Publications by authors named "Masha Livhits"
Article Synopsis
- The study examines thyroid tumors with isolated RAS mutations, comparing their oncologic outcomes to tumors with isolated BRAF mutations using comprehensive molecular testing.
- A total of 368 patients with Bethesda III-VI thyroid nodules were reviewed, revealing that 14% had isolated RAS mutations, with a 46% malignancy rate but no instances of structural recurrence after 5 years.
- The findings suggest that isolated RAS-mutated tumors have lower aggressive characteristics, indicating that thyroid lobectomy may be an adequate treatment option for these patients.
Context: BRAF V600E mutation is the most common genetic driver of papillary thyroid cancer (PTC), where it is found with various allele frequency (AF), reflecting the proportion of cells carrying the mutant and wild-type gene alleles.
Objective: To determine whether BRAF V600E AF can improve prognostication and inform initial surgical management of PTC.
Design: Retrospective cohort study (2016-2019).
Context: Little is known about how patients' emotions impact the choice between hemi- and total thyroidectomy (TT) for low-risk thyroid cancer (LR-TC) and how these emotions change after treatment.
Objective: To investigate thyroid cancer-specific fear and worry both before and after treatment of LR-TC with hemi- or TT.
Methods: This prospective cohort study enrolled adults with confirmed or likely LR-TC at 15 institutions.
Selpercatinib prior to radioactive iodine for pediatric papillary thyroid carcinoma.
J Pediatr Endocrinol Metab
November 2024
Objectives: We introduced selpercatinib prior to radioactive iodine therapy prior to radioactive iodine therapy (RAI) for pediatric papillary thyroid cancer (PTC) to enhance the tumorical effects of RAI.
Case Presentation: PTC has an excellent prognosis but is commonly associated with local and distant metastases. Successful complete response to the current standard of care, thyroidectomy with lymph node resection and RAI, is achieved in only a small minority of cases with metastases.
Article Synopsis
- The study evaluates how patients with low-risk thyroid cancer prioritize treatment outcomes after their surgical choices, emphasizing the emotional impact of their diagnosis on decision-making.
- Participants rated outcomes at the time of surgery decision and again after 9 months, revealing that patients' valuations changed significantly over time.
- Results indicate that after experiencing treatment, patients shifted focus from concerns about cancer recurrence to valuing quality of life aspects like energy levels, suggesting surgeons need to consider these changing priorities in discussions about treatment options.
Context: Use of artificial intelligence (AI) to predict clinical outcomes in thyroid nodule diagnostics has grown exponentially over the past decade. The greatest challenge is in understanding the best model to apply to one's own patient population, and how to operationalize such a model in practice.
Evidence Acquisition: A literature search of PubMed and IEEE Xplore was conducted for English-language publications between January 1, 2015 and January 1, 2023, studying diagnostic tests on suspected thyroid nodules that used AI.
Context: Molecular testing can refine the risk of malignancy in thyroid nodules with indeterminate cytology to decrease unnecessary diagnostic surgery.
Objective: This study was performed to evaluate the outcomes of cytologically indeterminate thyroid nodules managed with Afirma genomic sequencing classifier (GSC) testing.
Methods: Adult patients who underwent a biopsy at 3 major academic centers between July 2017 and June 2021 with Bethesda III or IV cytology were included.
Extent of Surgery for Medullary Thyroid Cancer and Prevalence of Occult Contralateral Foci.
JAMA Otolaryngol Head Neck Surg
March 2024
Article Synopsis
- The standard treatment for medullary thyroid cancer (MTC) is total thyroidectomy with central neck dissection, but reasons for this approach in patients with only one affected side are not well-defined.
- A study aimed to find hidden contralateral MTC lesions, which weren't visible through ultrasounds, to justify the total thyroid removal.
- From 176 patients studied, 26% had contralateral disease, and 5% had undetected lesions, suggesting genetic background influences the likelihood of hidden cancer in the other thyroid lobe.
Objective: The objective of this study was to analyze the risk of malignancy and the histopathology of telomerase reverse transcriptase promoter mutated cytologically indeterminate thyroid nodules (ITN).
Methods: A PUBMED search of molecularly tested ITN was conducted and data on mutated ITN with histopathology correlation were extracted.
Results: Twenty-six manuscripts (published between 2014 and 2022) reported on 77 mutated ITN.
Article Synopsis
- Indeterminate thyroid nodules with Hürthle cell cytology pose diagnostic challenges, prompting a study on the effectiveness of molecular tests like Afirma Gene Sequencing Classifier and Thyroseq v3.
- In a trial with 140 nodules, Afirma showed a higher benign call rate (84%) compared to Thyroseq (56%), indicating better reliability in identifying non-cancerous nodules.
- The results suggest that these molecular tests can significantly help patients avoid unnecessary surgeries, highlighting their importance in managing Hürthle cell nodules.
Schwannomas are benign, generally indolent tumors of neural crest origin and comprise the most common histologic tumor of peripheral nerves. Schwannomas are a rare histology for retroperitoneal tumors and very rare histologic findings for tumors of the adrenal gland with fewer than 50 cases in the reported literature. Here we present a case report of a non-hormonally functional but metabolically active adrenal tumor with indeterminate imaging characteristics with final pathology showing a 6.
View Article and Find Full Text PDFMolecular testing for indeterminate thyroid nodules: past, present, and future.
Curr Opin Endocrinol Diabetes Obes
October 2023
Purpose Of Review: To examine the origin, current progress, and future directions of molecular testing in indeterminate Bethesda III and Bethesda IV thyroid nodules.
