SIX YEAR CLINICAL AND IMAGING FOLLOW UP OF AN OFFICE BASED GENE EXPRESSION CLASSIFIERUSED TO MANAGE THYROID NODULES
|
|
- Mae White
- 5 years ago
- Views:
Transcription
1 SIX YEAR CLINICAL AND IMAGING FOLLOW UP OF AN OFFICE BASED GENE EXPRESSION CLASSIFIERUSED TO MANAGE THYROID NODULES
2 Investigator B Michael MD FACE ECNU Gettysburg PA
3 Disclosures Speakers Bureau Veracyte Corp Genzyme Corp
4 The Blind Men and The Elephant
5 The Blind Men and the Elephant by John Godfrey Saxe ( ) It was eight men of Indostan To learning much inclined, Who went to see the Elephant (Though all of them were blind), That each by observation Might satisfy his mind So oft in Hippocratic wars, The disputants, I ween, Rail on in utter ignorance Of what the other means, And prate about an Elephant Not one of them has seen
6 The Thyroid Cancer Parable
7 The Thyroid Cancer Challenge In the early days of thyroidology, 5% of thyroid nodules turned out to be malignant and without sophisticated testing, most pts went to surgery to rule out cancer 1 In the mid-80 s FNA reduced the number of diagnostic surgeries by about 50%, by identifying patients with benign cytology Today, however, 10-30% of thyroid FNA s are pre-classified by cytologists as indeterminate (not clearly benign or malignant), and in this group only 25% are malignant on surgical path (so that 75% of surgeries in this group could be avoided at a cost of $12-15,000 per surgery) 2,3 1 Mazzaferri EL NEJM Bryson et al Arch O Matolaryngol Head Neck Surg Li H, et al J Clin Endocrinol Metab 2011
8 Molecular Diagnostics in Thyroidology 60% of thyroid cancers appear to contain at least one known genetic mutation Molecular analysis has an evolving role as an adjunct to cytologic analysis of FNA material Several commercial products are now available to evaluate thyroid aspirates using genetic technologies
9 Veracyte/Afirma A commercially available gene expression classifier is approved for clinical use with indeterminate FNA specimens In three validation studies, the Afirma/GEC has demonstrated high sensitivity and high negative predictive value while helping physicians decide which patients with indeterminate FNA s should undergo Tx
10 METHODS The collection period constituted the first 26 months that the Afirma/GEC technique was commercially available
11 Study Structure 447 individual thyroid nodules were evaluated in adult patients between January 2011 and March 2014 in my location All nodules were >1 cm in size All material was submitted for liquid based cytology or alcohol fixation cytology to the same thyroid cytopathology group Preserved RNA was submitted for Afirma/GEC analysis on all indeterminate specimens (Veracyte in San Francisco)
12 44 GEC were successfully run on 44 patients with indeterminate cytology. 28 GEC suspicious specimens were referred for surgery
13 The compiled short term results of a larger multi city sample have been reported elsewhere. 16 GEC benign nodule patients were evaluated for long term follow up from the Gettysburg location This is the subject group of the study
14 Limited long term follow up data are available regarding patients evaluated in this manner I am reporting the 6 year outcomes data from the patients in a single location
15 Study Design Patients with benign Afirma/GEC markers were observed with interval history, physical exam and ultrasound at 6 months from initial biopsy, then annually thereafter with exceptions for symptoms or cosmesis)
16 RESULTS Three of the GEC benign Group underwent surgery within the first year of observation (18%) One had a large symptomatic nodule with benign histopathology One had rapid symptomatic enlargement of a nodule during pregnancy. (benign histopathology)
17 RESULTS One had two GEC evaluated nodules with one reported benign and the second suspicious. The classifier was correct in each case on final pathology
18 This raises the obvious questions What could possibly go wrong? Does utilizing this expensive test really save money in the long run?
19 RESULTS The remaining thirteen GEC benign patients(82%) were successfully followed by the criteria discussed. 6 have been followed 5-6 years 4 have been followed years 3 have been followed years
20 RESULTS All patients in this group have remained asymptomatic Physical exam has remained stable Serial ultrasound examination has shown no change in appearance, volume or characteristics of the nodules under surveillance
21 CONCLUSIONS Literature suggests 10-30% of thyroid nodules biopsied and submitted for cytology are not clearly benign or malignantcytologically indeterminate Initial results in pooled group reported previously 17.8 % Gettysburg subset 10%
22 CONCLUSIONS 37 percent of patients in this indeterminate group who previously would have been referred for surgery have been observed using Afirma/GEC results for guidance
23 CONCLUSIONS Long term Follow up of GEC benign thyroid nodules in a community practice setting for a time period of up to six years appears to be a viable option to surgery in many patients with indeterminate cytology on initial biopsy
24 CONCLUSIONS Potential savings to the medical system in this small sample are estimated at $91,000 using average medicare reimbursement for thyroid surgery in South Central PA plus facility fees and deducting the cost of genetic testing
25 UNANSWERED ISSUES What is the Afirma/GEC false negative rate in clinical practice? My numbers of operated benign Afirma/GEC s are too small at this point to be meaningful If a substantial number of GEC benign indeterminate patients can be safely followed over long time periods without adverse outcome does the above issue matter?
