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New Test Could Reduce Unnecessary Diagnostic Surgeries
Thyroid cancer: New test could reduce unnecessary diagnostic surgeries

A novel test that looks for a molecular

fingerprint in needle biopsies could help

improve the diagnosis of thyroid cancer

and reduce unnecessary surgeries,

according to new research.

A new thyroid cancer test could prevent unnecessary

invasive procedures.

A recent PNAS paper describes the new test and

how it performed in a pilot study.

The findings showed the new method to be faster

and around two-thirds more accurate than those that

doctors currently rely on to diagnose thyroid cancer.

The researchers say that larger trials now need to

validate these early findings before doctors can start

using the new test as part of routine clinical

diagnosis of thyroid cancer.

Should the larger studies confirm the findings, the

new test could prevent thousands of unnecessary

partial or total thyroid removals each year in the

United States.

Many patients who undergo thyroid removal have to

take hormone replacement therapy for the rest of

their lives.

"If we could prevent people from having surgery they

don't need and enable them to have a more precise

diagnosis," says co-senior study author Livia S.

Eberlin, Ph.D., assistant professor of chemistry and

diagnostic medicine at The University of Texas at

Austin, "we can improve treatment for patients and

lower costs for the healthcare system."

Thyroid cancer diagnoses

have gone up

The thyroid is a butterfly-shaped gland in the base

of the throat under the Adam's apple, or thyroid

cartilage. The gland has an important role in the

endocrine system.

With the help of iodine, the thyroid gland releases

hormones that control metabolic rate, heart rate,

body temperature, and blood pressure .

Since 1992, annual rates of thyroid cancer

diagnoses in the U.S. have climbed from 6 to more

than 14 per 100,000 adults, according to the

Surveillance, Epidemiology, and End Results (SEER)

Program of the National Cancer Institute (NCI), one

of the National Institutes of Health (NIH).

The NCI's SEER program also estimate that there

were 822,242 people living with thyroid cancer in

the U.S. in 2016.

The American Cancer Society suggest that the main

reason for the dramatic rise in thyroid cancer

diagnoses in recent decades is the greater use of

diagnostic technology such as ultrasound that can

spot small nodules in the thyroid.

Limitations of current

thyroid biopsy method

To diagnose thyroid cancer, doctors usually begin

with a biopsy procedure called fine needle

aspiration (FNA) to remove some thyroid tissue. A

pathologist then examines the biopsy samples to

see if the tissue is cancerous.

However, because of the limitations of the current

tissue analysis tools, around 1 in 5 FNA tests

cannot confirm whether cancer is present or not.

When FNA tests are inconclusive, doctors may then

carry out genetic tests, but even these can return

false-positive results: that is, indicate that thyroid

cancer is present when it isn't.

Because of these uncertainties, doctors often

suggest that patients undergo partial or total

removal of the thyroid.

The team behind the current study used mass

spectrometry imaging to develop a molecular

profile, or fingerprint, of the cancer. This technology

allows scientists to identify the chemical

byproducts, or metabolites, of cancer cell activity.

To find out which particular metabolites to include

in the fingerprint, the team compared molecular

profiles from tissues of 178 people with or without

thyroid cancer.

Faster and more accurate

FNA tests

The researchers then tested the accuracy of the new

fingerprint model in a pilot trial involving 68 people

who underwent FNA tests. Nearly a third of these

people had received inconclusive FNA results.

The findings revealed that the new fingerprint test

produced false-positive results in around 1 in 10

cases only. A test with this level of accuracy could

have kept 17 study participants from undergoing

unnecessary surgery.

The team is already preparing a 2-year trial to

validate the FNA findings of roughly 1,000 people

in Australia, Brazil, and the U.S.

"With this next generation test," says co-senior

study author Dr. James W. Suliburk, associate

professor and chief of endocrine surgery at Baylor

College of Medicine, in Houston, TX, "we can

provide thyroid cancer diagnoses faster and with

more precision than current techniques — this will

be the new state-of-the-art."