Although the 21st Annual Congress of the American Association of Clinical Endocrinologists (AACE) is focused primarily on developments in diabetes, studies relevant to the oncology world were also presented. Two, in particular, were on display as poster presentations.
“Insular Carcinoma: A New Face of Thyroid Cancer,” was conducted by Rattan et al of Geisinger and featured data on this histologically distinct subset of thyroid cancer, which falls between well-differentiated and anaplastic carcinomas.
The presentation, a case study of a 79-year-old male, included a summary in which the researchers explained that insular carcinoma is a subtype of thyroid carcinoma “whose criteria for diagnosis is not uniform among pathologists.” They also noted that this subtype exhibits increased aggressiveness and a propensity for both local recurrence and distant metastases. Because of this, the authors concluded that “it is important to identify insular thyroid carcinoma, as it warrants aggressive management with total thyroidectomy followed by radioactive iodine ablation of any remaining thyroid tissue, which leads to better outcomes.”
The second study on display, “Novel Gene Expression Classifier Raises Pre-Operative Suspicion of Medullary Thyroid Cancer,” was conducted by Kloos et al of Veracyte. Medullary thyroid carcinoma (MTC) is the most aggressive of the well-differentiated thyroid carcinomas.
The study focused on the use of the Afirma Gene Expression Classifier (GEC), a test that “measures RNA transcript signals from 142 genes and applies an algorithm to classify nodules, with indeterminate fine needle aspiration (FNA) cytology, as either ‘benign’ or ‘suspicious.’”
The study included more than 10,000 biopsied thyroid nodules and allowed for a combined prospective and retrospective analysis of pre-operative case series of cytologically indeterminate and malignant FNAs. No false positive cases occurred.
The researchers concluded that “the GEC can raise suspicion for MTC in certain FNA samples,” and that “surgical management is altered to include a minimum of total thyroidectomy and central neck dissection.” The research team also mentioned that “pre-operative RET proto-oncogene status alters management of unintentionally devascularized parathyroid glands.”
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