Diagnosis and management of differentiated thyroid cancer using molecular biology1. (12th February 2013)

• Record Type: Journal Article
• Authors: Witt, Robert L.; Ferris, Robert L.; Pribitkin, Edmund A.; Sherman, Steven I.; Steward, David L.; Nikiforov, Yuri E.
• Is Part Of: Laryngoscope. Volume 123:Number 4(2013:Apr.)
• Page Start: 1059
• Page End: 1064
• Publication Date: 2013-02-12
• Subjects: Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.23838
• Languages: English
• ISSNs: 0023-852X

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="abs1-1" sec-type="section"> <title>Objectives/Hypothesis:</title> <p>To define molecular biology in clinical practice for diagnosis, surgical management, and prognostication of differentiated thyroid cancer.</p> </sec> <sec id="abs1-2" sec-type="section"> <title>Data Sources:</title> <p>Ovid Medline 2006‐2012</p> </sec> <sec id="abs1-3" sec-type="section"> <title>Review Methods:</title> <p>Manuscripts with clinical correlates.</p> </sec> <sec id="abs1-4" sec-type="section"> <title>Results:</title> <p>Papillary thyroid carcinomas harbor point mutations of the <italic>BRAF</italic> and <italic>RAS</italic> genes or <italic>RET/PTC</italic> rearrangements, all of which activate the mitogen‐activated protein kinase pathway. These mutually exclusive mutations are found in 70% of PTC. <italic>BRAF</italic> mutation is found in 45% of papillary thyroid cancer and is highly specific. Follicular carcinomas are known to harbor <italic>RAS</italic> mutation or <italic>PAX8/PPAR</italic>γ rearrangement. These mutations are also mutually exclusive and identified in 70% of follicular carcinomas. Molecular classifiers measure the expression of a large number of genes on a microarray chip providing a substantial negative predictive value pending further validation.</p> </sec> <sec id="abs1-5" sec-type="section"> <title>Conclusions:</title> <p>1) 20% to 30% of cytologically classified Follicular Neoplasms and Follicular Lesion of Undetermined Significance collectively are malignant on final pathology. Approximately 70% to 80% of thyroid lobectomies performed solely for diagnostic purposes are benign. Molecular alteration testing may reduce the number of unnecessary thyroid procedures, 2) may reduce the number of completion thyroidectomies, and 3) may lead to more individualized operative and postoperative management. Molecular testing for <italic>BRAF, RAS, RET/PTC</italic>, and <italic>PAX8/PPAR</italic>γ for follicular lesion of undetermined significance and follicular neoplasm improve specificity, whereas molecular classifiers may add negative predictive value to fine needle aspiration diagnosis.</p> </sec> </abstract>