Molecular Testing Enhances Decision-Making Process in Thyroid Cancer of Indeterminate Malignancy

Rachel Narozniak
Published: Saturday, Sep 07, 2019
Andrew Turk,
MD

Andrew Turk, MD

In thyroid cancer, molecular diagnostic tests enable oncologists to evaluate thyroid nodules with atypical, suspicious, or indeterminate fine-needle aspiration (FNA) cytology to determine the best course of treatment based on cytopathological result.1,2 The Bethesda System for Reporting Thyroid Cytopathology ranks thyroid FNA across 6 categories, assigns a risk of malignancy to each category, and suggests a path for clinical management based on tier.3

ThyroSeq v2 and ThyGenX use next-generation sequencing (NGS) to perform FNA testing, ThyraMIR and RosettaGX Reveal facilitate quantitative reverse transcriptase polymerase chain reactions (RT-qPCR), and Afirma conducts an expression array.

Table. NCCN Treatment Recommendations Based on FNA Result5

Table. NCCN Treatment Recommendations Based on FNA Result5 “The patients in whom we’re really concerned about how these tests perform, the scenarios in which these assays are really clinically relevant, are patients whose cytology results are indeterminate,” Turk said.

Table 2. NCCN Treatment Recommendations Based on Molecular Diagnostics Results5

Table 2. NCCN Treatment Recommendations Based on Molecular Diagnostics Results5 Molecular diagnostic tests can also detect molecular aberrations associated with the pathogenesis of thyroid cancer to help identify alterations in BRAF, RAS, RET/PTC, and PAX8/PPARy.2 Knowledge of the actionable mutations present in a nodule provides valuable insight that can further sculpt the treatment decision and guide administration of systemic and targeted therapies.
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