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Xia Z, Huang X, Zhang T, Gao Z, Tang X, Zhang W, Miao Q. Ultrasonographic features and diagnostic accuracy of FNA and CNB in secondary thyroid malignancies: A retrospective study. Heliyon 2024; 10:e36305. [PMID: 39224267 PMCID: PMC11367495 DOI: 10.1016/j.heliyon.2024.e36305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 08/05/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024] Open
Abstract
Objective This study aims to examine the ultrasonographic features of secondary thyroid malignancies and compare the diagnostic efficacy of fine-needle aspiration (FNA) and core needle biopsy (CNB) in this condition. Methods A retrospective analysis was conducted on 29 patients with secondary thyroid malignancies treated at our center between July 2011 and October 2022. Ultrasound images and clinical data were analyzed, and the lesions were classified according to the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS). Results Among the 29 patients studied, primary tumor sites were predominantly the esophagus, lung, and nasopharynx. Comprehensive ultrasound data was available for 28 of these patients, revealing nodular lesions in 24 cases and diffuse lesions in 4 cases. Nodular lesions were predominantly solid or nearly solid hypoechoic nodules with parallel growth and extrathyroidal extension features, with a few showing macrocalcifications. Most patients had varying degrees of metastasis to neck lymph nodes. FNA accurately diagnosed 31.6 % of the lesions as secondary thyroid malignancies, while 5.3 % were misdiagnosed as papillary thyroid carcinoma (PTC). However, CNB demonstrated 100 % reliability in diagnosing secondary thyroid malignancies. Conclusion This study's categorization of secondary thyroid malignancy ultrasonographic features identifies nodular and diffuse patterns, with the application of ACR TI-RADS proving effective for nodular types. In detecting these lesions, CNB demonstrates superior sensitivity compared to FNA. Thus, in cases of thyroid lesions suspected to be malignant, particularly with enlarged neck lymph nodes and in patients with a history of malignancy, CNB is recommended as the diagnostic method of choice.
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Affiliation(s)
- Zhen Xia
- Department of Ultrasound, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaochen Huang
- Department of Pathology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Ting Zhang
- Department of Ultrasound, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Zhigang Gao
- Department of Ultrasound, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Xiuliang Tang
- Department of Ultrasound, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Zhang
- Department of Ultrasound, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Qing Miao
- Department of Ultrasound, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
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Zhou T, Xu L, Shi J, Zhang Y, Lin X, Wang Y, Hu T, Xu R, Xie L, Sun L, Li D, Zhang W, Chen C, Wang W, Xu C, Kong F, Xun Y, Yu L, Zhang S, Ding J, Wu F, Tang T, Zhan S, Zhang J, Wu G, Zheng H, Kong D, Luo D. US of thyroid nodules: can AI-assisted diagnostic system compete with fine needle aspiration? Eur Radiol 2024; 34:1324-1333. [PMID: 37615763 DOI: 10.1007/s00330-023-10132-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/20/2023] [Accepted: 07/04/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVES Artificial intelligence (AI) systems can diagnose thyroid nodules with similar or better performance than radiologists. Little is known about how this performance compares with that achieved through fine needle aspiration (FNA). This study aims to compare the diagnostic yields of FNA cytopathology alone and combined with BRAFV600E mutation analysis and an AI diagnostic system. METHODS The ultrasound images of 637 thyroid nodules were collected in three hospitals. The diagnostic efficacies of an AI diagnostic system, FNA-based cytopathology, and BRAFV600E mutation analysis were evaluated in terms of sensitivity, specificity, accuracy, and the κ coefficient with respect to the gold standard, defined by postsurgical pathology and consistent benign outcomes from two combined FNA and mutation analysis examinations performed with a half-year interval. RESULTS The malignancy threshold for the AI system was selected according to the Youden index from a retrospective cohort of 346 nodules and then applied to a prospective cohort of 291 nodules. The combination of FNA cytopathology according to the Bethesda criteria and BRAFV600E mutation analysis showed no significant difference from the AI system in terms of accuracy for either cohort in our multicenter study. In addition, for 45 included indeterminate Bethesda category III and IV nodules, the accuracy, sensitivity, and specificity of the AI system were 84.44%, 95.45%, and 73.91%, respectively. CONCLUSIONS The AI diagnostic system showed similar diagnostic performance to FNA cytopathology combined with BRAFV600E mutation analysis. Given its advantages in terms of operability, time efficiency, non-invasiveness, and the wide availability of ultrasonography, it provides a new alternative for thyroid nodule diagnosis. CLINICAL RELEVANCE STATEMENT Thyroid ultrasonic artificial intelligence shows statistically equivalent performance for thyroid nodule diagnosis to FNA cytopathology combined with BRAFV600E mutation analysis. It can be widely applied in hospitals and clinics to assist radiologists in thyroid nodule screening and is expected to reduce the need for relatively invasive FNA biopsies. KEY POINTS • In a retrospective cohort of 346 nodules, the evaluated artificial intelligence (AI) system did not significantly differ from fine needle aspiration (FNA) cytopathology alone and combined with gene mutation analysis in accuracy. • In a prospective multicenter cohort of 291 nodules, the accuracy of the AI diagnostic system was not significantly different from that of FNA cytopathology either alone or combined with gene mutation analysis. • For 45 indeterminate Bethesda category III and IV nodules, the AI system did not perform significantly differently from BRAFV600E mutation analysis.