26 In the future, larger numbers of GEC benign patients who undergo surgery for other reasons will likely provide a real world answer to this question I am preparing the data from the initial collection dates onward and hope to report these larger patient numbers as well
27 IN 2017 Clinical judgment using all the historic and diagnostic data still trumps any one test As the arbiter of who gets surgery and who doesn t, the endocrinologist remains the blind-man-in-chief.
28 The unexamined life is not worth living SOCRATES ( B.C.E.)
29 The unexamined practice is not worth paying CMS (1965-? )
30 SPECIAL THANKS RM Harrell MD FACP FACE ECNU Memorial Center for Integrative Endocrine Surgery, Hollywood FL (previous) Kathleen Hands MD FACE ECNU Thyroid Diagnostic Center of S. Texas San Antonio TX (previous)
31 THANK YOU
SURGICAL UTILITY OF AFIRMA: EFFECTS OF HIGH CANCER PREVALENCE AND ONCOCYTIC CELL TYPES IN PATIENTS WITH INDETERMINATE THYROID CYTOLOGY
ENDOCRINE PRACTICE Rapid Electronic Article in Press Rapid Electronic Articles in Press are preprinted manuscripts that have been reviewed and accepted for publication, but have yet to be edited, typeset
More informationThyroid Nodules. Hossein Gharib, MD, MACP, MACE
Thyroid Nodules Hossein Gharib, MD, MACP, MACE Professor of Medicine Mayo Clinic College of Medicine President Elect, American College of Endocrinology University Course January 2008 CP1294362-1 Thyroid
More informationMolecular Testing for Indeterminate Thyroid Nodules. October 20, 2018
Molecular Testing for Indeterminate Thyroid Nodules October 20, 2018 Patient 1: Left 1.0 cm AP x 1.6 cm transverse x 2.1 cm in length Well defined Isoechoic heterogeneous No calcification Grade 3 Vascularity
More informationEndocrine University 2016 Thyroid Ultrasound and FNAB Course
Endocrine University 2016 Thyroid Ultrasound and FNAB Course Information is based on national CMS guidelines Check with local carriers for specific guidelines Coding and reimbursement vary tremendously
More informationELEPHANT IN THE OFFICE!
Ethics ELEPHANT IN THE OFFICE! Ethical Choices Learn to distinguish between right & wrong Professional groups or an employer s code of ethics can help Restrain yourself from choosing the wrong path Don
More informationCLINICAL MEDICAL POLICY
Policy Name: Policy Number: Responsible Department(s): CLINICAL MEDICAL POLICY Molecular Markers for Fine Needle Aspirates of Thyroid Nodules MP-065-MD-DE Medical Management Provider Notice Date: 10/15/2018;
More informationGlyphosate: Get the Facts NEPPSC
Glyphosate: Get the Facts NEPPSC January 8, 2019 Timothy Pastoor, PhD, DABT, ATS Pastoor Science Communications, LLC I am not affiliated with Monsanto, Bayer or any entity with interests in glyphosate
More informationThyroid nodules 3/22/2011. Most thyroid nodules are benign. Thyroid nodules: differential diagnosis
Most thyroid nodules are benign Thyroid nodules Postgraduate Course in General Surgery thyroid nodules occur in 77% of the world s population palpable thyroid nodules occur in about 5% of women and 1%
More information5/3/2017. Ahn et al N Engl J Med 2014; 371
Alan Failor, M.D. Clinical Professor of Medicine Division of Metabolism, Endocrinology and Nutrition University of Washington April 20, 2017 No disclosures to report 1. Appropriately evaluate s in adult
More information2015 American Thyroid Association Thyroid Nodule and Cancer Guidelines
2015 American Thyroid Association Thyroid Nodule and Cancer Guidelines Angela M. Leung, MD, MSc, ECNU November 5, 2016 Outline Workup of nontoxic thyroid nodule(s) Ultrasound FNAB Management of FNAB results
More informationASC Companion Meeting at the 2017 USCAP: Ancillary Molecular Testing in "Indeterminate. Thyroid Nodules: How Far Have We Come?
