, and the molecular testing panel developed at UPMC can be run using the sample collected through the initial, minimally invasive biopsy, rather than a lobectomy. When the panel shows these mutations, a total thyroidectomy is advised.
Dr. Yip and her colleagues followed 671 UPMC patients with suspicious thyroid nodes who received biopsies. Approximately half the biopsy samples were run through the panel, and the other half were not. Patients whose tissue samples were not tested with the panel had a 2.5-fold higher statistically significant likelihood of having an initial lobectomy and then requiring a second operation.
“We’re currently refining the panel by adding tests for more genetic mutations, thereby making it even more accurate,” said coauthor Yuri Nikiforov, MD, PhD, Professor in the Department of Pathology at the University of Pittsburgh School of Medicine and Director of Thyroid Molecular Diagnostics at the UPMC/UPCI Multidisciplinary Thyroid Center. “Thyroid cancer is usually very curable, and we are getting closer to quickly and efficiently identifying and treating all cases of thyroid cancer.”
In 2009, the American Thyroid Association (ATA) revised its guidelines to add that doctors may consider the use of molecular markers when the initial biopsy is inconclusive.
“The ATA is currently revising those guidelines to take into account the latest research, including our findings,” said senior author Sally Carty, MD, Professor of Surgery at the University of Pittsburgh School of Medicine and Codirector of the UPMC/UPCI Multidisciplinary Thyroid Center. “The molecular testing panel holds promise for streamlining and eliminating unnecessary surgery not just here but nationwide.”
A previous study led by Dr. Yip showed the panel to be cost-saving when used to help in the diagnosis of thyroid cancer.
This study was funded by a grant from UPMC.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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