Collaboration between cytopathologists and clinical team leads to a publication in Thyroid® : Official Journal of the American Thyroid Association
By Xiaobing Jin | January 28
Multidisciplinary team collaboration is essential in clinical research, as it brings diverse expertise and perspectives to enhance the comprehensiveness and quality of studies. Our recent publication “Performance of Arima Genomic Sequencing Classifier in Binary Subcategories of Atypia of Undetermined Significance Thyroid Nodules: Single Versus Repeated Diagnosis” in Thyroid®, a prestigious official journal of the American Thyroid Association, exemplifies this approach. Authored by Drs. Xiaobing Jin (the first author), Madelyn Lew, Amer Heider, and Xin Jing (senior author), as well as Brian Smola, CT, and a group of clinicians specialized in thyroid diseases, this study represents a significant collaboration between cytopathologists and clinicians. It highlights the importance of multidisciplinary teamwork in advancing medical research and achieving impactful publications.
Thyroid nodules are very common, and fine needle aspiration cytology plays an initial role in the management of thyroid nodules. The Bethesda System for Thyroid Cytopathology (TBSRTC) has been widely implemented in the cytological assessment of thyroid nodules. Among the six diagnostic categories of TBSRTC, atypia of undetermined significance (AUS, category III) poses challenges in determining malignant risk and clinical management. To further simplify subclassification while reflecting malignant risk of AUS thyroid nodules, the most recent edition of TBSRTC divides AUS category into two broad categories as AUS-Nuclear atypia (AUS-N) and AUS-Other atypia (AUS-O) and recommends repeat fine needle aspiration and molecular testing in the management.
This study retrospectively reviewed 365 AUS thyroid nodules using 2023 TBSRTC as a guideline, assessing the performance of Affirm Genomic Sequencing Classifier (GSC) testing in each category and subsequently compared the individual performance in AUS-N or AUS-O subcategory between single AUS cohort and repeat AUS cohort. This study demonstrated that AUS-N nodules were more likely to be GSC suspicious, and histology-proven malignancy linked to suspicious GSC results also tended to be higher in AUS-N compared with AUS-O nodules. However, these variations do not appear to be related whether the diagnosis is a single or repeat AUS. These results provide important information for guiding the clinical management of AUS thyroid nodules.
As indicated by one of the reviewers, particular strengths of the study include a study population that appears generalizable to many real-work scenarios; the 94% rate of resection for GSC-suspicious nodules, making the outcome analysis for this group very robust; the data add to the current understanding of how molecular testing would influence current clinical practice by using the Bethesda subcategories now in use. This is another example of translational research from Michigan Pathology making a difference for our patients.
Citation:
Jin X, Broome DT, Lew M, Heider A, Haymart MR, Papaleontiou M, Chen D, Iyengar JJ, Esfandiari N, Sandouk Z, Douyon L, Hughes DT, Smola B, Jing X. Performance of Afirma Genomic Sequencing Classifier in Binary Subcategories of Atypia of Undetermined Significance Thyroid Nodules: Single Versus Repeat Diagnosis. Thyroid. 2025 Jan;35(1):41-49. doi: 10.1089/thy.2024.0277. Epub 2024 Dec 4. PMID: 39630538.
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