ASC Companion Meeting at the 2017 USCAP: Ancillary Molecular Testing in "Indeterminate Thyroid Nodules: How Far Have We Come? William C. Faquin, MD, PhD, Massachusetts General Hospital, Boston, MA The
More informationSection 2 Original Policy Date 2013 Last Review Status/Date September 1, 2014
Policy Number 2.04.82 Molecular Markers in Fine Needle Aspirates of the Thyroid Medical Policy Section 2 Original Policy Date 2013 Last Review Status/Date September 1, 2014 Disclaimer Our medical policies
More informationThe Bethesda System for Reporting Thyroid Cytopathology, Laila Khazai 11/4/17
The Bethesda System for Reporting Thyroid Cytopathology, 2017 Laila Khazai 11/4/17 In Summary No major changes for cytologists. The clinical team is faced with different risk of malignancies (ROM) associated
More informationHow to Use Molecular Genetic Studies in Endocrine Disease? (in the Management of Well- Differentiated Thyroid Cancer) No Conflicts to Declare
How to Use Molecular Genetic Studies in Endocrine Disease? (in the Management of Well- Differentiated Thyroid Cancer) No Conflicts to Declare Quan-Yang Duh Professor of Surgery University of California,
More informationThyroid Nodules. Family Medicine Refresher Course Geeta Lal MD, FACS April 2, No financial disclosures
Thyroid Nodules Family Medicine Refresher Course Geeta Lal MD, FACS April 2, 2014 No financial disclosures Objectives Review epidemiology Work up of Thyroid nodules Indications for FNAB Evolving role of
More informationImproving the Long Term Management of Benign Thyroid Nodules
25 th Annual Scientific AACE Clinical Congress Improving the Long Term Management of Benign Thyroid Nodules Stephanie L. Lee, MD, PhD Director, Thyroid Health Center Section of Endocrinology, Diabetes
More information5/18/2013. Most thyroid nodules are benign. Thyroid nodules: new techniques in evaluation
Most thyroid nodules are benign Thyroid nodules: new techniques in evaluation Incidence Etiology Risk factors Diagnosis Gene classification system Treatment Postgraduate Course in General Surgery Jessica
More informationRepeat Thyroid Nodule Fine-Needle Aspiration in Patients With Initial Benign Cytologic Results
Anatomic Pathology / REPEAT THYROID FINE-NEEDLE ASPIRATION Repeat Thyroid Nodule Fine-Needle Aspiration in Patients With Initial Benign Cytologic Results Melina B. Flanagan, MD, MSPH, 1 N. Paul Ohori,
More informationTHYROID CYTOLOGY THYROID CYTOLOGY FINE-NEEDLE-ASPIRATION ANCILLARY TESTS IN THYROID FNA
ANCILLARY TESTS IN THYROID FNA Prof. Fernando Schmitt Department of Pathology and Oncology, Medical Faculty of Porto University Head of Molecular Pathology Unit, IPATIMUP General-Secretary of the International
More informationMolecular Markers in Fine Needle Aspirates of the Thyroid
Molecular Markers in Fine Needle Aspirates of the Thyroid Policy Number: 2.04.78 Last Review: 3/2014 Origination: 3/2013 Next Review: 3/2015 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will
More informationWork Up & Evaluation of Thyroid Nodules In 2013: State of The Art
Work Up & Evaluation of Thyroid Nodules In 2013: State of The Art BC Surgical Oncology Network, Fall Update Todd McMullen MD PhD FRCSC FACS Endocrine Surgeon Divisions of General Surgery and Oncology Director,
More informationUSGFNA of thyroid nodules
US Guided FNA (USGFNA) of neck masses INTERVENTIONAL HEAD & NECK ULTRASOUND Brendan C. Stack, Jr., MD., FACS, FACE Professor Otolaryngology-Head and Neck Surgery Indications Technique Interpretation Results
More informationMolecular Cytology That Transforms Patient Care. William Blair 35 th Annual Growth Stock Conference June 9, 2015
Molecular Cytology That Transforms Patient Care William Blair 35 th Annual Growth Stock Conference June 9, 2015 Forward-Looking Statements Various remarks that we make in this presentation that are not
More informationThyroid nodules. Most thyroid nodules are benign
Thyroid nodules Postgraduate Course in General Surgery Jessica E. Gosnell MD Assistant Professor March 22, 2011 Most thyroid nodules are benign thyroid nodules occur in 77% of the world s population palpable
More informationThyroid Nodules: What to do next?
Thyroid Nodules: What to do next? Ally P. H. Prebtani Professor of Medicine Internal Medicine, Endocrinology & Metabolism McMaster University Canada Copyright 2017 by Sea Courses Inc. All rights reserved.
