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BLOG: Day 2 of ATA highlights methods for diagnosing thyroid cancer and the Van Meter Award lecture
SAN JUAN, Puerto Rico — Sun Lee, MD, second-year fellow at the Boston University School of Medicine, offers her thoughts on day 2 of the American Thyroid Association annual meeting. An early riser symposium on ways to diagnose thyroid cancer and the distinguished Van Meter Award lecture, which discussed research on subclinical hypothyroidism and aging, were of particular interest.
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The early riser symposium on the second day of 83rd Annual Meeting of the American Thyroid Association focused on a great, controversial topic regarding the use of molecular markers in diagnosis of thyroid cancer, especially when fine needle aspiration (FNA) cytology is indeterminate.
Sun Lee
Scott Boener, MD, of the University of Toronto, opened the symposium with an overview of indeterminate cytology results and strategies to overcome such results. Several strategies, including repeat FNA and second cytology review, were discussed. Although outcomes of both measures are poorly studied, it appears that the second cytology review may be a good option for atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) and suspicious for malignant cells (SMC), but not for follicular neoplasm. Immunohistochemistry was also discussed as an additional step to help in diagnosis of indeterminate cytology. However, this technique is not quite useful at this time, with inconsistency of results.
Yuri Nikiforov, MD, PhD, of the University of Pittsburgh, then spoke on molecular marker testing in improving diagnosis of indeterminate cytology. With previous seven-gene panel testing, the only category that benefited from the molecular marker testing had been AUS/FLUS. However, with an increase in the number of genes tested via next-generation sequencing, in which Nikiforov is involved in the development and testing of, the assessment of cancer risk in follicular neoplasm is also improved, potentially leading to avoidance of unnecessary surgery.
The last speaker of the symposium, Stefen Grebe, MD, PhD, of the Mayo Clinic in Rochester, Minn., presented a comparison of various commercially available molecular analysis tests for evaluation of thyroid nodules. All the tests available have their pros and cons, but the bottom line was that the negative predictive value (NPV) and positive predictive value (PPV) of each test would depend on the cancer prevalence in the patient population and that the costs of these tests remain high.
The symposium concluded on a lighter note, when the chair, Shereen Ezzat, MD, FACP, FRCPC, asked each panelist which method — cytology or molecular markers — they would employ to diagnose their own thyroid nodule FNA biopsy. Boener and Grebe chose cytology, while Nikiforov stood by his research and chose molecular markers.
The Van Meter Award lecture followed the early riser symposium. The Van Meter award, established in 1930, recognizes outstanding contributions to research on the thyroid gland or related subjects, and is given to an investigator who is not older than the age of 45. Anne R. Cappola, MD, ScM, of the University of Pennsylvania, this year’s recipient, gave a very engaging presentation on her research on subclinical hypothyroidism in relation to cardiovascular risk and aging. Although the research so far has failed to show any positive association between subclinical hypothyroidism and CVD risks, it is an important negative outcome. She also presented evidence of increasing thyroid-stimulating hormone (TSH) with increasing age, especially in people aged older than 80 years. Cappola concluded the lecture with future questions to be answered, such as why TSH increases with age and what the appropriate TSH reference range would be.