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Chen H, Song A, Wang Y, He Y, Tong J, Di J, Li C, Zhou Z, Cai X, Zhong D, Da J. BRAF V600E mutation test on fine-needle aspiration specimens of thyroid nodules: Clinical correlations for 4600 patients. Cancer Med 2021; 11:40-49. [PMID: 34851044 PMCID: PMC8704181 DOI: 10.1002/cam4.4419] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/08/2021] [Accepted: 10/23/2021] [Indexed: 12/17/2022] Open
Abstract
Background The BRAFV600E mutation is valuable for the diagnosis, prognosis, and therapy of papillary thyroid cancer (PTC). However, studies related to this mutation have involved only a small number of patients. Therefore, we performed a large‐scale analysis from a single institute to evaluate the accuracy of combined fine‐needle aspiration (FNA) and BRAFV600E mutation tests for PTC diagnosis. Methods A total of 4600 patients with thyroid nodules who underwent both FNA cytology and BRAFV600E mutation analysis on FNA specimens were enrolled. The association between the BRAFV600E mutation and clinicopathological features was analyzed. A separate analysis was performed for the 311 patients who underwent repeated FNA for comparison of cytological evaluation and BRAFV600E mutation results. The diagnostic efficacy of the BRAFV600E mutation test and cytologic diagnoses was evaluated for 516 patients who underwent preoperative FNA tests in comparison with conclusive postoperative histopathologic results. Results The cytology results of all 4600 FNA samples were categorized according to The Bethesda System for Reporting Thyroid Cytology (TBSRTC) stages I–VI, which accounted for 11.76%, 60.02%, 6.46%, 3.61%, 6.71%, and 11.43% of the samples, respectively. The BRAFV600E mutation was detected in 762 (16.57%) FNA samples, with rates of 1.48%, 0.87%, 20.20%, 3.01%, 66.02%, and 87.81% for TBSRTC I–VI lesions, respectively. Among the 311 repeat FNA cases, 81.0% of the BRAFV600E‐positive and 4.3% of the BRAFV600E‐negative specimens with an initial indication of cytological non‐malignancy were ultimately diagnosed as malignant by repeat FNA (p < 0.001). Among the 516 patients who underwent thyroidectomy, the sensitivity and specificity of the BRAFV600E mutation test alone for PTC diagnosis were 76.71% and 100.0%, respectively, which increased to 96.62% and 88.03%, respectively, when combining the BRAFV600E mutation test with cytology. BRAFV600E mutation was significantly associated with lymph node metastasis (p < 0.001), but not with age, gender, or tumor size. Conclusions The BRAFV600E mutation test in FNA samples has potential to reduce false negatives in PTC diagnosis, and therefore plays an important role in the diagnosis of thyroid nodules, especially those with an indeterminate or nondiagnostic cytology, which should be considered for repeat FNA.