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Affiliation(s)
- Tianhan Zhou
- Department of Surgical Oncology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- The Department of General Surgery, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Lei Xu
- Zhejiang Qiushi Institute for Mathematical Medicine, Hangzhou, China
| | - Jingjing Shi
- Department of Surgical Oncology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yu Zhang
- Department of Surgical Oncology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiangfeng Lin
- Department of Thyroid Surgery, Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Yuanyuan Wang
- Department of Thyroid Surgery, The First Affiliated Hospital of Henan University, Zhengzhou, China
| | - Tao Hu
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Rujun Xu
- Department of Pathology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lesi Xie
- Department of Pathology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lijuan Sun
- Department of Pathology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dandan Li
- Department of Pathology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenhua Zhang
- Department of Pathology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chuanghua Chen
- Department of Ultrasonography, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Wang
- Department of Ultrasonography, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chenke Xu
- Department of Ultrasonography, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fanlei Kong
- Department of Ultrasonography, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yanping Xun
- Department of Translational Medicine Research Center, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lingying Yu
- Department of Endocrinology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shirong Zhang
- Department of Translational Medicine Research Center, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jinwang Ding
- Department of Head and Neck Surgery, Cancer hospital of the University of Chinese Academy of Sciences, Hangzhou, China
| | - Fan Wu
- Department of Surgical Oncology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tian Tang
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Siqi Zhan
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiaoping Zhang
- Department of Surgical Oncology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guoyang Wu
- Department of General Surgery, Affiliated Zhongshan Hospital, Xiamen University, Xiamen, China.
| | - Haitao Zheng
- Department of Thyroid Surgery, Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, China.
| | - Dexing Kong
- College of Mathematical Medicine, Zhejiang Normal University, Jinhua, China.
- School of Mathematical Sciences, Zhejiang University, Hangzhou, China.
| | - Dingcun Luo
- Department of Surgical Oncology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.
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Liu Z, Zhang R, Jiang X, Ji L, Sun P, Ji Y, Zhang Y, Ding Y, Li K, Pu Z, Zhou F, Zou J. Highly Sensitive Enrichment of Low-Frequency Variants by Hairpin Competition Amplification. Anal Chem 2023; 95:12015-12023. [PMID: 37527514 DOI: 10.1021/acs.analchem.3c01803] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
Gene mutations are inevitably accumulated in cells of the human body. It is of great significance to detect mutations at the earliest possible time in physiological and pathological processes. However, genotyping low-copy tumor DNA (ctDNA) in patients is challenging due to abundant wild DNA backgrounds. One novel strategy to enrich rare mutations at low variant allele fractions (VAFs) with quantitative polymerase chain reaction (qPCR) and Sanger sequencing was contrived by introducing artificial hairpins into amplicons to compete with primers, coined as the hairpin competition amplification (HCA) system. The influence imposed by artificial hairpins on primer-binding in a high-temperature PCR system was investigated for the first time in this work, paving the way for the optimization of HCA. HCA differs from the previously reported work in which hairpins are formed to inhibit extension of wild-type DNA using 5-exonuclease-negative polymerase, where the readout is dependent on melting curve analysis after asymmetric PCR. Targeted at six different variants, HCA qPCR and HCA Sanger-enriched mutant DNA at VAFs as low as 0.1 or 0.01% were performed. HCA demonstrated advantages in multiplex reaction and temperature robustness. In profiling gene status from 12 lung cancer ctDNA samples and 16 thyroid cancer FNA DNA samples, HCA demonstrated a 100% concordance rate compared to ddPCR and commercial ARMS kit. HCA qPCR and Sanger sequencing can enrich low-abundance variants with high sensitivity and temperature robustness, presenting a novel and effective tool for precision diagnosis and treatment of rare variant diseases.
