Aims The distinction between benign and malignant thyroid nodules has important therapeutic implications. Our objective was to develop an assay that could classify indeterminate thyroid nodules as benign or suspicious, using routinely prepared fine needle aspirate (FNA) cytology smears.
Methods A training set of 375 FNA smears was used to develop the microRNA-based assay, which was validated using a blinded, multicentre, retrospective cohort of 201 smears. Final diagnosis of the validation samples was determined based on corresponding surgical specimens, reviewed by the contributing institute pathologist and two independent pathologists. Validation samples were from adult patients (≥18 years) with nodule size >0.5 cm, and a final diagnosis confirmed by at least one of the two blinded, independent pathologists. The developed assay, RosettaGX Reveal, differentiates benign from malignant thyroid nodules, using quantitative RT-PCR.
Results Test performance on the 189 samples that passed quality control: negative predictive value: 91% (95% CI 84% to 96%); sensitivity: 85% (CI 74% to 93%); specificity: 72% (CI 63% to 79%). Performance for cases in which all three reviewing pathologists were in agreement regarding the final diagnosis (n=150): negative predictive value: 99% (CI 94% to 100%); sensitivity: 98% (CI 87% to 100%); specificity: 78% (CI 69% to 85%).
Conclusions A novel assay utilising microRNA expression in cytology smears was developed. The assay distinguishes benign from malignant thyroid nodules using a single FNA stained smear, and does not require fresh tissue or special collection and shipment conditions. This assay offers a valuable tool for the preoperative classification of thyroid samples with indeterminate cytology.
- THYROID CANCER
- MOLECULAR ONCOLOGY
- LABORATORY TESTS
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Review history and Supplementary material
Abstract in Hebrew
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- Abstract in Hebrew - Online abstract
GL-Y and ND contributed equally.
Handling editor Runjan Chetty
Contributors GL-Y analysed the data, developed the algorithm and the software, and wrote the manuscript. ND, TS-P, HB analysed the data, developed the algorithm and the software, and reviewed and edited the manuscript. ASh collected data, reviewed the slides, was involved in interpretation of the data, and reviewed and edited the manuscript. SM, YS, MF, VK, MEL, MH, SZA, CJVB, XZ, AZ, SV identified clinical cases, reviewed the slides and collected data. LL-T and MS reviewed and analysed slides. MK contributed to experimental design, collected the data, was involved in interpretation of the data, and reviewed and edited the manuscript. YG contributed to experimental design and collected the data. ST, EK, HM, MM, DL, SK-R, HM, MN, ASm, OD, KA performed experiments and were involved in calibrations and protocol development. KAB was involved in conceptualisation and reviewed and edited the manuscript. DB was involved in conceptualisation, was involved in interpretation of the data, and wrote the manuscript. EM was involved in conceptualisation, overviewed experimental design and procedures, was involved in interpretation of the data, and reviewed and edited the manuscript. All authors read and approved the final manuscript.
Competing interests Authors affiliated with Rosetta Genomics are full-time employees of the company and/or hold equity in the company, which stands to gain from the publication of this manuscript. One of the authors (A. Shtabsky) is a payed consultant for Rosetta Genomics. The authors from medical/clinical centres have received research funding from the company as part of this and/or other collaborative projects.
Ethics approval IRB (for each institution).
Provenance and peer review Not commissioned; externally peer reviewed.
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