Search Results (7)

Background: The management of indeterminate thyroid nodules (Bethesda III/IV) has evolved with molecular testing, aiming to reduce unnecessary surgeries. However, the comparative effectiveness of different platforms in influencing surgical decision-making remains unclear. This systematic review and meta-analysis evaluate the impact of molecular testing on surgical avoidance rates. Methods: A systematic literature search was conducted across eight electronic databases, including Embase, PubMed, and Cochrane Library, from January 2019 to December 2024, following PRISMA guidelines to encompass most recent advancements in the last 5 years. Studies evaluating Afirma Gene Expression Classifier (GEC), Afirma Genomic Sequencing Classifier (GSC), ThyroSeq V2, ThyroSeq V3, and ThyGenX/ThyraMIR were included. The primary outcome was surgical avoidance, analyzed using a random-effects model. Results: Thirty-one studies comprising 4464 indeterminate thyroid nodules met inclusion criteria. Pooled surgical avoidance rates varied across platforms: ThyroSeq V2 (50.3%, 95% CI: 20.8–79.6%), ThyroSeq V3 (62.5%, 95% CI: 54.8–70.0%), Afirma GEC (58.8%, 95% CI: 43.6–73.1%), Afirma GSC (50.6%, 95% CI: 34.3–66.8%), and ThyGenX/ThyraMIR (68.6%, 95% CI: 63.1–73.9%). ThyGenX/ThyraMIR had the highest surgical avoidance rate and lowest heterogeneity (I² = 51.2%), while ThyroSeq showed improvement from V2 to V3. Conclusions: Molecular testing reduces unnecessary thyroid surgeries, with avoidance rates ranging from 50.3% to 68.6%. While ThyGenX/ThyraMIR showed the highest avoidance rate, its limited representation warrants cautious interpretation. Standardized protocols are needed to optimize clinical application. Further prospective studies should compare platforms and assess long-term outcomes and cost-effectiveness. Full article

The high prevalence of thyroid nodules and increased availability of neck ultrasound have led to an increased incidence of diagnostic thyroid fine needle aspirations, with approximately 20% yielding indeterminate results. The recent availability of molecular tests has helped guide the clinical management of these cases. This paper aims to review and compare three main commercially available molecular cytology platforms in the U.S.—Afirma GSC, Thyroseq GC, and ThyGeNEXT + ThyraMIR. Sequential improvements of the Afirma GSC and Thyroseq GC tests have increased positive and negative predictive values, sensitivity, and specificity. Comparative studies revealed similar diagnostic performance between these tests, with considerations for factors such as cost and processing time. Thyroseq GC provides detailed genomic information and specific management recommendations. ThyGeNEXT + ThyraMIR, though less studied, presents promising results, particularly in miRNA analysis for weak driver mutations. Challenges in interpreting results include variations in reporting and the evolving nature of testing platforms. Questions persist regarding cost-effectiveness and the utility of ultrasound characteristics in selecting candidates for molecular testing. While molecular testing has primarily served diagnostic purposes, advancements in understanding genetic alterations now offer therapeutic implications. FDA-approved options target specific genetic alterations, signaling a promising future for tailored treatments. Full article

Indeterminate thyroid nodules (ITN) represent 20–30% of biopsied nodules, with a 10–60% risk of malignancy. Molecular testing can stratify the risk of malignancy among ITNs, and subsequently reduce the need for unnecessary diagnostic surgery. We aimed to assess the performance of these molecular tests at a single institution. Patients with Bethesda III, IV, and V nodules with Afirma and Interpace Diagnostics genetic testing data from November 2013 to November 2021 were included. Three cohorts were formed, including GSC + XA, ThyGeNEXT + ThyraMIR, and GSC + GEC. Statistical analysis determined the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic odds ratio (DOR), and accuracy of each type of testing. The PPV of nodules undergoing genetic testing by ThyGeNEXT + ThyraMIR (45.00%, 95%CI: 28.28–62.93%, p = 0.032) and GSC + XA (57.14%, 95%CI: 29.32–81.08%, p < 0.001) were superior to that of GEC + GSC (30.72%, 95%CI: 26.83–34.90%). The NPV was above 85% in all cohorts, suggesting overall suitable rule-out tests. The Afirma platform (GSC + XA) had the highest NPV at 96.97%. The overall accuracy for nodules undergoing ThyGeNEXT + ThyraMIR was 81.42% (95%CI: 73.01–88.11%, p < 0.001). A total of 230 patients underwent thyroidectomy, including less than 60% of each of the ThyGeNEXT + ThyraMIR and GSC + XA cohorts. Specifically, only 25% of patients in the GSC + XA cohort underwent surgery, considerably decreasing the rate of unnecessary surgical intervention. Sub-group analysis, including only patients with surgical pathology, found that PPV tended to be higher in the GSC + XA cohort, at 66.67% (95%CI: 37.28–87.06%), as compared to the ThyGeNEXT + ThyraMIR cohort, at 52.94% (95%CI: 35.25–69.92%). The Afirma genetic testing platform GSC + XA outperformed the other platforms with regards to both PPV and NPV and decreased the rate of surgery in patients with ITNs by 75%, significantly preventing unnecessary surgical intervention. Full article