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Affiliation(s)
- Zhaocheng Liu
- Department of Laboratory Medicine, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, China
- Center of Clinical Research, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu, China
| | - Rui Zhang
- Department of Laboratory Medicine, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, China
- Center of Clinical Research, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu, China
| | - Xixi Jiang
- Department of Laboratory Medicine, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, China
| | - Li Ji
- Department of Laboratory Medicine, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, China
- Center of Clinical Research, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu, China
| | - Ping Sun
- Department of Pathology, Jiangnan University Medical Center, Wuxi 214023, Jiangsu, China
| | - Yong Ji
- Department of Thoracic Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu, China
| | - Yu Zhang
- Department of Ultrasound, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu, China
| | - Yan Ding
- Department of Ultrasound, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu, China
| | - Koukou Li
- Department of Laboratory Medicine, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, China
- Center of Clinical Research, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu, China
| | - Zhening Pu
- Department of Laboratory Medicine, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, China
- Center of Clinical Research, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu, China
| | - Fengsheng Zhou
- Department of Ultrasound, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu, China
| | - Jian Zou
- Department of Laboratory Medicine, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, China
- Center of Clinical Research, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu, China
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Zhang Y, Lu F, Zhang YF, Xu HX, Shi H, Guo LH, Wei Q. Predicting malignancy in thyroid nodules with benign cytology results: The role of Conventional Ultrasound, Shear Wave Elastography and BRAF V600E. Clin Hemorheol Microcirc 2021; 81:33-45. [PMID: 34958011 DOI: 10.3233/ch-211337] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND: Ultrasound-guided fine-needle aspiration (US-FNA) is the most accurate method for preoperative diagnosis of thyroid nodules, but how to deal with false negative results. OBJECTIVE: This study aimed to find preoperative diagnosis methods including Conventional Ultrasound (CUS), Shear Wave Elastography (SWE) and BRAF V600E testing to differentiate false negative nodules. METHODS: Forty-nine nodules in 49 patients with benign FNA results and pathological diagnoses were included. CUS and SWE features were evaluated. BRAF V600E analysis was performed after FNA. Diagnostic performances of three methods were analyzed in predicting malignancy in benign FNA results. RESULTS: Twenty-seven of 49 nodules were malignant, and 22 nodules were benign. Hypoechogenicity, taller-than-wider, irregular boundary, microcalcification, SWE max, SWE mean and BRAF V600E mutation were risk factors for malignancy. All 7 malignant nodules with BRAF V600E mutations and 18 of 20 malignant nodules without BRAF V600E mutations have two or more suspicious CUS features. Six of 7 malignant nodules with BRAF V600E mutations and 16 of 20 malignant nodules without BRAF V600E mutations had SWE mean value greater than the cut-off value. CONCLUSIONS: CUS, SWE and BRAF V600E were diagnostic tools for malignancy in FNA benign nodules. Further clinical decisions should be considered for nodules with 2 or more suspicious CUS features and SWE parameters greater than cut-off values whether BRAF V600E is mutational or not.
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Affiliation(s)
- Ying Zhang
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Feng Lu
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yi-Feng Zhang
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hui Shi
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Le-Hang Guo
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Qing Wei
- Department of Pathology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
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Marina M, Zatelli MC, Goldoni M, Del Rio P, Corcione L, Martorana D, Percesepe A, Bonatti F, Mozzoni P, Crociara A, Ceresini G. Combination of ultrasound and molecular testing in malignancy risk estimate of Bethesda category IV thyroid nodules: results from a single-institution prospective study. J Endocrinol Invest 2021; 44:2635-2643. [PMID: 33860907 PMCID: PMC8572191 DOI: 10.1007/s40618-021-01571-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/04/2021] [Indexed: 01/21/2023]
Abstract
PURPOSE Malignancy prediction in indeterminate thyroid nodules is still challenging. We prospectively evaluated whether the combination of ultrasound (US) risk stratification and molecular testing improves the assessment of malignancy risk in Bethesda Category IV thyroid nodules. METHODS Ninety-one consecutively diagnosed Bethesda Category IV thyroid nodules were prospectively evaluated before surgery by both ACR- and EU-TIRADS US risk-stratification systems and by a further US-guided fine-needle aspiration cytology (FNAC) for the following molecular testing: BRAFV600E, N-RAS codons 12/13, N-RAS codon 61, H-RAS codons 12/13, H-RAS codon 61, K-RAS codons 12/13, and K-RAS codon 61 point-mutations, as well as PAX8/PPARγ, RET/PC1, and RET/PTC 3 rearrangements. RESULTS At histology, 37% of nodules were malignant. No significant association was found between malignancy and either EU- or ACR-TIRADS. In total, 58 somatic mutations were identified, including 3 BRAFV600E (5%), 5 N-RAS 12/13 (9%), 13 N-RAS 61 (22%), 7 H-RAS 12/13 (12%), 11 H-RAS 61 (19%), 6 K-RAS 12/13 (10%), 8 K-RAS 61 (14%) mutations and 2 RET/PTC1 (4%), 0 RET/PTC 3 (0%), 3 PAX8/PPARγ (5%) rearrangements. At least one somatic mutation was found in 28% and 44% of benign and malignant nodules, respectively, although malignancy was not statistically associated with the outcome of the mutational test. However, the combination of ACR-, but not EU-, TIRADS with the presence of at least one somatic mutation, was significantly associated with malignant histology (P = 0.03). CONCLUSION US risk stratification and FNAC molecular testing may synergistically contribute to improve malignancy risk estimate of Bethesda category IV thyroid nodules.
