fewer thyroidectomies with new test?

[scienceguy19]

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http://www.nejm.org/doi/full/10.1056/NEJMoa1203208?query=featured_home

Looks like we will be getting fewer thyroids in the future with this new molecular test.

 

[Pathologee]

Veracyte testing does seem promising. It has a high negative predictive value in AUS and suspicious for follicular neoplasm cases. I wouldn't worry about getting less thyroidectomies. As long as there are worried patients, and endocrine surgeons who encourage surgery on big lesions, there will be thyroids to examine.

 

[2121115]

Most thyroidectomies are for symptomatic goiters anyway.

 

[pathstudent]

If anything hopefully it will reduce thyroid FNA specimens.

Don't like those at all.

 

[lipomas]

Yeah, this will reduce thyroidectomies by about 1%. They already follow a lot of these nodules, and patients want a lot of them out anyway.

What we really need is a study that shows that every circumscribed thyroid nodule is not going to kill the patient. FVPTC are more benign than non FV PTC.

 

[NuckingFuts]

Just curious- how many of you are asked to perform frozens on thyroids irrespective of prior FNA results?

 

[pathstudent]

Just curious- how many of you are asked to perform frozens on thyroids irrespective of prior FNA results?

If it is a pediatric case, always.

On adults rarely if the FNA was positive. occassionally if the FNA was negative.

 

[yaah]

We usually get frozens if they are only doing one side, and then only if the FNA was suspicious, atypical, or non-diagnostic (or not done).

 

[deleted314957]

i had one surgeon who always did but i have finally convinced him how silly it is to freeze a follicular nodule or a fna demonstrated pap ca

 

[WEBB PINKERTON]

If anything hopefully it will reduce thyroid FNA specimens.

Don't like those at all.

Since the FNA is what is used for the Veracyte test, i wouldn't count on less Thyroid FNA.

This test costs like 3500 dollars and I have a feeling it will prevent very few surgeries.

I been sending pulmonary specimens to Veracyte for years. They are working on some molecular tests for lung as well.

 

[WEBB PINKERTON]

Veracyte's data from the Medicare 2012 website........Not bad considering how few specimens they had.


VERACYTE, INC.
Location
SOUTH SAN FRANCISCO, CALIF.
Specialty / Facility Type
Clinical Laboratory
Total Medicare payments in 2012
$3,820,909.43

ProcedureNumber performed Average payment per procedure Total payments for procedure
Clinical chemistry test 961 $3200.00 $3,075,200.00
Cytopath eval fna report 5673 $131.40 $745,432.20
Molecular rna stabilization 111 $7.45 $191.95
Molecule isolate nucleic 11 $5.32 $58.52

 

[Doctor Zaius]

How are they getting paid $131.40 by medicare for a thyroid fna?? I'm getting $56 from medicare for FNA interpretations.

 

[WEBB PINKERTON]

First off, I hate Dr Zaius from the first Planet of the Apes movie. He pissed me off big time because of his treatment of Cornelius, Zira and Taylor. God I thought Nova was hot. If I was Taylor I would have taken her to the forbidden zone and had some fun.

TC and PC combined would be my guess for what they are getting paid on 88173.

3200 dollars for 961 patients for that molecular test is what caught my eye. Over 3 million dollars......How many surgeries did they actually prevent is my question?

God I love that Medicare website. You can see who is swimming naked when the tide rolls out.

 

[Doctor Zaius]

Agreed, Nova was ridiculously hot. Much moreso than Freida Pinto in the reboot.

TC+PC makes sense, thanks.

There was an abstract at the ATA a few years ago where Mayo reported their experience with veracyte. The rate of molecular "suspicious" dx was much higher than in the NEJM article and the PPV was far lower.

http://online.liebertpub.com/doi/pdfplus/10.1089/thy.2012.2209.abs

I don't understand how this test has gotten so much traction on the basis of 1 industry funded study.

 

[WEBB PINKERTON]

In my territory it had initial traction but now it seems stuck in the mudd. Interest in the test has died off considerably. Someone was hitting the ENTs in my state heavy early on after FDA approval. Not sure if it was Veracyte or that Thyroid Cytopathology Partners lab. They sure have a lot of female pathologists at that Thyroid lab.

http://www.thyroidcytopath.com/about-us/

I have been working with Veracyte for years on some tests for interstitial lung disease. That is another area they are hoping to develop tests for.

 

[yaah]

I just wonder what the state of thyroid malignancy will be in another 20 years. The survival rate for thyroid cancer now is almost better than any other type of cancer, with rare exception (anaplastic mostly, some medullary). A lot of things we call cancer don't really behave much like cancer. Where the molecular tests will have any utility will be in picking out the aggressive papillary cancers or follicular cancers or ones that could potentially go bad and cause significant morbidity. It's kind of like prostate cancer, it's just hard right now to pick out the bad ones. Maybe molecular will help, maybe it won't. But I have higher hopes for molecular in thyroid CA than I do in most other sites.