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Affiliation(s)
- Huang Chen
- Department of Pathology, The China-Japan Friendship Hospital, Beijing, China
| | - Aiping Song
- Department of Pathology, The China-Japan Friendship Hospital, Beijing, China
| | - Ye Wang
- Department of Pathology, The China-Japan Friendship Hospital, Beijing, China
| | - Yifan He
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Jie Tong
- Department of Pathology, The China-Japan Friendship Hospital, Beijing, China
| | - Jinxi Di
- Department of Pathology, The China-Japan Friendship Hospital, Beijing, China
| | - Chun Li
- Department of Pathology, The China-Japan Friendship Hospital, Beijing, China
| | - Zhongren Zhou
- Department of Endocrinology, The China-Japan Friendship Hospital, Beijing, China
| | - Xiaopin Cai
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Dingrong Zhong
- Department of Pathology, The China-Japan Friendship Hospital, Beijing, China
| | - Jiping Da
- Department of Pathology, The China-Japan Friendship Hospital, Beijing, China.,Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hosptial, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
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Liu Y, He L, Yin G, Cheng L, Zeng B, Cheng J, Yang L. Association analysis and the clinical significance of BRAF gene mutations and ultrasound features in papillary thyroid carcinoma. Oncol Lett 2019; 18:2995-3002. [PMID: 31452778 PMCID: PMC6704325 DOI: 10.3892/ol.2019.10641] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 06/14/2019] [Indexed: 12/13/2022] Open
Abstract
The aim of the present study was to evaluate the associations between the B-Raf proto-oncogene serine/threonine kinase (BRAF)V600E mutation and conventional and contrast-enhanced ultrasonographic features in patients with papillary thyroid carcinoma (PTC), and to subsequently investigate the clinical value of these associations. In total, 207 thyroid nodules (diameter ≤2 cm) were selected. Conventional ultrasound, contrast-enhanced ultrasound, BRAFV600E mutational analysis and ultrasound-guided fine-needle aspiration biopsy were preoperatively performed, and histopathological assessment of PTC was postoperatively confirmed. The nodules were divided into 2 groups based on the BRAFV600E mutational analysis, namely the mutant or the wild-type variant groups, and the association analyses of the ultrasonographic features between these 2 groups were performed. Overall, 74.9% (155/207) of the PTC nodules had the BRAFV600E mutation, while 25.1% (52/207) had the wild-type BRAF allele. The 2 groups were analyzed using univariate logistic regression analysis, which demonstrated no significant differences regarding morphology, boundary, hypoechogenicity of the nodules, blood flow signal, enhancement uniformity, enhancement degree and clearance time (P>0.05). Moreover, the 2 groups demonstrated significant differences regarding the aspect ratio, microcalcification, nodule size following enhancement, enhancement mode and enhancement time (P<0.05). A multivariate logistic regression analysis was performed to further validate the association of these features with the BRAFV600E mutation; however, only microcalcification [odds ratio (OR), 2.256; 95% confidence interval (CI), 1.160–5.500; P=0.020] and nodule size following enhancement (OR, 2.119; 95% CI, 1.039–4.321; P=0.039) were associated with the BRAF mutational status. The associations found between the two ultrasonographic features and BRAFV600E mutation indicate that they can predict the BRAF mutational status to provide a reliable basis for clinical diagnosis and treatment.
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Affiliation(s)
- Ying Liu
- Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P.R. China
| | - Lingyun He
- Department of Scientific Research and Education Section, Chongqing Health Center for Women and Children, Chongqing 401120, P.R. China
| | - Guobing Yin
- Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P.R. China
| | - Long Cheng
- Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P.R. China
| | - Bin Zeng
- Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P.R. China
| | - Juan Cheng
- Department of Ultrasound, Second Affiliated Hospital of Chongqing Medical University and Chongqing Key Laboratory of Ultrasound Molecular Imaging, Chongqing 400010, P.R. China
| | - Lu Yang
- Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P.R. China
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Effect of Sentinel Node Biopsy in Clinically N0, BRAF V600E–Mutated, Small Papillary Thyroid Carcinoma. Clin Nucl Med 2019; 44:359-364. [DOI: 10.1097/rlu.0000000000002465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Koh J, Kim EK, Kim JY, Kwak JY, Yoon JH, Moon HJ. Comparison of Ultrasound, Pathologic and Prognostic Characteristics of the Follicular Variant of Papillary Thyroid Cancer According to Fine-Needle Aspiration Cytology. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2864-2872. [PMID: 27658752 DOI: 10.1016/j.ultrasmedbio.2016.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 07/29/2016] [Accepted: 08/05/2016] [Indexed: 06/06/2023]
Abstract
The aim of the study described here was to compare ultrasound features, pathologic characteristics and prognoses of the follicular variant of papillary thyroid carcinoma (FVPTC) according to cytology results. Eighty-seven FVPTCs were classified according to the first cytology results as the surgery group (n = 66, follicular neoplasm/Hürthle cell neoplasm, suspicious for malignancy and malignancy) and the indeterminate group (n = 21, non-diagnostic and benign), for whom the management was follow-up. The indeterminate group had a longer mean interval to surgery (p = 0.020) and larger tumor size (p = 0.018). More tumors were assessed as probably benign in the indeterminate group than in the surgery group (p < 0.001). Extrathyroidal extension and lymph node metastasis did not significantly differ between the two groups, and no patient had a recurrence (mean follow-up interval: 54.9 ± 16.9 mo). The indeterminate group exhibited more probably benign features and larger size on ultrasound, with surgery being performed at a later date. However, aggressive pathologic characteristics and tumor recurrence did not significantly differ between the two groups.