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Affiliation(s)
- M Marina
- Dipartimento di Medicina e Chirurgia, SSD Medicina Interna Ad Indirizzo Onco-Endocrinologico, Università di Parma-Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - M C Zatelli
- Dipartimento di Scienze Mediche, Sezione di Endocrinologia e Medicina Interna, UOL Endocrinologia-Università Degli Studi di Ferrara, Ferrara, Italy
| | - M Goldoni
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - P Del Rio
- UOC Clinica Chirurgica, Università di Parma-Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - L Corcione
- UOC Anatomia e Istologia Patologica-Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - D Martorana
- UOC Genetica, Università di Parma, Parma, Italy
| | - A Percesepe
- UOC Genetica, Università di Parma, Parma, Italy
| | - F Bonatti
- UOC Oncologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - P Mozzoni
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - A Crociara
- UOC Endocrinologia e Malattie del Ricambio, Azienda Ospedaliero, Universitaria di Ferrara, Ferrara, Italy
| | - G Ceresini
- Dipartimento di Medicina e Chirurgia, SSD Medicina Interna Ad Indirizzo Onco-Endocrinologico, Università di Parma-Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
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Gimm O, Ivansson K, Beka E, Rossitti HM, Garvin S, Söderkvist P. Increased diagnostic sensitivity of palpation-guided thyroid nodule fine-needle aspiration cytology by BRAF V600E-mutation analysis. J Pathol Clin Res 2021; 7:556-564. [PMID: 34156770 PMCID: PMC8503891 DOI: 10.1002/cjp2.231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/22/2021] [Accepted: 05/27/2021] [Indexed: 12/16/2022]
Abstract
Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer and its incidence is increasing. Preoperative diagnosis is warranted in order to avoid 'two-stage' procedures that are associated with additional costs and higher radioactive iodine remnant uptake. In the setting of thyroid cancer, somatic BRAF V600E-mutations are highly specific for PTC and can be analyzed in aspirates from fine-needle aspiration cytology (FNAC). The 'gold standard' to perform FNAC is ultrasound guidance. Here, we analyze whether adding BRAF V600E-mutation analysis could be of value in palpation-guided FNACs. A total of 430 consecutive patients were included. Ultrasound-guided FNACs were performed in 251 patients and 179 patients underwent palpation-guided FNACs. BRAF V600E-mutation analysis was performed using two methods, an allele-specific polymerase chain reaction (PCR) analyzed by capillary gel electrophoresis (PCR/Qiaxcel), and a droplet digital PCR (ddPCR) assay. A total of 80 patients underwent surgery, and histology revealed 25 patients to have PTC. Of the 25 PTCs, 23 (92%) showed a BRAF V600E-mutation. Both mutation analysis methods (PCR/Qiaxcel and ddPCR) produced concordant results. In the ultrasound-guided group, the preoperative diagnostic sensitivity of FNAC using the Bethesda classification alone was very high and additional BRAF V600E-mutation analysis added little to the preoperative diagnostic sensitivity. By contrast, in the palpation-guided group, by adding BRAF V600E-mutation analysis, eight instead of four patients were diagnosed of having PTC. This increase in the diagnostic sensitivity was statistically significant (p < 0.05). The costs per sample were as low as 62 USD (PCR/Qiaxcel and ddPCR) and 35 USD (PCR/Qiaxcel only). Ultrasound-guided FNAC should be aimed for when dealing with thyroid nodules. However, if palpation-guided FNAC cannot be avoided or may be required due to resource utilization, adding BRAF V600E-mutation analysis using the methods described in this study might significantly increase the proportion of preoperatively diagnosed PTCs. The additional costs can be considered very reasonable.
