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dc.typeArtigo de periódicopt_BR
dc.titleMolecular Markers In The Diagnosis Of Thyroid Nodules.pt_BR
dc.contributor.authorWard, Laura Spt_BR
dc.contributor.authorKloos, Richard Tpt_BR
unicamp.authorLaura S Ward, Laboratory of Cancer Molecular Genetics, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil. ward@fcm.unicamp.brpt_BR T Kloos,pt
dc.subjectBiopsy, Fine-needlept_BR
dc.subjectGenetic Markerspt_BR
dc.subjectPredictive Value Of Testspt_BR
dc.subjectSensitivity And Specificitypt_BR
dc.subjectThyroid Nodulept_BR
dc.description.abstractAn indeterminate thyroid nodule cytology result occurs about every sixth fine-needle aspiration. These indeterminate nodules harbor a 24% risk of malignancy (ROM); too high to ignore, but driving surgery where most nodules are benign. Molecular diagnostics have emerged to ideally avoid surgery when appropriate, and to trigger the correct therapeutic surgery when indicated, as opposed to an incomplete diagnostic surgery. No current molecular test offers both high sensitivity and high specificity. A molecular diagnostic test with high sensitivity (e.g. Afirma Gene Expression Classifier sensitivity 90%) offers a high Negative Predictive Value when the ROM is relatively low, such as < 30%. Only such tests can rule-out cancer. In this setting, a molecularly benign result suggests the same ROM as that of operated cytologically benign nodules (~6%). Thus, clinical observation can replace diagnostic surgery; increasing quality of life and decreasing medical costs. However, its low specificity cannot rule-in cancer as a suspicious result has a Positive Predictive Value (PPV) of ~40%, perhaps too low to routinely reflex to definitive cancer surgery. Conversely, high specificity tests (BRAF, RAS, PPAR/PAX-8, RET/PTC, PTEN) offer high PPV results, and only these tests can rule-in cancer. Here a positive molecular result warrants definitive therapeutic surgery. However, their low sensitivity cannot rule-out cancer and a negative molecular result cannot dissuade diagnostic surgery; limiting their cost-effectiveness. Whether or not there is a useful and cost-effective role to sequentially combine these approaches, or to modify existing approaches, is under investigation.en
dc.relation.ispartofArquivos Brasileiros De Endocrinologia E Metabologiapt_BR
dc.relation.ispartofabbreviationArq Bras Endocrinol Metabolpt_BR
dc.identifier.citationArquivos Brasileiros De Endocrinologia E Metabologia. v. 57, n. 2, p. 89-97, 2013-Mar.pt_BR
dc.description.provenanceMade available in DSpace on 2015-11-27T13:31:32Z (GMT). No. of bitstreams: 1 pmed_23525286.pdf: 350738 bytes, checksum: 83725063ae65e1047c6ffccb9b3be4b3 (MD5) Previous issue date: 2013en
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