Korean Journal of Otorhinolaryngology-Head and Neck Surgery

Korean Society of Otolaryngology-Head and Neck Surgery (대한이비인후과학회)
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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
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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

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