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Affiliation(s)
- Oliver Gimm
- Department of Surgery and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Kristin Ivansson
- Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Ervin Beka
- Department of Surgery and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Hugo M Rossitti
- Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Stina Garvin
- Department of Clinical Pathology, and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Peter Söderkvist
- Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
- Clinical Genomics Linköping, Science for Life LaboratoryLinköping UniversityLinköpingSweden
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Anand N, Agrawal T, Gupta A, Shukla S, Pradhan R, Husain N. Diagnostic Efficacy of BRAFV600E Immunocytochemistry in Thyroid Aspirates in Bethesda Category IV and Papillary Thyroid Carcinoma. J Cytol 2021; 38:113-119. [PMID: 34703086 PMCID: PMC8489694 DOI: 10.4103/joc.joc_248_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 04/01/2021] [Accepted: 07/29/2021] [Indexed: 11/04/2022] Open
Abstract
Background In papillary thyroid carcinoma (PTC), BRAFV600E is a common mutation and is associated with aggressive clinical behaviour. Immunocytochemistry (ICC) and molecular testing are recommended in the Bethesda System for Reporting Thyroid Cytopathology 2017 (TBSRTC) category III, IV and V. Aims The current study aimed to evaluate the diagnostic efficacy of conventional FNAC versus FNAC with BRAFV600E immunostaining in cases of TBSRTC category IV, cases of suspicious for PTC and cases of PTC. Methods and Material The study included a prospective case series of 45 patients with clinically palpable thyroid nodules with TBSRTC category IV, category V (suspicious for PTC) and PTC. The corresponding histology specimens of all the 45 cases were also analyzed. Immunostaining for BRAFV600E was performed on FNAC cell blocks and their corresponding histology sections using anti-BRAF (VE1) clone (Ventana). The diagnostic efficacy of the BRAFV600E immunostaining was compared on cytological specimens with histological specimens. Results BRAFV600E immunostaining helped to improve the sensitivity of the cytology to confirm the PTC as a diagnostic aid for thyroid FNAs. Cytology alone had a sensitivity of 62.96% and a lower specificity of 60.70%. The combination of both the tests together provided 84.62% sensitivity and much higher specificity of 100%. PPV was also increased to 100% and NPV was raised 94.12%. Conclusions The performance of BRAFV600E immunostaining on the cytological specimen is a rapid, simple and cost-effective test and could be considered in TBSRTC category IV and suspicious and malignant cases of PTC.
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Affiliation(s)
- Nidhi Anand
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Tushar Agrawal
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Anurag Gupta
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Saumya Shukla
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Roma Pradhan
- Department of Endocrine Surgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nuzhat Husain
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Sheng D, Yu X, Li H, Zhang M, Chen J. BRAF V600E mutation and the Bethesda System for Reporting Thyroid Cytopathology of fine-needle aspiration biopsy for distinguishing benign from malignant thyroid nodules. Medicine (Baltimore) 2021; 100:e27167. [PMID: 34664843 PMCID: PMC8448077 DOI: 10.1097/md.0000000000027167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 08/16/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) predicts the risk of malignancy for the different categories of the ultrasound-guided fine-needle aspiration biopsy (FNAB). The objective of this study is to investigate the efficiencies of the v-raf murine sarcoma viral oncogene homolog B1 (BRAF) V600E mutation test and the TBSRTC categories in distinguishing between benign and malignant thyroid nodules. METHODS In this study, 362 ultrasound-guided fine-needle aspiration (FNA) samples from 344 patients aged from 17 to 76 years old were retrospectively reviewed. The patients were classified into six groups (I-VI) according to the TBSRTC system. The amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) was used to evaluate the BRAF V600E mutation level in total 362 samples. Among of the 344 patients, 128 patients (131 thyroid nodules) who underwent surgeries were followed by histopathological examination. The predictive values of the BRAF V600E mutation test and TBSRTC categories were evaluated in these 131 thyroid nodules. RESULTS The median ages of the patients in the TBSRTC IV-VI group were smaller than those in the TBSRTC I-III groups. The proportion of nodules over 1 cm was larger than it in the TBSRTC IV group compared to the other groups. Significant differences in BRAF V600E mutation were observed (P < .001) among these six groups. The sensitivity (89.57%) for the detection of malignant thyroid nodules, negative predictive value (NPV; 45.45%) for the detection of benign nodules, and accuracy (86.26%) for distinguishing between benign and malignant thyroid nodules increased by combining the BRAF V600E mutation test and TBSRTC system when compared with the BRAF V600E mutation test and TBSRTC system respectively. The BRAF V600E mutation test alone demonstrated the increased positive predictive value (PPV; 98.91%) and specificity (93.75%) for the detection of malignant thyroid nodules compared to the TBSRTC method (alone or in combination with the BRAF V600E method). CONCLUSION In summary, significant differences in age, nodule diameter, and BRAF V600E mutation were noted among the six categories of the TBSRTC system. The combination of the BRAF V600E mutation test and TBSRTC system demonstrated increases in the NPV, sensitivity, and accuracy, while the BRAF V600E method proved superiority to the TBSRTC system with regard to the PPV and specificity.
