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Molecular Genetics & Genomic Medicine Sep 2020Indeterminate thyroid nodules are diagnosed in up to 30% of fine-needle aspirations and the risk of malignancy in these cases are highly variable. Consequently, managing... (Review)
Review
BACKGROUND
Indeterminate thyroid nodules are diagnosed in up to 30% of fine-needle aspirations and the risk of malignancy in these cases are highly variable. Consequently, managing these nodules has been a challenge. While a diagnostic thyroidectomy would help clarify the pathology, there is the risk of developing surgical-related complications for a procedure that may not have been necessary and associated high costs. Genomic testing of indeterminate thyroid nodules may help better guide management.
METHODS
We present an unbiased comprehensive review of available molecular testing for classifying indeterminate thyroid nodules, as well as their strengths and limitations, with the objective to allow practitioners to choose the best testing modality for their patients.
RESULTS
Molecular testing of these nodules provided a platform to help distinguish benign versus malignant nodules, providing more confidence to rule in or rule out the likelihood of thyroid cancer in indeterminate nodules.
CONCLUSION
Genomic testing has evolved to more comprehensive panels to better stratify indeterminate nodules, including Hürthle cell neoplasms and noninvasive follicular neoplasm with papillary-like nuclear features. Understanding the methodology of each available test improves patient care and reduces unnecessary costs.
Topics: Biopsy, Fine-Needle; Genetic Testing; Humans; Reagent Kits, Diagnostic; Sequence Analysis, DNA; Thyroid Nodule
PubMed: 32436637
DOI: 10.1002/mgg3.1288 -
European Urology Focus Sep 2019The indeterminate multiparametric prostate magnetic resonance image (mpMRI) lesion is one which cannot be classified as "positive" or "negative" for suspected cancer.... (Comparative Study)
Comparative Study Review
CONTEXT
The indeterminate multiparametric prostate magnetic resonance image (mpMRI) lesion is one which cannot be classified as "positive" or "negative" for suspected cancer. Currently, there is no consensus on how to manage patients with indeterminate mpMRIs where areas cannot be classified as positives or negatives (Prostate Imaging Reporting and Data System [PI-RADS] 3 or Likert 3).
OBJECTIVE
To define the concept of indeterminate lesion and describe the management strategies that may be adopted for these patients.
EVIDENCE ACQUISITION
A literature search of the PubMed database was performed including the search terms "prostate indeterminate lesions", "PI-RADS 3", "Likert 3", "magnetic resonance imaging", and "prostate cancer".
EVIDENCE SYNTHESIS
There is no universally accepted definition of what constitutes an indeterminate lesion on mpMRI. This is partly due to the experience of the reporting radiologist and their willingness to call a lesion indeterminate, knowing that this may have consequences for biopsy decisions. This is also partly due to the significant variation in mpMRI acquisition parameters used between different sites. Strategies for managing the indeterminate lesion include: (1) biopsy, where there is a highly variable prevalence of prostate cancer (PCa), reflecting the differences in clinically significant PCa definitions, mpMRI protocols and interobserver variability in characterization of indeterminate lesions and (2) surveillance, where early results suggest that this strategy may be of value for some selected patients with prostate-specific antigen (PSA) monitoring and/or interval mpMRI. The use of prebiopsy MRI, in conjunction with traditional clinical parameters and secondary biomarkers-nomograms, may allow a more accurate selection of patients who can avoid biopsy.
CONCLUSIONS
A strategy of close surveillance based on PSA monitoring and interval mpMRI is a feasible management option for motivated patients with indeterminate mpMRI. This surveillance strategy could result in fewer men needing to undergo biopsy, and although early results are promising, long-term results for such a strategy are awaited.
PATIENT SUMMARY
In some patients who have an MRI scan of their prostate, the scan may identify an area which may or may not contain cancer. This area is typically called the "indeterminate" lesion. In this report, we attempted to define the concept of indeterminate lesion on multiparametric magnetic resonance (mpMRI) and described the strategies that may be performed for these patients. The use of mpMRI in conjunction with traditional clinical parameters may allow more accurate risk stratification and assessment of the need for prostate biopsy.