More informationA Study of Thyroid Swellings and Correlation between FNAC and Histopathology Results
International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 6 Number 4 (2017) pp. 265-269 Journal homepage: http://www.ijcmas.com Original Research Article https://doi.org/10.20546/ijcmas.2017.604.030
More informationRunning Title: Utility of HCG Washout in Cervical LND FNA
AACE Clinical Case Reports Rapid Electronic Articles in Press Rapid Electronic Articles in Press are preprinted manuscripts that have been reviewed and accepted for publication, but have yet to be edited,
More informationThe Bethesda Indeterminate Categories: An Update to Diagnosis and Molecular Testing
William C. Faquin, MD, PhD Professor of Pathology Harvard Medical School Director, Head and Neck Pathology Massachusetts Eye and Ear Massachusetts General Hospital The Bethesda Indeterminate Categories:
More informationMolecular Cytology. Improving Patient Outcomes and Reducing the Cost of Care. June 2014
Molecular Cytology Improving Patient Outcomes and Reducing the Cost of Care June 2014 Forward-Looking Statements Various remarks that we make in this presentation that are not historical, including those
More informationThyroid Ultrasound And Ultrasound-Guided FNA Biopsy
Thyroid Ultrasound And Ultrasound-Guided FNA Biopsy If you are looking for the ebook Thyroid Ultrasound and Ultrasound-Guided FNA Biopsy in pdf format, in that case you come on to correct website. We furnish
More informationDisclosures. Learning objectives. Case 1A. Autoimmune Thyroid Disease: Medical and Surgical Issues. I have nothing to disclose.
Disclosures Autoimmune Thyroid Disease: Medical and Surgical Issues I have nothing to disclose. Chrysoula Dosiou, MD, MS Clinical Assistant Professor Division of Endocrinology Stanford University School
More informationHEAD AND NECK ENDOCRINE SURGERY
HEAD AND NECK ENDOCRINE SURGERY OCTOBER 22-23, 2010 THE MARK HOPKINS SAN FRANCISCO, CA THYROID FNA AND CYTOPATHOLOGY THEODORE R. MILLER, MD THE THYROID NODULE Prevalence of palpable nodule: Female ~ 6%
More informationMedical Policy Manual. Topic: Molecular Markers in Fine Needle Aspirates of the Thyroid. Date of Origin: April 2013
Medical Policy Manual Topic: Molecular Markers in Fine Needle Aspirates of the Thyroid Date of Origin: April 2013 Section: Genetic Testing Last Reviewed Date: April 2014 Policy No: 49 Effective Date: July
More informationThyroid Nodules. Dr. HAKIMI, SpAK Dr. MELDA DELIANA, SpAK Dr. SISKA MAYASARI LUBIS, SpA
Thyroid Nodules ENDOCRINOLOGY DIVISION ENDOCRINOLOGY DIVISION Dr. HAKIMI, SpAK Dr. MELDA DELIANA, SpAK Dr. SISKA MAYASARI LUBIS, SpA Anatomical Considerations The Thyroid Nodule Congenital anomalies Thyroglossal
More informationThyroid Cancer (Carcinoma)
Information for Patients Thyroid Cancer (Carcinoma) Prepared by the American Association of Clinical Endocrinologists (AACE), a not-for-profit national organization of highly qualified specialists in hormonal
More informationClinical Guidance in Thyroid Cancers. Stephen Robinson Imperial at St Mary s On behalf of BTA
Clinical Guidance in Thyroid Cancers Stephen Robinson Imperial at St Mary s On behalf of BTA Background to thyroid cancer Incidence probably increasing slowly 1971-95; 2.3 women 0.9 men /100,000 2001;
More informationThyroid Cytopathology: Weighing In The Bethesda System
Thyroid Cytopathology: Weighing In The Bethesda System V8 Conflicts No financial consideration Bias Work in the Canadian environment where litigation is less Thyroid cytology is often referred in by small
More informationLet s Make Sense of Present & Predict Future. In Light of Past 1/12/2016
The New Diagnostic Paradigms in Thyroid Surgical Pathology and Affects on Reporting of Thyroid Fine Needle Aspiration Specimens Deliberations, Criticisms & Discussions Zubair W. Baloch, MD, PhD. Professor
More informationMolecular Markers in Fine Needle Aspirates of the Thyroid Section 2.0 Medicine Subsection 2.04 Pathology/Laboratory
2.04.78 Molecular Markers in Fine Needle Aspirates of the Thyroid Section 2.0 Medicine Subsection 2.04 Pathology/Laboratory Effective Date November 26, 2014 Original Policy Date November 26, 2014 Next
More informationWhat you need to know about Thyroid Cancer
What you need to know about Thyroid Cancer This booklet has been designed to help you to learn more about your thyroid cancer. It covers the most important areas and answers some of the frequently asked
More informationULTRASOUND GUIDED FNA: WHEN, HOW, AND WHY
ULTRASOUND GUIDED FNA: WHEN, HOW, AND WHY Marika Russell, MD, FACS Assistant Professor, UCSF OHNS Disclosures: none Overview Background Indications Technique Outcomes Survey Office-based ultrasound? USG-FNA?