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Affiliation(s)
- Danli Sheng
- Department of Pathology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoli Yu
- Department of Pathology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hui Li
- Department of Pathology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Murui Zhang
- Department of Pathology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jianzhong Chen
- Institute of Immunology, School of Medicine, Zhejiang University, Hangzhou, China
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9
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Bolin J. Thyroid Follicular Epithelial Cell-Derived Cancer: New Approaches and Treatment Strategies. J Nucl Med Technol 2021; 49:199-208. [PMID: 34244225 DOI: 10.2967/jnmt.120.257105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 04/14/2021] [Indexed: 11/16/2022] Open
Abstract
Thyroid follicular epithelial cell-derived cancer includes papillary carcinoma, follicular carcinoma, Hürthle cell carcinoma, poorly differentiated thyroid cancer, and anaplastic thyroid carcinoma. Although the incidence of thyroid cancer has increased over the past 30 years, there has not been a significant increase in patient mortality. Use of increasingly sensitive detection methods such as high-resolution imaging has enabled earlier detection and better characterization of the thyroid malignancies. In the past several years, researchers have evaluated genetic mutations promoting thyroid carcinogenesis and oncogenesis. The identification of genetic mutations is important in understanding tumor initiation and progression. Additionally, these identified mutations may also serve as potential diagnostic or prognostic indicators and therapeutic molecular targets.
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Affiliation(s)
- Julie Bolin
- Nuclear Medicine Technology Program, GateWay Community College, Phoenix, Arizona
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10
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Higher EU-TIRADS-Score Correlated with BRAF V600E Positivity in the Early Stage of Papillary Thyroid Carcinoma. J Clin Med 2021; 10:jcm10112304. [PMID: 34070605 PMCID: PMC8199205 DOI: 10.3390/jcm10112304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/10/2021] [Accepted: 05/20/2021] [Indexed: 01/21/2023] Open
Abstract
The data demonstrating a correlation between sonographic markers of malignancy of thyroid cancer (TC) and its genetic status are scarce. This study aimed to assess whether the addition of genetic analysis at the preoperative step of TC patients' stratification could aid their clinical management. The material consisted of formalin-fixed paraffin-embedded tumor fragments of 49 patients who underwent thyroidectomy during the early stages of papillary TC (PTC). Tumor DNA and RNA were subjected to next-generation sequencing (NGS) on Ion Proton using the Oncomine™ Comprehensive Assay panel. We observed a significant correlation between BRAF V600E and a higher EU-TIRADS score (p-value = 0.02) with a correlation between hypoechogenicity and taller-than-wide tumor shape in analysed patients. There were no other significant associations between the identified genetic variants and other clinicopathological features. For TC patient's stratification, a strong suspicion of BRAF V600E negativity in preoperative management of TC patients could limit the over-treatment of asymptomatic, very low-risk, indolent disease and leave room for active surveillance.
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11
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Nylén C, Mechera R, Maréchal-Ross I, Tsang V, Chou A, Gill AJ, Clifton-Bligh RJ, Robinson BG, Sywak MS, Sidhu SB, Glover AR. Molecular Markers Guiding Thyroid Cancer Management. Cancers (Basel) 2020; 12:cancers12082164. [PMID: 32759760 PMCID: PMC7466065 DOI: 10.3390/cancers12082164] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 12/12/2022] Open
Abstract
The incidence of thyroid cancer is rapidly increasing, mostly due to the overdiagnosis and overtreatment of differentiated thyroid cancer (TC). The increasing use of potent preclinical models, high throughput molecular technologies, and gene expression microarrays have provided a deeper understanding of molecular characteristics in cancer. Hence, molecular markers have become a potent tool also in TC management to distinguish benign from malignant lesions, predict aggressive biology, prognosis, recurrence, as well as for identification of novel therapeutic targets. In differentiated TC, molecular markers are mainly used as an adjunct to guide management of indeterminate nodules on fine needle aspiration biopsies. In contrast, in advanced thyroid cancer, molecular markers enable targeted treatments of affected signalling pathways. Identification of the driver mutation of targetable kinases in advanced TC can select treatment with mutation targeted tyrosine kinase inhibitors (TKI) to slow growth and reverse adverse effects of the mutations, when traditional treatments fail. This review will outline the molecular landscape and discuss the impact of molecular markers on diagnosis, surveillance and treatment of differentiated, poorly differentiated and anaplastic follicular TC.
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Affiliation(s)
- Carolina Nylén
- Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, NSW 2065, Australia; (C.N.); (R.M.); (M.S.S.); (S.B.S.)
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna L1:00, 171 76 Stockholm, Sweden
| | - Robert Mechera
- Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, NSW 2065, Australia; (C.N.); (R.M.); (M.S.S.); (S.B.S.)
- Department of Visceral Surgery, Clarunis University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Isabella Maréchal-Ross
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (I.M.-R.); (V.T.); (A.C.); (A.J.G.); (R.J.C.-B.); (B.G.R.)
| | - Venessa Tsang
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (I.M.-R.); (V.T.); (A.C.); (A.J.G.); (R.J.C.-B.); (B.G.R.)
