Systems and methods for expression-based classification of thyroid tissue
A system for classifying thyroid nodule tissue as malignant or benign is provided that is based on the identification of sets of gene transcripts, which are characterized in that changes in expression of each gene transcript within a set of gene transcripts can be correlated to with either malignant or benign thyroid nodule disease. The thyroid classification system provides for sets of “thyroid classifying” target sequences and further provides for combinations of polynucleotide probes and primers derived there from. These combinations of polynucleotide probes can be provided in solution or as an array. The combination of probes and the arrays can be used for diagnosis. The invention further provides further methods of classifying thyroid nodule tissue.
1. A method, comprising:
(a) assaying by sequencing, array hybridization or nucleic acid amplification the expression level of each of a first group of transcripts and a second group of transcripts in a fine needle aspirate test sample from a thyroid nodule of a subject, wherein said first group of transcripts includes least two transcripts corresponding to at least two sequences selected from SEQ ID No. 1-4 and 8-282, and said second group of transcripts includes at least two transcripts corresponding to at least two sequences selected from SEQ ID No. 5-7 and 283-659; and
(b) in a programmed computer, comparing said expression level of each of said first group of transcripts and second group of transcripts with reference expression levels of transcripts corresponding to sequences as set forth in SEQ ID No. 1 to 659 to (1) classify said thyroid nodule as malignant if there is an increase in an expression level corresponding to said first group or a decrease in an expression level corresponding to said second group, or (2) classify said thyroid nodule as benign if there is an increase in said expression level corresponding to said second group or a decrease in said expression level corresponding to said first group.
2. The method of claim 1 , wherein an increased relative level of expression of one or more transcripts, a decreased relative level of expression of one or more transcripts, or a combination thereof is used to classify the thyroid nodule as malignant.
3. The method of claim 1 , wherein an increased relative level of expression of one or more transcripts, a decreased relative level of expression of one or more transcripts, or a combination thereof is used to classify the thyroid nodule as benign.
4. The method of claim 1 , wherein said assaying comprises determining the expression level by a method selected from the group consisting of RT-PCR, Northern blotting, ligase chain reaction, and a combination thereof.
5. The method of claim 1 , further comprising measuring the expression level of at least one control nucleic acid in the test sample.
6. The method of claim 1 , wherein the test sample is fresh-frozen or fixed.
7. The method of claim 1 , wherein the expression level is measured by pattern recognition.
8. The method of claim 7 , wherein said pattern recognition comprises a linear combination of expression levels of the target sequences.
9. The method of claim 1 , wherein (b) comprises using said programmed computer to (1) classify said thyroid nodule as malignant if there is an increase in an expression level corresponding to said first group and a decrease in an expression level corresponding to said second group, or (2) classify said thyroid nodule as benign if there is an increase in said expression level corresponding to said second group and a decrease in said expression level corresponding to said first group.
10. The method of claim 1 , wherein said assaying is by nucleic acid amplification using at least two primers that each amplify a transcript corresponding to a sequence as set forth in any one of SEQ ID No. 1 to 659.
11. The method of claim 1 , further comprising (c) based upon a classification of said thyroid nodule as malignant or benign, (i) designating a treatment modality for said subject or (ii) generating a report that designates said thyroid nodule as malignant or benign.
12. The method of claim 11 , wherein said treatment modality is selected from the group consisting of total thyroidectomy, near-total thyroidectomy, partial thyroidectomy, cosmetic debulking, radioactive iodine treatment, watchful waiting, thyroid hormone suppression therapy, total or near-total thyroidectomy followed by radioactive iodine ablation therapy and permanent thyroid hormone replacement therapy, or a combination thereof.
13. The method of claim 1 , wherein said first group of transcripts includes a sequence as set forth in any one of SEQ ID No. 1-4, 8-12 and 261.
14. The method of claim 1 , wherein said second group of transcripts includes a sequence as set forth in any one of SEQ ID No. 5-7, 283-306, 657, 658 and 659.