Topics: Humans; Image-Guided Biopsy; Magnetic Resonance Imaging; Male; Multiparametric Magnetic Resonance Imaging; Prostatic Neoplasms; Watchful Waiting
PubMed: 29525382
DOI: 10.1016/j.euf.2018.02.012 -
Techniques in Coloproctology Jun 2007The term indeterminate colitis has been used to describe cases of inflammatory bowel disease that cannot be classified as ulcerative colitis or Crohn's disease. However,... (Review)
Review
The term indeterminate colitis has been used to describe cases of inflammatory bowel disease that cannot be classified as ulcerative colitis or Crohn's disease. However, this term has suffered varying definitions, which in addition to numerous difficulties in diagnosing inflammatory bowel disease has led to much confusion. The term indeterminate colitis should only be used in cases where a colectomy has been performed and the overlapping features of Crohn's disease and ulcerative colitis do not allow a definitive diagnosis. Over time the majority of patients remain with a diagnosis of indeterminate colitis, or show symptoms similar to ulcerative colitis. Ileal pouch-anal anastomosis surgery can be performed in such patients, with outcomes of pouch failure and functional outcome that are similar to those in patients with ulcerative colitis but with increased risk of postoperative pouch complications. This review addresses the definition of indeterminate colitis, its pathology, natural history, and outcomes of restorative proctocolectomy.
Topics: Colitis; Colitis, Ulcerative; Colonic Pouches; Crohn Disease; Diagnosis, Differential; Humans; Inflammatory Bowel Diseases; Proctocolectomy, Restorative; Terminology as Topic
PubMed: 17510748
DOI: 10.1007/s10151-007-0337-y -
Current Gastroenterology Reports Apr 2012About 10% of patients with colitis due to inflammatory bowel disease have indeterminate colitis. Despite newer diagnostic tools, the frequency has not diminished over... (Review)
Review
About 10% of patients with colitis due to inflammatory bowel disease have indeterminate colitis. Despite newer diagnostic tools, the frequency has not diminished over the past 33 years. The current preferred term among academicians is colonic inflammatory bowel disease unclassified(IBDU), although indeterminate colitis is the term endorsed for inclusion in the ICD-10 coding system. Indeterminate colitis is more frequent among children. Theanti-Saccharomyces cerevisiae (ASCA) and perinuclear anti-cytoplasmic antibody (pANCA) are useful in distinguishing IBDU from ulcerative colitis and Crohn’s disease. However, current serologic and genetic studies, as well as endoscopic and imaging studies lack sufficient positive predictive values to make a definite diagnosis of Crohn’s colitis or ulcerative colitis. Patients with IBDU who undergo proctocolectomy with ileal pouch-anal anastomosis have more complications than patients with ulcerative colitis. Although some patients with indeterminate colitis eventually develop characteristic ulcerative colitis or Crohn’s disease, a subgroup are durably indeterminate.
Topics: Colitis; Colitis, Ulcerative; Crohn Disease; Humans; Serologic Tests
PubMed: 22314810
DOI: 10.1007/s11894-012-0244-x -
Journal of the Advanced Practitioner in... Jan 2023Indeterminate thyroid nodules can present a confounding scenario for both provider and patient. Once a diagnosis of an indeterminate thyroid nodule is made, appropriate...
Indeterminate thyroid nodules can present a confounding scenario for both provider and patient. Once a diagnosis of an indeterminate thyroid nodule is made, appropriate management can range from conservative observation to surgical resection. A thorough evaluation, including a dedicated history and physical examination, biochemical profile, pathologic information from a seasoned pathologist, and thyroid ultrasound by an experienced radiologist can help point health-care providers in the right direction. However, the ultimate diagnosis cannot be rendered unless surgical excision is performed. Provider and patient must agree on a personalized risk vs. benefit profile for the indeterminate thyroid nodule.
PubMed: 36741215
DOI: 10.6004/jadpro.2023.14.1.9 -
Trends in Endocrinology and Metabolism:... Jul 2020Clonal hematopoiesis of indeterminate potential (CHIP), defined as a clone of hematopoietic cells consisting of a single acquired mutation during a lifetime, has... (Review)
Review
Clonal hematopoiesis of indeterminate potential (CHIP), defined as a clone of hematopoietic cells consisting of a single acquired mutation during a lifetime, has recently been discovered to be a major risk factor for atherosclerotic cardiovascular disease (CVD). As such, this phenomenon has sparked interest into the role that these single mutations may play in CVD. Atherosclerotic CVD is a complex disease and we have previously shown that atherosclerosis can be accelerated by metabolic- or autoimmune-related risk factors such as diabetes, obesity, and rheumatoid arthritis. In this review, we discuss the role of CHIP, the interplay between CHIP and metabolic diseases, as well as how metabolism of hematopoietic stem cells (HSCs) could regulate CHIP-related HSC fate.
