Compositions and methods for classifying thyroid nodule disease
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 an 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 at least two transcripts corresponding to at least two sequences selected from SEQ ID Nos. 1-2, and wherein said second group of transcripts includes at least two transcripts corresponding to at least two sequences selected from SEQ ID Nos. 7-8; and
(b) in a programmed computer, comparing said expression level of each of said first group of transcripts and said second group of transcripts with reference expression levels of transcripts corresponding to sequences as set forth in SEQ ID Nos. 1-2 and 7-8 to (1) classify said thyroid nodule as malignant if there is an increase in an expression level corresponding to said first group of transcripts or a decrease in an expression level corresponding to said second group of transcripts, or (2) classify said thyroid nodule as benign if there is an increase in said expression level corresponding to said second group of transcripts or a decrease in said expression level corresponding to said first group of transcripts.
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 said expression level using RT-PCR, Northern blotting, ligase chain reaction, or any combination thereof.
5. The method of claim 1 , further comprising measuring an expression level of at least one control nucleic acid in said fine needle aspirate test sample.
6. The method of claim 1 , wherein said fine needle aspirate test sample is fresh-frozen or fixed.
7. The method of claim 1 , wherein said expression level is measured by pattern recognition.
8. The method of claim 7 , wherein said pattern recognition comprises a linear combination of expression levels.
9. The method of claim 7 , wherein said pattern recognition comprises a nonlinear combination of expression levels.
10. 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 of transcripts and a decrease in an expression level corresponding to said second group of transcripts, or (2) classify said thyroid nodule as benign if there is an increase in said expression level corresponding to said second group of transcripts and a decrease in said expression level corresponding to said first group of transcripts.
11. The method of claim 1 , wherein said assaying comprises nucleic acid amplification using at least one primer that amplifies a transcript corresponding to a sequence as set forth in any one of SEQ ID Nos. 1-2 and 7-8.
12. The method of claim 1 , wherein said assaying comprises (i) nucleic acid amplification using at least one primer that amplifies a transcript corresponding to a sequence as set forth in any one of SEQ ID Nos. 1-2, and (ii) nucleic acid amplification using at least one primer that amplifies a transcript corresponding to a sequence as set forth in any one of SEQ ID No. 7-8.
13. The method of claim 1 , further comprising (c) based upon a classification of said thyroid nodule as malignant or benign, designating a treatment modality for said subject.
14. The method of claim 13 , 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, and a combination thereof.
15. The method of claim 1 , further comprising (c) based upon a classification of said thyroid nodule as malignant or benign, generating a report that designates said thyroid nodule as malignant or benign.