- Department of Endocrinology, Royal North Shore Hospital, University of Sydney, St. Leonards, NSW 2065, Australia
| | - Angela Chou
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (I.M.-R.); (V.T.); (A.C.); (A.J.G.); (R.J.C.-B.); (B.G.R.)
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, University of Sydney, St. Leonards, NSW 2065, Australia
| | - Anthony J. Gill
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (I.M.-R.); (V.T.); (A.C.); (A.J.G.); (R.J.C.-B.); (B.G.R.)
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, University of Sydney, St. Leonards, NSW 2065, Australia
| | - Roderick J. Clifton-Bligh
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (I.M.-R.); (V.T.); (A.C.); (A.J.G.); (R.J.C.-B.); (B.G.R.)
- Department of Endocrinology, Royal North Shore Hospital, University of Sydney, St. Leonards, NSW 2065, Australia
- Cancer Genetics Unit, Kolling Institute, Sydney, NSW 2010, Australia
| | - Bruce G. Robinson
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (I.M.-R.); (V.T.); (A.C.); (A.J.G.); (R.J.C.-B.); (B.G.R.)
- Department of Endocrinology, Royal North Shore Hospital, University of Sydney, St. Leonards, NSW 2065, Australia
- Cancer Genetics Unit, Kolling Institute, Sydney, NSW 2010, Australia
| | - Mark S. Sywak
- Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, NSW 2065, Australia; (C.N.); (R.M.); (M.S.S.); (S.B.S.)
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (I.M.-R.); (V.T.); (A.C.); (A.J.G.); (R.J.C.-B.); (B.G.R.)
| | - Stan B. Sidhu
- Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, NSW 2065, Australia; (C.N.); (R.M.); (M.S.S.); (S.B.S.)
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (I.M.-R.); (V.T.); (A.C.); (A.J.G.); (R.J.C.-B.); (B.G.R.)
- Cancer Genetics Unit, Kolling Institute, Sydney, NSW 2010, Australia
| | - Anthony R. Glover
- Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, NSW 2065, Australia; (C.N.); (R.M.); (M.S.S.); (S.B.S.)
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (I.M.-R.); (V.T.); (A.C.); (A.J.G.); (R.J.C.-B.); (B.G.R.)
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Faculty of Medicine, St. Vincent’s Clinical School, University of New South Wales Sydney, Sydney, NSW 2010, Australia
- Correspondence: ; Tel.: +61-2-9463-1477
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12
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Trimboli P, Scappaticcio L, Treglia G, Guidobaldi L, Bongiovanni M, Giovanella L. Testing for BRAF (V600E) Mutation in Thyroid Nodules with Fine-Needle Aspiration (FNA) Read as Suspicious for Malignancy (Bethesda V, Thy4, TIR4): a Systematic Review and Meta-analysis. Endocr Pathol 2020; 31:57-66. [PMID: 31811566 DOI: 10.1007/s12022-019-09596-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In patients with thyroid fine-needle aspiration (FNA) report of suspicious for malignancy (SFM), both lobectomy and thyroidectomy might be considered. BRAF mutation analysis could guide towards accurate surgical therapy. The primary outcome was the reliability of BRAF (V600E) in detecting malignancy in nodules with FNA reading of SFM. The secondary outcome was to analyze its positive predictive value (PPV) and negative predictive value (NPV) considering the surgical histology as gold standard. A literature search of online databases was performed in June 2019. BRAF prevalence among thyroid nodules with FNA read as SFM according to the most popular classification systems (i.e., Bethesda V, Thy4, TIR4 category) was searched. The random-effects model was used. Three hundred sixty original articles were identified and 34 were finally included in the study. There were 1428 thyroid nodules with FNA read as SFM and 1287 (90.1%) lesions underwent surgery with a cancer rate 89.6%. The pooled prevalence of BRAF (V600E) mutation among all nodules with SFM cytology was 47% (95% CI = 40 to 54, I2 = 85.5%). Pooled PPV and NPV of BRAF testing were 99% (95% CI, 97-99) and 24% (95% CI, 16-32), respectively. BRAF (V600E) mutation was found in about one in two nodules with thyroid FNA read as SFM, its PPV to detect cancers was excellent, and its NPV was very poor. The routine BRAF testing in FNA read as SFM cannot be recommended. BRAF (V600E) test may be useful to extend surgical approach in selected cases with further suspicious clinical/ultrasound features.
