Faculty Bibliography

OBJECTIVES/OBJECTIVE:Radiofrequency ablation (RFA) has become increasingly utilized for thyroid nodules. However, best practice recommendations on data collection and outcomes reporting are lacking. The objective of this study was to generate consensus guidelines for thyroid RFA data collection for purposes of quality assurance and collaborative research. METHODS:We recruited a multidisciplinary panel of experienced RFA practitioners through the North American Society for Interventional Thyroidology. Using a modified Delphi process, experts created and iteratively revised a data collection form encompassing items from the pre-, intra-, and post-procedural phases. Emphasis was placed on parameters that are readily available to both community and academic-based practitioners. Items with >70% (strongly-agree) or 100% (agree) consensus for inclusion were retained. The Delphi process and the final reporting instrument were built on REDCap. RESULTS:Ten panelists from 9 institutions performing a median of 22.5 cases/year completed five Delphi rounds. All panelists voted strongly-agree for retention on 63% (n=37) of included items. The final instrument was divided into three forms: 1. Pre-procedure (n= 18 items), 2. Immediate post-procedure (n=9 items), and 3. Follow-up (n=10 items). CONCLUSIONS:Adoption of these three new thyroid RFA data collection forms by new and established interventionalists may facilitate collaboration, standardized outcomes reporting, and clinical trial design.

PURPOSE/UNASSIGNED:Radiofrequency ablation (RFA) is an effective and safe modality for the treatment of thyroid nodules. Nodule rupture is a major complication of RFA. There is little known on the natural history of nodule rupture due to a lack of clinical experience and no consensus on its management. A comprehensive review of nodule rupture presentation, diagnosis, and management is needed. METHODS/UNASSIGNED:We report a case of nodule rupture and conduct a literature review. A total of 33 patients experiencing nodule rupture after RFA were included, and their clinical presentation, management, and outcomes were collected and analyzed. RESULTS/UNASSIGNED:Nodule rupture presents with acute swelling (90.3%) and pain (77.4%) within 7 months of RFA procedure, most commonly due to disruption of the anterior thyroid capsule (87%), and can be diagnosed with ultrasonography. Most ruptures can be managed conservatively, exemplified by our reported case. There are no reported cases of long-term sequalae. CONCLUSION/UNASSIGNED:Nodule rupture is the second most common major complication of RFA. Based on the available evidence, we propose a treatment algorithm for nodule rupture and recommendations for future data collection to address gaps in our understanding of rupture etiology and effective management.

CONTEXT/BACKGROUND:Comprehensive genomic analysis of thyroid nodules for multiple classes of molecular alterations detected in a large series of fine-needle aspiration (FNA) samples has not been reported. OBJECTIVE:To determine the prevalence of clinically relevant molecular alterations in Bethesda categories III-VI (BCIII-VI) thyroid nodules. DESIGN/METHODS:Retrospective analysis of FNA samples tested by ThyroSeq v3 using Genomic Classifier and Cancer Risk Classifier. SETTING/METHODS:UPMC MGP laboratory. PARTICIPANTS/METHODS:A total of 50,734 BCIII-VI nodules from 48,225 patients. INTERVENTION/METHODS:None. MAIN OUTCOME MEASURES/METHODS:Prevalence of diagnostic, prognostic, and targetable genetic alterations. RESULTS:Among 50,734 informative FNA samples, 65.3% were test-negative, 33.9% positive, 0.2% positive for medullary carcinoma, and 0.6% positive for parathyroid. The benign call rate in BCIII-IV nodules was 68%. Among test-positive samples, 73.3% had mutations, 11.3% gene fusions, and 10.8% isolated copy number alteration. Comparing BCIII-IV nodules with BCV-VI nodules revealed a shift from predominantly RAS-like alterations to BRAF V600E-like alterations and fusions involving receptor tyrosine kinases (RTK). Using ThyroSeq Cancer Risk Classifier, a high-risk profile, which typically included TERT or TP53 mutations, was found in 6% of samples, more frequently BCV-VI. RNA-Seq confirmed ThyroSeq detection of novel RTK fusions in 98.2% of cases. CONCLUSIONS:In this series, 68% of BCIII-IV nodules were classified as negative by ThyroSeq, potentially preventing diagnostic surgery in this subset of patients. Specific genetic alterations were detected in most BCV-VI nodules, with a higher prevalence of BRAF and TERT mutationsand targetable gene fusions compared to BCIII-IV nodules, offering prognostic and therapeutic information for patient management.