DOI QR코드

DOI QR Code

BRAFV600E Mutation is a Strong Preoperative Indicator for Predicting Malignancy in Thyroid Nodule Patients with Atypia of Undetermined Significance Identified by Fine Needle Aspiration

세침흡인검사 결과 Atypia of Undetermined Significance로 진단된 갑상선 결절에서 악성을 예측할 수 있는 위험인자

  • Choi, Hye Rang (Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University School of Medicine) ;
  • Choi, Bo-Yoon (Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University School of Medicine) ;
  • Cho, Jae Hoon (Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University School of Medicine) ;
  • Lim, Young Chang (Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University School of Medicine)
  • 최혜랑 (건국대학교 의과대학 이비인후과학교실) ;
  • 최보윤 (건국대학교 의과대학 이비인후과학교실) ;
  • 조재훈 (건국대학교 의과대학 이비인후과학교실) ;
  • 임영창 (건국대학교 의과대학 이비인후과학교실)
  • Received : 2018.04.03
  • Accepted : 2018.06.04
  • Published : 2018.11.25

Abstract

Background and Objectives This study aimed to identify a reliable preoperative predictive factor for the development of thyroid cancer in patients with atypia of undetermined significance (AUS) identified by fine needle aspiration biopsy (FNAB). Subjects and Method This was a retrospective cohort study. Two hundred and ninety-nine patients diagnosed with AUS by preoperative FNAB who underwent curative thyroid surgery at our institution between September 2005 and February 2014 were analyzed. Clinical, radiological and molecular features were investigated as preoperative predictors for postoperative permanent malignant pathology. Results The final pathologic results revealed 36 benign tumors including nodular hyperplasia, follicular adenoma, adenomatous goiter, nontoxic goiter, and lymphocytic thyroiditis, as well as 263 malignant tumors including 1 follicular carcinoma and 1 invasive follicular carcinoma; the rest were papillary thyroid carcinomas. The malignancy rate was 87.9%. The following were identified as risk factors for malignancy by univariate analysis: $BRAF^{V600E}$ gene mutation, specific ultrasonographic findings including smaller nodule size, low echogenicity of the nodule, and irregular or spiculated margin (p<0.05). Multivariate analysis revealed that only $BRAF^{V600E}$ mutation was a statistically significant risk factor for malignancy (p<0.05). When $BRAF^{V600E}$ mutation was positive, 98.5% of enrolled patients developed malignant tumors. In addition, the diagnostic rate of malignancy in these cases was approximately 16-fold higher than BRAF-negative cases. Conclusion Patients with AUS thyroid nodules should undergo $BRAF^{V600E}$ gene mutation analysis to improve diagnostic accuracy and if the mutation is confirmed, surgery is recommended due to the high risk of malignancy.

