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首页> 外文期刊>Otolaryngology--head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery >Rethinking Malignancy Risk in Indeterminate Thyroid Nodules with Positive Molecular Studies: Southern California Permanente Experience
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Rethinking Malignancy Risk in Indeterminate Thyroid Nodules with Positive Molecular Studies: Southern California Permanente Experience

机译：重新思考与阳性分子研究不确定的甲状腺结节中的恶性风险：南加州永久性经验

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Objectives To recognize that thyroid nodules with atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS; Bethesda III) have different risks of malignancy based on genetic mutation and to consider molecular testing of nodules with AUS/FLUS to help avoid unnecessary morbidity or cost. Study Design Retrospective cohort study. Setting Multiple locations within Southern California Permanente Medical Group. Subjects and Methods Patients included those with indeterminate thyroid nodules and AUS/FLUS on 2 separate fine-needle aspirations with positive ThyGenX testing from 2014 to 2017 who underwent thyroid surgery. Patients were classified as having benign or malignant disease. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features was considered benign. Results A total of 231 patients had repeat AUS/FLUS with positive molecular testing and surgery. The most frequent type of malignancy was papillary carcinoma, followed by follicular carcinoma. The overall prevalence of malignancy in nodules with mutations was 74.0%, although there was considerable variation: BRAF = 100%, RET = 100%, PAX8-PPAR gamma = 84.6%, HRAS = 70.7%, NRAS = 63.4%, and KRAS = 33%-a statistically significant finding (P < .001). Conclusions Not all molecular mutations in thyroid nodules with AUS/FLUS have a high risk of malignancy. Of note, patients with BRAF and RET mutations in our population had a 100% risk of malignancy. Patients with PAX, HRAS, or NRAS mutations had a high risk of malignancy, while patients with KRAS mutations had a lower risk of malignancy. Further studies are needed to determine if the presence of certain molecular mutations can help personalize care and aid in the decision for thyroid surgery.
机译：目的识别出甲状腺结节的甲状腺结节未确定的显着性/卵泡性损伤，其显着意义（aus / flus; bethesda III）基于基因突变具有不同的恶性风险，并考虑与aus / flus的结节的分子测试，以帮助避免不必要的发病率或成本。研究设计回顾性队列研究。在南加州永久医疗组中设定多个地点。受试者和方法患者包括在2个单独的细针吹奏器中含有不确定的甲状腺结节和Aus / Flus的那些，从2014年到2017年从2014年到2017年进行了阳性胸膜测试。患者被归类为具有良性或恶性疾病。具有乳头状核特征的非侵蚀性卵泡甲状腺肿瘤被认为是良性的。结果共有231名患者重复AUS / FLU，阳性分子检测和手术。最常见的恶性肿瘤是乳头状癌，其次是滤泡癌。突变结节中恶性肿瘤的总体患病率为74.0％，但相当大的变异：BRAF = 100％，RET = 100％，PAX8-PPARγ= 84.6％，HRAs = 70.7％，NRAs = 63.4％，KRAS = 33％-a统计上显着的发现（p <.001）。结论并非所有甲状腺结节中的所有分子突变都具有高血糖的恶性肿瘤风险很高。注意，患有BRAF和我们人口的RET突变的患者的恶性肿瘤风险100％。患有Pax，HRA或NRAS突变的患者具有很高的恶性风险，而KRAS突变的患者的恶性风险较低。需要进一步的研究来确定某些分子突变的存在是否有助于个性化护理和援助甲状腺手术的决定。

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