According to historical sources, a watermill existed in the valley of the Trojanka River on the north-western shore of Raduszyn Lake from the 15th century. Its dams lasted for centuries causing the water flow through the Raduszyn reservoir to slow down and deposit various mineral fractions in it. The aim of paper was to develop a scientific background for the sustainable management of organic matter extracted from the peat top and from deeper layers that are unsuitable for direct use, that is, decomposed peat. A SWOT (strengths, weaknesses, opportunities, threats) analysis was used to describe ways of restoration of the water reservoir alongside the characterization of organic matter and the financial condition of the studied enterprise. For the use of the studied material as a homogeneous substrate for plant cultivation, the contents of nitrogen, phosphorus, potassium, and copper were insufficient, whilst calcium was excessive. Microbiological analyses of the organic materials intended as an additive for horticultural substrates confirmed the presence of plant growth-promoting bacteria. The occurrence of such microorganisms in the substrate can limit the use of mineral fertilizers and chemical plant protection products. The results of the research can be an example for enterprises restoring or creating water reservoirs by extraction of organic matter, which is often considered as waste that generates costs and does not bring financial benefits. Such a measure can be used to improve the efficiency of water reservoir restoration enterprises and at the same time contribute to sustainable land development. Full article

In the past few decades, molecular characterization of thyroid cancer has made significant progress and is able to identify thyroid-cancer-related molecular markers that can then be applied clinically for improved decision making. The aim of this review is to provide a general overview about the molecular markers (mutations and alterations) of thyroid cancers, present several molecular tests, and discuss the clinical applications of identifying these markers supported by the clinical experience of several high-volume thyroid cancer specialists at the McGill university hospitals in Montreal, Canada. Our group experience showed that molecular testing can reclassify more than half of the patients with indeterminate thyroid nodules (Bethesda III and IV) into benign and spare these patients from unnecessary diagnostic surgery. Furthermore, it can help optimize the initial management in thyroid cancers with no evidence of high risk of recurrence of disease preoperatively. While routine molecular testing is not firmly established for thyroid FNA specimens that are suspicious or positive for malignancy (Bethesda V and VI), knowledge of a thyroid nodule’s molecular risk group profile in such cases, together with its clinical and radiologic features, can help select the optimal surgical options (lobectomy versus upfront total thyroidectomy and central neck dissection), as demonstrated by our studies. Full article

The past decade has witnessed significant advances in the application of molecular diagnostics for the pre-operative risk-stratification of cytologically indeterminate thyroid nodules. The tests that are currently marketed in the United States for this purpose combine aspects of tumor genotyping with gene and/or microRNA expression profiling. This review compares the general methodology and clinical validation studies for the three tests currently offered in the United States: ThyroSeq v3, Afirma GSC and Xpression Atlas, and ThyGeNEXT/ThyraMIR. Full article

According to regulations in some European countries, peat is treated as a fossil fuel or soil for mushroom horticulture and its management is subject to the law for mining activities. As a result of the exploitation of peat bogs, the cutaway or pit lakes remain, which when properly prepared can be local water resources. Such post-peat water bodies can be used for recreation and they can be particularly important in areas struggling with water deficiency in the rural landscape. Maintaining good water quality in such reservoirs requires a number of preparatory works, including the removal of the remaining organic matter that would rest at the bottom of the new pit lake, affecting the water quality. Studies of water quality and aquatic plant communities in the studied post-peat lake were carried out during the period 2012–2014 in order to determine the changes in water quality and the usefulness of water for cyprinids. Aquatic plant communities identified in the reservoir showed a simplified species composition, characteristic of initial communities, and they occupied small areas in the water and on the banks. It has been shown that water quality parameters of the studied water body were stable and corresponded to thresholds established for cyprinids. Full article