Ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) is the most reliable nonsurgical test for distinguishing benign from malignant thyroid nodules. However, there is no consensus on which nodules should undergo FNAB, yet. The aim of our study is therefore to assess the diagnostic sensitivity of FNAB in a series of unselected thyroid nodules and to investigate the additional diagnostic contribution of BRAF V600E analysis in the detection of differentiated thyroid cancer. To thjs aim, 1856 patients with thyroid nodules displaying at least one US feature suspicious of malignant lesion were submitted to FNAB, for a total of 2421 cytoaspirates submitted to cytological evaluation and to biomolecular analysis.We found that cytology has high positive predictive value and specificity for the diagnosis of malignant lesions. BRAF V600E mutation was found in 115 samples, 80 of which were also cytologically diagnosed as papillary thyroid cancer. BRAF mutation analysis significantly enhanced the diagnostic value of cytology, increasing FNAB diagnostic sensitivity for malignant nodules by 28%. Diameter was not a good predictor of thyroid nodule malignancy. Each investigated US/clinical characteristic of suspected malignancy correlated with the presence of a thyroid cancer in thyroid nodules with diameter of 4 mm or greater.These data indicate that all nodules with at least one US/clinical characteristic of suspected malignancy should undergo FNAB. The diagnostic sensitivity for thyroid cancer is significantly increased by BRAF V600E mutation analysis, indicating that the screening for BRAF mutation in FNAB samples has a relevant diagnostic potential and should always be performed.
Thyroid Nodule Screening for Malignancy: A Prospective Study on Ultrasonographic/Clinical Profile, Cytology and BRAF V600E Mutation Evaluation
ROSSI, Martina;BURATTO, Mattia;FILIERI, Carlo;TAGLIATI, Federico;TRASFORINI, Giorgio;ROSSI, Roberta;BECCATI, Maria Donatella;DEGLI UBERTI, Ettore;ZATELLI, Maria Chiara
2012
Abstract
Ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) is the most reliable nonsurgical test for distinguishing benign from malignant thyroid nodules. However, there is no consensus on which nodules should undergo FNAB, yet. The aim of our study is therefore to assess the diagnostic sensitivity of FNAB in a series of unselected thyroid nodules and to investigate the additional diagnostic contribution of BRAF V600E analysis in the detection of differentiated thyroid cancer. To thjs aim, 1856 patients with thyroid nodules displaying at least one US feature suspicious of malignant lesion were submitted to FNAB, for a total of 2421 cytoaspirates submitted to cytological evaluation and to biomolecular analysis.We found that cytology has high positive predictive value and specificity for the diagnosis of malignant lesions. BRAF V600E mutation was found in 115 samples, 80 of which were also cytologically diagnosed as papillary thyroid cancer. BRAF mutation analysis significantly enhanced the diagnostic value of cytology, increasing FNAB diagnostic sensitivity for malignant nodules by 28%. Diameter was not a good predictor of thyroid nodule malignancy. Each investigated US/clinical characteristic of suspected malignancy correlated with the presence of a thyroid cancer in thyroid nodules with diameter of 4 mm or greater.These data indicate that all nodules with at least one US/clinical characteristic of suspected malignancy should undergo FNAB. The diagnostic sensitivity for thyroid cancer is significantly increased by BRAF V600E mutation analysis, indicating that the screening for BRAF mutation in FNAB samples has a relevant diagnostic potential and should always be performed.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