More informationVolume 2 Issue ISSN
Volume 2 Issue 3 2012 ISSN 2250-0359 Correlation of fine needle aspiration and final histopathology in thyroid disease: a series of 702 patients managed in an endocrine surgical unit *Chandrasekaran Maharajan
More informationThyroid Update. Timothy C. Petersen, MD, ECNU
Thyroid Update Timothy C. Petersen, MD, ECNU TPMG Coastal Endocrinology Virginia Beach, VA About Me Board Certified Endocrinology, Diabetes, and Metabolism Internal Medicine ECNU Certified Endocrine Certification
More informationThyroidology Private Practice
Thyroidology Private Practice Mark A. Lupo, MD, FACE, ECNU Thyroid & Endocrine Center of Florida Sarasota, Florida October 18, 2013 ATA Fellows Track My Thyroidology Practice Single sub-specialty private
More information3/27/2017. Disclosure of Relevant Financial Relationships. Each year over 550,000 thyroid FNAs are performed in the U.S.!!! THYROID FNA: THE GOOD NEWS
Disclosure of Relevant Financial Relationships William C. Faquin, MD, PhD Director, Head and Neck Pathology Massachusetts Eye and Ear Massachusetts General Hospital Professor of Pathology Harvard Medical
More informationThyroid Cancer: When to Treat? MEGAN R. HAYMART, MD
Thyroid Cancer: When to Treat? MEGAN R. HAYMART, MD ASSOCIATE PROFESSOR OF MEDICINE UNIVERSITY OF MICHIGAN MICHIGAN AACE 2018 ANNUAL MEETING Thyroid Cancer: When Not to Treat? FOCUS WILL BE ON LOW-RISK
More informationThyroid Nodule Management
Thyroid Nodule Management Shane O. LeBeau, MD Clinical Associate Professor of Medicine Clinical Lead, Endocrine Thyroid Unit Division of Endocrinology, Diabetes and Metabolism University of Pittsburgh
More informationRE-AUDIT OF THYROID FNA USING THE THY GRADING SYSTEM AND HISTOLOGY AT SUNDERLAND ROYAL HOSPITAL, 2011
Audit: RE-AUDIT OF THYROID FNA USING THE THY GRADING SYSTEM AND HISTOLOGY AT SUNDERLAND ROYAL HOSPITAL, 2011 Auditors: Dr Lena Wilkinson SpR Histopathology Dr. Debra Milne Consultant Histocytopathologist
More informationSocioeconomics Update in Thyroid Practice
Socioeconomics Update in Thyroid Practice Mark A. Lupo, MD, FACE, ECNU Thyroid & Endocrine Center of Florida Assistant Clinical Professor of Medicine Florida State University, College of Medicine Sarasota,
More informationManagement of Thyroid Nodules. February 2 nd, 2018 Sarah Hopkins
Management of Thyroid Nodules February 2 nd, 2018 Sarah Hopkins No disclosures Goals: Review Initial Evaluation of Thyroid Nodules Review Indications for Biopsy Approach to Multinodular Goiter Review Management
More informationSonographic Features of Thyroid Nodules & Guidelines for Management
Sonographic Features of Thyroid Nodules & Guidelines for Management Mark A. Lupo, MD, FACE, ECNU Thyroid & Endocrine Center of Florida Assistant Clinical Professor of Medicine Florida State University,
More informationSurgical Management of Thyroid Disease. Tom Shi Connally, MD, FACS
Surgical Management of Thyroid Disease Tom Shi Connally, MD, FACS Disclosures Speaker Bureau: Veracyte Castle Diagnostics Objectives Understand the role of ultrasound and FNA in managing thyroid cancer
More informationRole of ultrasonography in recognition of malignant potential of thyroid nodules on the basis of their internal composition
Role of ultrasonography in recognition of malignant potential of thyroid nodules on the basis of their internal composition Nodular thyroid is a common clinical entity. All patients were evaluated by grey
More informationIntroduction: Ultrasound guided Fine Needle Aspiration: When and how
International Course of Thyroid Ultrasonography and minimally invasive procedure 7-8 October 2016 University of Pisa, Italy Introduction: Ultrasound guided Fine Needle Aspiration: When and how Teresa Rago
More informationOh, I get it, the TSH goes up and down
Evaluation and Management of the Thyroid Nodule Oh, I get it, the TSH goes up and down UCSF Head and Neck Conference October 24, 2008 Peter A. Singer, M.D. Professor and Chief Clinical Endocrinology University
More informationFNA thyroid. Thyroid FNA accuracy. Thyroid FNA And Cytopathology. Variability in FNA sampling via palpation