Keywords

References

  1. Ozemir IA, Bayraktar B, Anilir E, Orhun K, Eren T, Sagiroglu J, et al. The association of papillary thyroid cancer with microcalcification in thyroid nodules with indeterminate cytology based on fine-needle aspiration biopsy. Turk J Med Sci 2016;46(6):1719-23. https://doi.org/10.3906/sag-1509-84
  2. Turkyilmaz S, Ulusahin M, Celebi B, Cekic AB, Mungan S, Kucuktulu U, et al. Thyroid nodules classified as atypia or follicular lesions of undetermined significance deserve further research: analysis of 305 surgically confirmed nodules. Cytopathology 2017;28(5):391-9. https://doi.org/10.1111/cyt.12438
  3. Russ G, Leboulleux S, Leenhardt L, Hegedus L. Thyroid incidentalomas: epidemiology, risk stratification with ultrasound and workup. Eur Thyroid J 2014;3(3):154-63. https://doi.org/10.1159/000365289
  4. Estrada Munoz L, Diaz Del Arco C, Ortega Medina L, Fernandez Acenero MJ. Thyroid atypia/follicular lesion of undetermined significance: attitudes towards the diagnosis of Bethesda system III nodules. Acta Cytol 2017;61(1):21-6. https://doi.org/10.1159/000452156
  5. Gao LY, Wang Y, Jiang YX, Yang X, Liu RY, Xi XH, et al. Ultrasound is helpful to differentiate Bethesdaclass III thyroid nodules a PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2017;96(16):e6564. https://doi.org/10.1097/MD.0000000000006564
  6. Lee JH, Han K, Kim EK, Moon HJ, Yoon JH, Park VY, et al. Risk stratification of thyroid nodules with atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) cytology using ultrasonography patterns defined by the 2015 ATA guidelines. Ann Otol Rhinol Laryngol 2017;126(9):625-33. https://doi.org/10.1177/0003489417719472
  7. Kiernan CM, Solorzano CC. Bethesda category III, IV, and V thyroid nodules: can nodule size help predict malignancy? J Am Coll Surg 2017;255(1):77-82.
  8. Lee YB, Cho YY, Jang JY, Kim TH, Jang HW, Chung JH, et al. Current status a nd d iagnostic values of t he Bethesda system for reporting thyroid cytopathology in a papillary thyroid carcinomaprevalent area. Head Neck 2017;39(2):269-74. https://doi.org/10.1002/hed.24578
  9. Cha YJ, Pyo JY, Hong S, Seok JY, Kim KJ, Han JY, et al. Thyroid fine-needle aspiration cytology practice in Korea. J Pathol Transl Med 2017;51(6):521-7. https://doi.org/10.4132/jptm.2017.09.26
  10. Ho AS, Sarti EE, Jain KS, Wang H, Nixon IJ, Shaha AR, et al. Malignancy rate in thyroid nodules classified as Bethesda category III (AUS/FLUS). Thyroid 2014;24(5):832-9. https://doi.org/10.1089/thy.2013.0317
  11. Chen JC, Pace SC, Khiyami A, McHenry CR. Should atypia of undetermined significance be subclassified to better estimate risk of thyroid cancer? Am J Surg 2014;207(3):331-6. https://doi.org/10.1016/j.amjsurg.2013.09.022
  12. Cibas ES, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid 2017;27(11):1341-6. https://doi.org/10.1089/thy.2017.0500
  13. Seo JW, Jang AL, Suh SH, Park HS, Kang MK, Hong JC. Atypia of undetermined significance on thyroid fine needle aspiration-risk factors for malignancy. Clin Otolaryngol 2017;42(2):234-8. https://doi.org/10.1111/coa.12700
  14. Decaussin-Petrucci M, Descotes F, Depaepe L, Lapras V, Denier ML, Borson-Chazot F, et al. Molecular testing of BRAF, RAS and TERT on thyroid FNAs with indeterminate cytology improves diagnostic accuracy. Cytopathology 2017;28(6):482-7. https://doi.org/10.1111/cyt.12493
  15. Kim SK, Kim DL, Han HS, Kim WS, Kim SJ, Moon WJ, et al. Pyrosequencing analysis for detection of a BRAFV600E mutation in an FNAB specimen of thyroid nodules. Diagn Mol Pathol 2008;17(2):118-25. https://doi.org/10.1097/PDM.0b013e31815d059d
  16. Valderrabano P, Khazai L, Thompson ZJ, Leon ME, Otto KJ, Hallanger-Johnson JE, et al. Cancer risk stratification of indeterminate thyroid nodules: a cytological approach. Thyroid 2017;27(10):1277-84. https://doi.org/10.1089/thy.2017.0221
  17. Paschke R, Cantara S, Crescenzi A, Jarzab B, Musholt TJ, Sobrinho Simoes M. European Thyroid Association guidelines regarding thyroid nodule molecular fine-needle aspiration cytology diagnostics. Eur Thyroid J 2017;6(3):115-29. https://doi.org/10.1159/000468519
  18. Valderrabano P, McIver B. Evaluation and management of indeterminate thyroid nodules: the revolution of risk stratification beyond cytological diagnosis. Cancer Control 2017;24(5):1-14. https://doi.org/10.1177/107327481702400118
  19. Kim TH, Jeong DJ, Hahn SY, Shin JH, Oh YL, Ki CS, et al. Triage of patients with AUS/FLUS on thyroid cytopathology: effectiveness of the multimodal diagnostic techniques. Cancer Med 2016;5(5):769-77. https://doi.org/10.1002/cam4.636