Topics: Animals; Cardiovascular Diseases; Clonal Hematopoiesis; Diabetes Mellitus; Humans; Mutation
PubMed: 32521236
DOI: 10.1016/j.tem.2020.02.005 -
Clinical, Cosmetic and Investigational... 2023Indeterminate dendritic cell tumor (IDCT) is an extremely uncommon histiocytic and dendritic neoplasms subtype that presents as single or multiple papules. There is... (Review)
Review
Indeterminate dendritic cell tumor (IDCT) is an extremely uncommon histiocytic and dendritic neoplasms subtype that presents as single or multiple papules. There is currently no standard method for diagnosis and treatment, and the selection of therapeutic approaches is mainly based on successful examples of folk medicine. We describe a case of a pathology diagnosed indeterminate dendritic cell tumor, which shows the presence of CD1a, S100, and CD68, but lack langerin. She was treated with multi-chemotherapy regimens used to treat lymphoma and gained good results short term but was easy to recur. In addition, we reviewed the literature on the effectiveness and safety of chemotherapy in IDCT patients.
PubMed: 37881204
DOI: 10.2147/CCID.S429566 -
The Surgical Clinics of North America Aug 2019Cytologically indeterminate thyroid nodules are associated with a broad range (5%-75%) of malignant risk and accurately informing definitive management poses a... (Review)
Review
Cytologically indeterminate thyroid nodules are associated with a broad range (5%-75%) of malignant risk and accurately informing definitive management poses a challenge. Advancements in molecular testing of fine-needle aspiration biopsies have improved preoperative diagnostic accuracy and prognostication. For indeterminate nodules, such testing ideally will reduce the need for surgery for benign nodules and potentially guide appropriate extent of initial surgery for malignancy.
Topics: Biomarkers, Tumor; Biopsy, Fine-Needle; Decision Making; Diagnosis, Differential; Humans; Thyroid Neoplasms; Thyroid Nodule
PubMed: 31255193
DOI: 10.1016/j.suc.2019.04.002 -
American Journal of Clinical Pathology Aug 2021UroVysion cases with one to three abnormal cells that do not meet the threshold for positivity may be better classified as "indeterminate." The aim of this study is to...
OBJECTIVES
UroVysion cases with one to three abnormal cells that do not meet the threshold for positivity may be better classified as "indeterminate." The aim of this study is to determine the incidence and clinical significance of these indeterminate UroVysion results.
METHODS
The UroVysion fluorescence in situ hybridization (FISH) results over a 4-year period in our institution were retrospectively analyzed. Follow-up of the initial UroVysion cases, including urine cytology or bladder biopsy performed within 12 months of the initial diagnosis of the result, was obtained from pathology reports.
RESULTS
A significant fraction (178 of 1,907, 9.3%) of the UroVysion cases had indeterminate results. Overall, the subsequent malignancy rate of the group with indeterminate UroVysion results (14 of 59, 23.7%) was higher than the group with normal results (48 of 319, 15.0%), although the difference was not significant (P = .124). For patients without a history of urinary tract neoplasm, the subsequent malignancy rate in the group with indeterminate results (7 of 18, 38.9%) was significantly higher than the group with normal results (16 of 103, 15.5%) (P = .044).
CONCLUSIONS
Our results support that indeterminate UroVysion FISH result may warrant closer clinical follow-up in patients without a history of urinary tract neoplasm. We suggest reporting these cases as "aneusomy of undetermined significance."
Topics: Cytodiagnosis; Fluorescence; Humans; In Situ Hybridization, Fluorescence; Pathology, Molecular; Retrospective Studies; Urinary Bladder Neoplasms
PubMed: 33693491
DOI: 10.1093/ajcp/aqaa254 -
Cold Spring Harbor Perspectives in... Jul 2015Although we are used to the idea that many organisms stop growing when they reach a predictable size, in many taxa, growth occurs throughout the life of an organism, a... (Review)
Review
Although we are used to the idea that many organisms stop growing when they reach a predictable size, in many taxa, growth occurs throughout the life of an organism, a phenomenon referred to as indeterminate growth. Our comparative analysis suggests that indeterminate growth may indeed represent the ancestral condition, whereas the permanent arrest of growth may be a more derived state. Consistent with this idea, in diverse taxa, the basal branches show indeterminate growth, whereas more derived branches arrest their growth. Importantly, in some closely related taxa, the termination of growth has evolved in mechanistically distinct ways. Also, even within a single organism, different organs can differ with respect to whether they terminate their growth or not. Finally, the study of tooth development indicates that, even at the level of a single tissue, multiple determinate patterns of growth can evolve from an ancestral one that is indeterminate.
Topics: Animals; Biological Evolution; Invertebrates; Tooth; Vertebrates
PubMed: 26216720
DOI: 10.1101/cshperspect.a019174