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Affiliation(s)
- Jieun Koh
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji-Ye Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Kwak
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Mitchell B, Dhingra JK, Mahalingam M. BRAF and Epithelial-Mesenchymal Transition: Lessons From Papillary Thyroid Carcinoma and Primary Cutaneous Melanoma. Adv Anat Pathol 2016; 23:244-71. [PMID: 27145091 DOI: 10.1097/pap.0000000000000113] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The increased prevalence of BRAF mutations in thyroid carcinoma and primary cutaneous melanoma (PCM) hint that dysregulation of BRAF might contribute to the noted association between PCM and thyroid carcinoma. A recent study evaluating the rate of BRAFV600E mutations among patients who had been diagnosed with primary papillary thyroid carcinoma (PTC) and PCM showed that patients with either PCM or PTC were at an increased risk of developing the other as a second primary malignant neoplasm. Furthermore, the authors noted that samples from patients suffering from both malignancies exhibited a higher rate of incidence of the BRAFV600E mutation, compared with patients not suffering from both malignancies. These studies support the hypothesis that the pathogenesis of these 2 malignancies might share a conserved molecular pattern associated with dysregulation of the BRAF protein. One mechanism through which BRAF might contribute to PCM and thyroid carcinoma progression is through induction of epithelial-mesenchymal transition (EMT). Specifically, the Snail/E-cadherin axis has been demonstrated as a pathway dysregulated by BRAF, leading to EMT in both malignancies. Our analysis focuses on the results of these recent investigations, and through a review of select molecules relevant to EMT, looks to provide a context by which to better understand the relevance and role of stromal-parenchymal signaling and the BRAF mutation in the pathogenesis of PTC and PCM.
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Affiliation(s)
- Brendon Mitchell
- *University of Florida College of Medicine, Gainesville, FL †Department of Otolaryngology, Tufts Medical center, Boston, MA ‡Dermatopathology Section, Department of Pathology and Laboratory Medicine, VA Consolidated Laboratories, West Roxbury, MA
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Park VY, Kim EK, Moon HJ, Yoon JH, Kwak JY. The thyroid imaging reporting and data system on US, but not the BRAFV600E mutation in fine-needle aspirates, is associated with lateral lymph node metastasis in PTC. Medicine (Baltimore) 2016; 95:e4292. [PMID: 27442672 PMCID: PMC5265789 DOI: 10.1097/md.0000000000004292] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The majority of patients with papillary thyroid carcinoma (PTC) have an excellent prognosis, but some show poorer outcomes and would benefit from adjunctive prognostic tools. The B-Raf proto-oncogene, serine/threonine kinase (BRAF) mutation, either based on both its presence or its quantitative measurement, and ultrasound (US) features may serve as a prognostic marker. The aim of this study was to investigate (1) the association between clinical-pathologic prognostic factors and the BRAF mutation found in fine-needle aspirates, based on both its presence and its corresponding cycle threshold (Ct) value, and (2) the association between prognostic factors and suspicious US features classified by the thyroid imaging reporting and data system (TIRADS) in PTC.Two-hundred fifty-eight consecutive patients with PTC > 1 cm and who underwent preoperative US-guided fine-needle aspiration were included in this retrospective study. Clinical-pathologic variables were compared between patients with and without the BRAF mutation. Multivariate analyses were performed to investigate (1) the association between clinical-pathologic prognostic factors and the BRAF mutation found in fine-needle aspirates, based on both its presence and corresponding Ct values, and (2) the association between prognostic factors and suspicious TIRADS US features.BRAF-positive patients had a higher proportion of multiple tumors (P = 0.017). The number of suspicious US features classified by the TIRADS was an independent factor for predicting lateral lymph node metastasis, both in all 258 patients (odds ratio [OR] = 1.902, P = 0.005) and in 214 BRAF-positive patients (OR = 1.686, P = 0.037). The BRAF mutation status or BRAFCt values were not associated with any of the clinical-pathologic prognostic factors.In conclusion, a higher number of suspicious US features classified by the TIRADS, but not the BRAF mutation, are associated with lateral lymph node metastasis in patients with PTC, and can aid in the preoperative identification of patients at increased risk of lateral lymph node metastasis.
