Last year for Thyroid Awareness Month, I wrote about the advances in ultrasound and fine-needle aspiration (FNA) biopsy to identify patients requiring surgery for thyroid cancer. This year I would like to introduce next-generation sequencing (NGS). NGS can look at variable genetic alterations within a thyroid FNA specimen and provides a comprehensive understanding of tumor biology.
In the case of the thyroid nodule, NGS offers diagnostic improvements for FNA cytology (specimen) with indeterminate features. Meaning in specimens where we cannot determine based on standard microscopic features whether a patient has cancer or not, NGS analyses the genetic features of the specimen to help determine the likelihood of cancer and whether surgery should be recommended. Given that 20-30% of FNA samples fall into categories of indeterminate cytology in up to 30% of patients, NGS can be utilized to help guide treatment and potentially avoid surgery.
NGS also can be used in patients with known cancer to help guide therapy. Certain cancer mutations lead to more aggressive cancer. Knowing a patient has a high-risk mutation allows for a more extensive surgery to be performed. For example, performing total thyroidectomy with lymph node dissection, rather than total thyroidectomy alone. Also, NGS can be used to determine whether the addition of radioactive iodine therapy postoperatively might lead to a better long-term outcome. For high-risk patients and those with recurrent cancer, an emerging treatment strategy is the development of immunotherapy. NGS can be used to determine the appropriateness of adding this therapy.
The thyroid surgeons at UTHealth East Texas ENT Center work collaboratively with our esteemed endocrinology colleagues to recommend the best treatment strategy for you or your loved one.
Information provided by Robert Strominger, MD. For more information or to schedule an appointment, call 903-747-4098 or visit uthealthtylerhospital.com/services/ear-nose-and-throat/head-neck-surgery.