Thyroid FNA And Cytopathology University of California, San Francisco FNA thyroid Wide range of accuracy- causes Overview of tools and sampling Preparation techniques Impact of US guidance Impact of training
More information40 TH EUROPEAN CONGRESS 0F CYTOLOGY LIVERPOOL, UK October 2-5, 2016
Outcomes from the diagnostic approach of thyroid lesions using US-FNA and LBC in clinical practice Emmanouel Mastorakis MD PhD Cytopathologist Director in Cytopathology Laboratory Regional General Hospital
More informationRecertification Process Manual
Endocrine Certification in Neck Ultrasound ECNU - Recertification Process Manual For candidates who have successfully completed the Endocrine Certification in Neck Ultrasound process The Endocrine Certification
More informationUpdate on Thyroid FNA The Bethesda System. Shikha Bose M.D. Associate Professor Cedars Sinai Medical Center
Update on Thyroid FNA The Bethesda System Shikha Bose M.D. Associate Professor Cedars Sinai Medical Center Thyroid Nodules Frequent occurrence Palpable: 4-7% of adults Ultrasound: 10-31% Majority benign
More informationACCME/Disclosures. Questions to Myself? 4/11/2016
The New Diagnostic Paradigms in Thyroid Surgical Pathology and Affects on Reporting of Thyroid Fine-Needle Aspiration Specimens Deliberations, Criticisms & Discussions Zubair W. Baloch, MD, PhD. Professor
More informationStrategies for detection of recurrent disease in longterm follow-up of differentiated thyroid cancer
Strategies for detection of recurrent disease in longterm follow-up of differentiated thyroid cancer A rational approach to longterm follow-up based on dynamic risk assessment. World Congress on Thyroid
More informationDr Catherine Woolnough, Hospital Scientist, Chemical Pathology, Royal Prince Alfred Hospital. NSW Health Pathology University of Sydney
Dr Catherine Woolnough, Hospital Scientist, Chemical Pathology, Royal Prince Alfred Hospital NSW Health Pathology University of Sydney Thyroid Cancer TC incidence rates in NSW Several subtypes - Papillary
More information(1) Endocrinologists do not have the training and do not possess the skills to perform specimen adequacy assessment.
February 20, 2014 Kathleen Todd, MT (ASCP) Medical Technologist Division of Laboratory Services Survey and Certification Group Centers for Medicare & Medicaid Services 7500 Security Blvd. (Mailstop: C2-21-16)
More informationNational Training Course in Thyroid Ultrasound and FNAC
For endocrinologists and specialists in thyroid disease National Training Course in Thyroid Ultrasound and FNAC Guy s Hospital London, UK British Thyroid Association Course details Dates Friday Venue Robens
More informationClinical performance and utility of Afirma GEC in a community hospital practice
Clinical performance and utility of Afirma GEC in a community hospital practice Michael Traynor, Jacob Torrison, Faculty: Hallanger-Johnson JE, Newman DW, and Beal JR PURPOSE: To assess the performance
More informationInterpreting the Thyroid Ultrasound Report
Interpreting the Thyroid Ultrasound Report Michael Neuman, MD Radiology Specialists of the Northwest February 2, 2018 Goals Review indications for thyroid ultrasound Review the role of ultrasound in evaluation
More informationThe Frozen Section: Diagnostic Challenges and Pitfalls
The Frozen Section: Diagnostic Challenges and Pitfalls William C. Faquin, M.D., Ph.D. Director, Head and Neck Pathology Massachusetts General Hospital & Massachusetts Eye and Ear Infirmary Harvard Medical
More informationFNA Thyroid Cytology Structured Reporting Proforma
FNA Thyroid Cytology Structured Reporting Proforma Mandatory questions (i.e. protocol standards) are in bold (e.g. S1.03). Family name Given name(s) Date of birth S1.02 Clinical details Male Female Intersex/indeterminate
More information3/29/2012. Thyroid cancer- what s new. Thyroid Cancer. Thyroid cancer is now the most rapidly increasing cancer in women
Thyroid cancer- what s new Thyroid Cancer Changing epidemiology Molecular markers Lymph node dissection Technical advances rhtsh Genetic testing and prophylactic surgery Vandetanib What s new? Jessica
More informationReview of Literatures