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Affiliation(s)
| | | | | | | | - Jin Young Kwak
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Correspondence: Jin Young Kwak, Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Korea (e-mail: )
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Chen Y, Sadow PM, Suh H, Lee KE, Choi JY, Suh YJ, Wang TS, Lubitz CC. BRAF(V600E) Is Correlated with Recurrence of Papillary Thyroid Microcarcinoma: A Systematic Review, Multi-Institutional Primary Data Analysis, and Meta-Analysis. Thyroid 2016; 26:248-55. [PMID: 26671072 DOI: 10.1089/thy.2015.0391] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Given the increasing incidence of papillary thyroid carcinoma despite stable disease-specific mortality rates, the potential for the disease to reoccur is a key outcome to predict. The BRAF(V600E) mutation has been associated with recurrent disease in larger tumors. However, its correlation in papillary thyroid microcarcinoma (PTMC) is not clear in individual series. METHODS The MEDLINE, EMBASE, Web of Science, and Cochrane databases were searched for studies including patients with PTMC undergoing initial surgical treatment. Studies with at least two years of follow-up, BRAF genotyping (the comparator), and recurrence as an outcome were included, as were unpublished primary data on 485 patients from two institutions. The metameter analyzed was odds ratio (OR) for recurrence between patients with BRAF(V600E) versus BRAF wild type (BRAFwt). RESULTS The initial search identified 431 references. After screening of the abstracts for inclusion, 44 manuscripts were reviewed in full by two independent reviewers. Four published studies and primary data from two institutional cohorts were included in the final analysis. A meta-analysis of 2247 PTMC patients revealed that patients with a BRAF(V600E) mutation had a higher likelihood for recurrence (odds ratio 2.09 [confidence interval 1.31-3.33], p = 0.002). CONCLUSIONS This meta-analysis shows that BRAF mutational status correlates with recurrence of PTMCs, highlighting the potential utility of genotyping in preoperative and postoperative planning. BRAF mutation may be helpful in risk-stratifying patients with PTMC for surgical management versus observation.
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Affiliation(s)
- Yufei Chen
- 1 Department of Surgery, Massachusetts General Hospital , Boston, Massachusetts
| | - Peter M Sadow
- 2 Department of Pathology, Massachusetts General Hospital , Boston, Massachusetts
| | - Hyunsuk Suh
- 3 Department of Surgery, Mount Sinai Medical Center , New York, New York
| | - Kyu Eun Lee
- 4 Department of Surgery, Seoul National University Hospital and College of Medicine , Seoul, Korea
| | - June Young Choi
- 4 Department of Surgery, Seoul National University Hospital and College of Medicine , Seoul, Korea
| | - Yong Joon Suh
- 4 Department of Surgery, Seoul National University Hospital and College of Medicine , Seoul, Korea
| | - Tracy S Wang
- 5 Department of Surgery, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Carrie C Lubitz
- 1 Department of Surgery, Massachusetts General Hospital , Boston, Massachusetts
- 6 Institute for Technology Assessment , Boston, Massachusetts
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