Preoperative and follow-up tests for thyroid tumors

描述（由申请人提供）：我们的长期目标是开发一种更准确的测试，可以在术前区分良性和恶性甲状腺结节。目前，细针穿刺（FNA）细胞学检查是评估甲状腺结节的最佳非手术诊断工具。然而，大约30%的结节被归类为可疑。由于目前的方法是基于形态学特征，并未能提高灵敏度和特异性，它仍然是一个常见的临床问题，特别是对病理学家的挑战。为了解决这个问题，我们之前对滤泡性甲状腺腺瘤（FTA）和滤泡性甲状腺癌（FTC）进行了基因表达谱分析。这种分析和随后的分析显示，四种新的标志物（DDIT 3，ARG 2，C1 orf 24和ITM 1）在两种肿瘤之间存在差异，表达水平的线性组合将FTC与FTA区分开来，估计预测准确度为0.83。DDIT 3和ARG 2的市售抗体用于在一组独立的FTA和FTC石蜡包埋切片中进行进一步验证。每种抗体的敏感性和特异性分别为85%和91%。联合使用这两种抗体并没有改善估计值。我们定制了C1 or 24和ITM 1的抗体，并在上述FTA和FTC切片中对其进行了测试。我们达到了100%的灵敏度。此外，这些新的标记物可以可靠地将其他甲状腺病变分类为良性或恶性。我们的假设是，基因表达谱将定位新的诊断标记，可以提高测试的特异性。我们将使用基因表达系列分析（SAGE）来分析Hurthle细胞腺瘤，该细胞腺瘤最初被错误分类为恶性，因此预计将提高术前诊断试验的特异性。我们的下一个目标是开发一种可以常规用作FNA细胞学辅助的测试。为了实现这一目标，我们建议在本申请的R33阶段评估抗体和定量RT-PCR检测诊断甲状腺结节的有效性。为了评估两种检测的准确性和可行性，将这些分析的结果与最终组织学结果进行比较。开发一种用于评估甲状腺结节的创新和更准确的术前诊断测试不仅会导致癌症诊断的进展，而且还将改善治疗决策，同时降低长期健康成本。

DESCRIPTION (provided by applicant): Our long term goal is to develop a more accurate test that can preoperatively distinguish a benign from a malignant thyroid nodule. Currently, fine-needle aspiration (FNA) cytology is the best non-surgical diagnostic tool for evaluating a thyroid nodule. However, approximately 30% of all nodules are classified as suspicious. Because the current method is based on morphological features, and fails to improve the sensitivity and specificity, it remains a frequent clinical problem with challenges in particular to the pathologist. To address this problem, we previously performed gene expression profiling both a follicular thyroid adenoma (FTA), and a follicular thyroid carcinoma (FTC). This profiling and subsequent analysis revealed that four novel markers (DDIT3, ARG2, C1orf24 and ITM1) differed between the two tumors and a linear combination of expression levels distinguished FTC from FTA with an estimated predictive accuracy of 0.83. Commercially available antibodies for DDIT3 and ARG2 were used for further validation in an independent set of FTA and FTC paraffin-embedded sections. Sensitivity and specificity were 85% and 91% respectively for each antibody. Using the two antibodies in combination did not improve the estimates. We custom produced antibodies for C1or24 and ITM1 and tested them in the aforementioned set of FTA and FTC sections. We achieved a sensitivity of 100%. Furthermore, these novel markers can reliably classify other thyroid lesions into benign or malignant classes. Our hypothesis is that gene expression profiling will locate novel diagnostic markers that can improve the specificity of the test. We will use Serial Analysis of Gene Expression (SAGE), to profile Hurthle cell adenoma which was originally misclassified as malignant and, therefore, predicted to improve the specificity of preoperative diagnosis test. Our next goal is to develop a test that can be routinely used as an adjuvant with FNA cytology. To achieve this goal, we propose in R33 phase of this application to evaluate the effectiveness of both antibody and quantitative RT-PCR tests to diagnose thyroid nodules. To assess the accuracy and feasibility of both tests, the results from these analyses will be compared with final histology. The development of an innovative and more accurate preoperative diagnostic test for evaluating thyroid nodules will not only result in progress in cancer diagnosis but will also improve treatment decisions while reducing long-term health costs.