Review of Literatures Fine needle biopsy was popular in the Scandinavian countries some four decades ago. Though FNAC for any palpable tumor was first introduced in America in the 1920s by Martin, Ellis
More informationBackground to the Thyroid Nodule
William C. Faquin, MD, PhD Professor of Pathology Harvard Medical School Director of Head and Neck Pathology Massachusetts Eye and Ear Massachusetts General Hospital THYROID FNA: PART I Background to the
More informationBuilding On The Best A Review and Update on Bethesda Thyroid 2017
Building On The Best A Review and Update on Bethesda Thyroid 2017 Syed Z. Ali, MD, FRCPath, FIAC Professor of Pathology and Radiology The Johns Hopkins Hospital, Baltimore, Maryland USA TBSRTC Diagnostic
More informationPreoperative Evaluation
Preoperative Evaluation Lateral compartment lymph nodes are easier to detect and are amenable to FNA Central compartment lymph nodes are much more difficult to detect and FNA (Tg washout testing is compromised)
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Molecular Markers in Fine Needle Aspirates of the Thyroid Page 1 of 25 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Molecular Markers in Fine Needle Aspirates
More informationMolecular Markers in Fine Needle Aspirates of the Thyroid
Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided
More informationThyroid nodules - medical and surgical management. Endocrinology and Endocrine Surgery Manchester Royal Infirmary
Thyroid nodules - medical and surgical management JRE Davis NR Parrott Endocrinology and Endocrine Surgery Manchester Royal Infirmary Thyroid nodules - prevalence Thyroid nodules common, increase with
More informationApproach to Thyroid Nodules
Approach to Thyroid Nodules Alice Y.Y. Cheng, MD, FRCPC Twitter: @AliceYYCheng Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted
More informationHow to Handle Thyroid FNA
How to Handle Thyroid FNA Maoxin Wu, MD, PhD Chief of Cytopathology Director of Fine Needle Aspiration (FNA) and Core Biopsy Services Clinical Professor, Department of Pathology Joint appointment, Department
More informationMegan R. Haymart, MD 83 rd Annual Meeting of the ATA October 16, 2013
Megan R. Haymart, MD 83 rd Annual Meeting of the ATA October 16, 2013 Disclosure: Nothing to Disclose Learning Objectives Thyroid cancer - diagnosis - prognosis - treatment - follow-up Thyroid function
More informationTBSRTC 1- Probabilistic approach and Relationship to Clinical Algorithms
The Benefits of a Uniform Reporting System for Thyroid Cytopathology BETHESDA REPORTING SYSTEM Prof. Fernando Schmitt Department of Pathology and Oncology, Medical Faculty of Porto University Head of Molecular
More informationRisk of Thyroid Cancer Based on Thyroid Ultrasound Imaging Characteristics
Risk of Thyroid Cancer Based on Thyroid Ultrasound Imaging Characteristics Diabetes Update and Advances in Endocrinology & Metabolism Vickie A Feldstein MD Rebecca Smith- Bindman MD Department of Radiology
More informationUniversity of Pisa, Italy
SCIENTIFIC PROGRAMME International School of Thyroid Ultrasonography University of Pisa, Italy Live educational course dates The International School of Thyroid Ultrasonography Advanced practical thyroid
More informationThyroid Ultrasound for the Endocrine Surgeon: A Valuable Clinical Tool that Enhances Diagnostic and Therapeutic Outcomes
Thyroid Ultrasound for the Endocrine Surgeon: A Valuable Clinical Tool that Enhances Diagnostic and Therapeutic Outcomes Allan Siperstein MD The Cleveland Clinic Audience Quiz Taken ultrasound course Perform
More informationEndocrine Surgery When to Refer and What We Do
Endocrine Surgery When to Refer and What We Do None Disclosures W. Heath Giles, M.D., F.A.C.S. Surgery Residency Program Director Assistant Professor of Surgery What is Endocrine Surgery? Who performs
More informationMolecular Markers in Fine Needle Aspirates of the Thyroid
Molecular Markers in Fine Needle Aspirates of the Thyroid Policy Number: 2.04.78 Last Review: 3/2018 Origination: 3/2013 Next Review: 3/2019 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will
More informationThe New England Journal of Medicine. A Bronchial Genomic Classifier for the Diagnostic Evaluation of Lung Cancer