Recent Findings: The diagnostic performance of current genomic tests shows improved benign call rates, specificity and positive-predictive values over prior test versions. The choice of test platform for clinical use should consider test performance, institutional rate of malignancy, nodule cytology and the potential for prognostication to help guide decision-making.
Editorial: Predictive tools in pheochromocytoma and paraganglioma.
Front Endocrinol (Lausanne)
July 2023
Article Synopsis
- Molecular testing plays a significant role in diagnosing thyroid nodules, particularly those with indeterminate cytology, but its effectiveness in predicting outcomes for nodules that are already suspicious or malignant remains uncertain.
- This study aimed to assess whether molecular profiling of Bethesda V and VI thyroid nodules can improve the prognostication of oncological outcomes and aid in determining initial treatment strategies.
- Among 105 patients studied, ThyroSeq identified genomic alterations in 95% of samples, revealing that patients classified as low risk did not experience recurrence, while those at intermediate risk had some recurrence, and high-risk patients had multiple concerning mutations.
Article Synopsis
- A comprehensive genomic analysis was conducted on a large number of thyroid nodules (50,734 FNA samples) to identify molecular alterations and better understand their clinical significance, particularly in Bethesda categories III-VI.
- The results showed that a majority (65.3%) of the samples tested negative for significant alterations, while a smaller proportion (33.9%) tested positive, revealing different mutation patterns in BCIII-IV and BCV-VI nodules, with BCV-VI showing more aggressive genetic changes.
- The findings indicate that 68% of BCIII-IV nodules were negative, highlighting the potential to avoid unnecessary surgery, while BCV-VI nodules had more actionable mutations that could inform treatment decisions for patients.
Context: Molecular testing has improved risk stratification and increased nonoperative management for patients with indeterminate thyroid nodules, but data on the long-term outcomes of current molecular tests Afirma Gene Sequencing Classifier (GSC) and Thyroseq v3 are limited.
Objective: To determine the rate of delayed operation and the false negative rate of the Afirma GSC and Thyroseq v3 in Bethesda III and IV thyroid nodules.
Methods: Prospective follow-up of a single center, randomized, clinical trial comparing the performance of Afirma GSC and Thyroseq v3 in the diagnosis of indeterminate thyroid nodules at the University of California, Los Angeles (UCLA).
Context: The Afirma® GSC aids in risk stratifying indeterminate thyroid nodule cytology (ITN). The 2018 GSC validation study (VS) reported a sensitivity (SN) of 91%, specificity (SP) of 68%, positive predictive value (PPV) of 47%, and negative predictive value (NPV) of 96%. Since then, 13 independent real-world (RW) postvalidation studies have been published.
View Article and Find Full Text PDFBackground: Recent studies examining treatment disparities in thyroid cancer care found that appropriate use of surgery and radioactive iodine may be improving over time.
Methods: California Cancer Registry and California Office of Statewide Health Planning and Development data was evaluated for the effect of race on overall and disease-specific survival for thyroid cancer in California (1999-2017). Reoperation data was also examined.
Background: Many adrenal incidentalomas do not undergo appropriate biochemical testing and complete imaging characterization to assess for hormone hypersecretion and malignancy. With the growing availability of clinical narratives in the electronic medical record, automated surveillance using advanced data analytic techniques may represent a promising method to improve management.
Methods: A data provisioning process using a series of structured query language scripts was used to abstract all chest and abdominal computed tomography and magnetic resonance imaging reports from an academic health care system in 2018.
Importance: Adrenalectomy is the definitive treatment for multiple adrenal abnormalities. Advances in technology and genomics and an improved understanding of adrenal pathophysiology have altered operative techniques and indications.
Objective: To develop evidence-based recommendations to enhance the appropriate, safe, and effective approaches to adrenalectomy.
Objective: Phenoxybenzamine (nonselective, noncompetitive alpha-blocker) is the preferred drug for preoperative treatment of pheochromocytoma, but doxazosin (selective, competitive alpha-blocker) may be equally effective. We compared the efficacy of doxazosin vs phenoxybenzamine.
Methods: We conducted a prospective study of patients undergoing pheochromocytoma or paraganglioma resection by randomizing pretreatment with phenoxybenzamine or doxazosin at a single tertiary referral center.
Thyroid nodules with indeterminate cytology are increasingly subjected to molecular testing. We evaluated the diagnostic performances of Afirma Genomic Sequencing Classifier (GSC) and ThyroSeq v3 in thyroid nodules with high versus low/intermediate suspicion ultrasound classification. In this prospective cohort study, we analyzed all Bethesda III and IV thyroid nodules that underwent fine-needle aspiration biopsies in the University of California Los Angeles Health System from July 2017 to April 2020.
View Article and Find Full Text PDFBackground And Objectives: The recent de-escalation of care for differentiated thyroid cancer (DTC) has broadened the range of initial treatment options. We examined the association between physicians' perception of risk and their management of DTC.
Methods: Thyroid specialists were surveyed with four clinical vignettes: (1) indeterminate nodule (2) tall cell variant papillary thyroid cancer (PTC), (3) papillary thyroid microcarcinoma (mPTC), and (4) classic PTC.
Background: External beam radiation therapy (EBRT) is rarely used to treat patients with differentiated or medullary thyroid cancer. Although EBRT is generally administered to patients with high-risk or unresectable diseases, neither its indications for the use nor the associated outcomes are well-defined. We used a statewide cohort to assess the trends in EBRT use and postradiation outcomes in California.
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