192 chapter 2 MicroRNA Our systematic literature search yielded six high-quality original articles that studied the role of microRNA expression analysis in diagnosing thyroid malignancy in indeterminate nodules (Table 42) [187, 192, 197-199]. Each of the six studies evaluated a different set of microRNAs, most often selected from previously published histopathological studies. Only several separate microRNAs were analysed in more than one study. One study selected its own set of microRNAs by identification through microarray analysis [198]. The expression profile of the selected microRNAs was first evaluated in a test set of cytological and/or histopathological specimens. Secondly, the significantly up- or downregulated microRNAs were validated by RT-PCR on an independent random set of (indeterminate) thyroid FNAC samples for which a final histological diagnosis was available. Some studies developed a decision model for the validation step [187, 192, 197]. Because of the large variation in the investigated microRNAs in the included studies, we deemed it inappropriate to perform a meta-analysis. Individual study results are reported in Table 43. Figure 52. SROC curve of the Afirma® GEC – Hürthle cell nodules Summary receiver operating characteristic plot showing sensitivity versus 1-specificity of the Afirma® GEC in Hürthle cell nodules with available histopathology. AUC = 0.34 (95% CI: 0.30-0.38). AUC, area under the curve; HSROC, hierarchical summary receiver operating characteristic.
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