The New England Journal of Medicine A Bronchial Genomic Classifier for the Diagnostic Evaluation of Lung Cancer May 18, 2015 Forward-Looking Statements Various remarks that we make on this call that are
More informationULTRASOUND GUIDED THYROID FINE- NEEDLE ASPIRATION, SAMPLE ADEQUACY WITH AND WITHOUT IMMEDIATE CYTOPATHOLOGY ANALYSIS
ULTRASOUND GUIDED THYROID FINE- NEEDLE ASPIRATION, SAMPLE ADEQUACY WITH AND WITHOUT IMMEDIATE CYTOPATHOLOGY ANALYSIS Richard Grinstead, DO Chief Radiology Resident, PGY-4, R-3 Arnot Ogden Medical Center
More informationAACE/ACE Advanced Endocrine Neck Ultrasound Training Course 2016
AACE/ACE Advanced Endocrine Neck Ultrasound Training Course 2016 This 9mm left inferior nodule should remind us all why we re here! There is no absolute number of images required for documentation
More informationMTP: Thyroid Nodules
Canadian Endocrine Update MTP: Thyroid Nodules Deric Morrison MD, FRCP, ECNU Assistant Professor, Division of Endocrinology and Metabolism, Western University April 2014 Faculty/Presenter Disclosure Faculty:
More informationWTC 2013 Panel Discussion: Minimal disease
WTC 2013 Panel Discussion: Minimal disease Susan J. Mandel MD MPH Panelists Ken Ain Yasuhiro Ito Stephanie Lee Erich Sturgis Mark Urken Faculty/Presenter Disclosure Relationships with commercial interests
More informationPRACTICE GUIDELINES: Thyroid Nodules and Cancer 2017 ESEO Alexandria
PRACTICE GUIDELINES: Thyroid Nodules and Cancer 2017 ESEO Alexandria James V. Hennessey MD Associate Professor of Medicine Harvard Medical School Case 1 28 year old woman sees OB for routine visit ROS:
More informationCorrespondence should be addressed to David N. Bimston; Received 23 January 2017; Accepted 20 March 2017; Published 13 April 2017
Hindawi International Surgical Oncology Volume 2017, Article ID 4689465, 6 pages https://doi.org/10.1155/2017/4689465 Research Article Noninvasive Encapsulated Follicular Variant of Papillary Thyroid Cancer:
More informationThe role of the cytologist in breast cancer screening
The role of the cytologist in breast cancer screening I.Seili-Bekafigo, MD, PhD Clinical cytologist KBC Rijeka Croatian Society for Clinical Cytology Fine needle aspiration (FNA, FNAB, FNAC) Fine needle
More informationOverview of Indeterminate Cytology
83 rd Annual Meeting American Thyroid Association Overview of Indeterminate Cytology Scott Boerner MD FRCPC Head Cytopathology, University Health Network University of Toronto DISCLOSURE Nothing to disclose
More informationPEDIATRIC Ariel Katz MD
PEDIATRIC Ariel Katz MD Dept. Otolaryngology Head &Neck Surgery Wolfson Medical Center Holon, Israel OBJECTIVES Overview/Background Epidemiology/Etiology Intro to Guidelines Workup Treatment Follow-Up
More informationDifferentiated Thyroid Carcinoma
Differentiated Thyroid Carcinoma The GOOD cancer? Jennifer Sipos, MD Associate Professor of Medicine Director, Benign Thyroid Program Division of Endocrinology, Diabetes and Metabolism The Ohio State University
More informationDisclosures. Parathyroid Pathology. Objectives. The normal parathyroid 11/10/2012
Disclosures Parathyroid Pathology I have nothing to disclose Annemieke van Zante MD/PhD Assistant Professor of Clinical Pathology Associate Chief of Cytopathology Objectives 1. Review the pathologic features
More informationNIFTP Cytologic Aspects
NIFTP Cytologic Aspects William C. Faquin, MD PhD Director, Head and Neck Pathology Massachusetts General Hospital & Massachusetts Eye and Ear Infirmary Boston, MA USA So, what is the story about FVPTC
More informationAACE Thyroid Cancer Tumor board 25 years of the Endocrine and Surgery collaboration
AACE Thyroid Cancer Tumor board 25 years of the Endocrine and Surgery collaboration Dr. Peter Singer, Endocrinology Dr. Peter Sadow, Pathology Moderator Dr. Greg Randolph, Otolaryngology Relevant Financial
More informationHow good are we at finding nodules? Thyroid Nodules Thyroid Cancer Epidemiology Initial management Long-term follow up Disease-free status
New Perspectives in Thyroid Cancer Jennifer Sipos, MD Assistant Professor of Medicine Division of Endocrinology The Ohio State University Outline Thyroid Nodules Thyroid Cancer Epidemiology Initial management
More information