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Morphology combined with ancillary techniques: An algorithm approach for thyroid nodules.

E D Rossi1, M Martini1, S Capodimonti1

  • 1Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli" School of Medicine, Rome, Italy.

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Summary
This summary is machine-generated.

This study validates a diagnostic algorithm for follicular neoplasms (FNs), combining morphology and ancillary tests like immunocytochemistry (ICC) and molecular analysis. The algorithm accurately identifies malignancy risk, aiming to reduce unnecessary thyroidectomies.

Keywords:
BRAF mutationimmunocytochemistrymolecular testingplump cellsthyroid malignanciesthyroid nodules

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Area of Science:

  • Endocrinology
  • Oncology
  • Pathology

Background:

  • Morphological analysis has limitations in diagnosing follicular neoplasms (FNs).
  • Ancillary techniques like immunocytochemistry (ICC) and molecular testing improve risk of malignancy (ROM) assessment and FN management.
  • Diagnostic models incorporating ICC, BRAFV600E mutations, and micro RNA analysis are proposed for FNs.

Purpose of the Study:

  • To validate a diagnostic algorithm for follicular neoplasms (FNs).
  • To evaluate the combined role of morphology and ancillary techniques in diagnosing FNs.
  • To improve the accuracy of risk of malignancy (ROM) assessment in FNs.

Main Methods:

  • A cohort of 37 FNs with histological follow-up was analyzed.
  • Control groups included 20 benign nodules and 20 malignant thyroid lesions.
  • Immunocytochemistry (ICC), BRAFV600E mutation analysis, and miR-375 expression were performed on liquid-based cytology (LBC) samples.

Main Results:

  • The morphological detection of BRAFV600E mutation was associated with 100% risk of malignancy (ROM).
  • In wild-type cases, concordant positive ICC panels showed 83.3% ROM, while negative panels had 10.5% ROM.
  • High miR-375 expression levels indicated a 100% ROM.

Conclusions:

  • A diagnostic algorithm integrating morphology and ancillary techniques is recommended for accurate FN diagnosis.
  • Morphological identification of BRAFV600E mutation serves as an initial step in detecting malignant FNs.
  • Implementing this algorithm aims to significantly reduce unnecessary thyroidectomies.