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Affiliation(s)
- Pierpaolo Trimboli
- Department of Nuclear Medicine and Thyroid Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
| | - Lorenzo Scappaticcio
- Department of Nuclear Medicine and Thyroid Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Unit of Endocrinology and Metabolic Diseases, University of Campania "L. Vanvitelli", Naples, Italy
| | - Giorgio Treglia
- Department of Nuclear Medicine and Thyroid Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Leo Guidobaldi
- Azienda Sanitaria Unità Sanitaria Locale Roma 2, Rome, Italy
| | - Massimo Bongiovanni
- Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Luca Giovanella
- Department of Nuclear Medicine and Thyroid Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Medical School Zürich, University of Zürich, Zürich, Switzerland
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13
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Prete A, Borges de Souza P, Censi S, Muzza M, Nucci N, Sponziello M. Update on Fundamental Mechanisms of Thyroid Cancer. Front Endocrinol (Lausanne) 2020; 11:102. [PMID: 32231639 PMCID: PMC7082927 DOI: 10.3389/fendo.2020.00102] [Citation(s) in RCA: 211] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/17/2020] [Indexed: 12/21/2022] Open
Abstract
The incidence of thyroid cancer (TC) has increased worldwide over the past four decades. TC is divided into three main histological types: differentiated (papillary and follicular TC), undifferentiated (poorly differentiated and anaplastic TC), and medullary TC, arising from TC cells. This review discusses the molecular mechanisms associated to the pathogenesis of different types of TC and their clinical relevance. In the last years, progresses in the genetic characterization of TC have provided molecular markers for diagnosis, risk stratification, and treatment targets. Recently, papillary TC, the most frequent form of TC, has been reclassified into two molecular subtypes, named BRAF-like and RAS-like, associated to a different range of cancer risks. Similarly, the genetic characterization of follicular TC has been proposed to complement the new histopathological classification in order to estimate the prognosis. New analyses characterized a comprehensive molecular profile of medullary TC, raising the role of RET mutations. More recent evidences suggested that immune microenvironment associated to TC may play a critical role in tumor invasion, with potential immunotherapeutic implications in advanced and metastatic TC. Several types of ancillary approaches have been developed to improve the diagnostic value of fine needle aspiration biopsies in indeterminate thyroid nodules. Finally, liquid biopsy, as a non-invasive diagnostic tool for body fluid genotyping, brings a new prospective of disease and therapy monitoring. Despite all these novelties, much work remains to be done to fully understand the pathogenesis and biological behaviors of the different types of TC and to transfer this knowledge in clinical practice.
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Affiliation(s)
- Alessandro Prete
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Patricia Borges de Souza
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Simona Censi
- Endocrinology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Marina Muzza
- Division of Endocrinology and Metabolism IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Nicole Nucci
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Marialuisa Sponziello
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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14
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Goldner WS, Angell TE, McAdoo SL, Babiarz J, Sadow PM, Nabhan FA, Nasr C, Kloos RT. Molecular Variants and Their Risks for Malignancy in Cytologically Indeterminate Thyroid Nodules. Thyroid 2019; 29:1594-1605. [PMID: 31469053 PMCID: PMC6864764 DOI: 10.1089/thy.2019.0278] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Gene panels are routinely used to assess predisposition to hereditary cancers by simultaneously testing multiple susceptibility genes and/or variants. More recently, genetic panels have been implemented as part of solid tumor malignancy testing assessing somatic alterations. One example is targeted variant panels for thyroid nodules that are not conclusively malignant or benign upon fine-needle aspiration (FNA). We systematically reviewed published studies from 2009 to 2018 that contained genetic data from preoperative FNA specimens on cytologically indeterminate thyroid nodules (ITNs) that subsequently underwent surgical resection. Pooled prevalence estimates per gene and variant, along with their respective positive predictive values (PPVs) for malignancy, were calculated. Summary: Our systematic search identified 540 studies that were supplemented by 18 studies from bibliographies or personal files. Sixty-one studies met all inclusion criteria and included >4600 ITNs. Overall, 26% of nodules contained at least 1 variant or fusion. However, half of them did not include details on the specific gene, variant, and/or complete fusion pair reported for inclusion toward PPV calculations. The PPVs of genomic alterations reported at least 10 times were limited to BRAFV600E (98%, 95% confidence interval [CI 96-99%]), PAX8/PPARG (55% [CI 34-78%]), HRASQ61R (45% [CI 22-72%]), BRAFK601E (42% [CI 19-68%]), and NRASQ61R (38% [CI 23-55%]). Excluding BRAFV600E, the pooled PPV for all other specified variants and fusions was 47%. Multiple variants within the same nodule were identified in ∼1% of ITN and carried a cumulative PPV of 77%. Conclusions: The chance that a genomic alteration predicts malignancy depends on the individual variant or fusion detected. Only five alterations were reported at least 10 times; BRAFV600E had a PPV of 98%, while the remaining four had individual PPVs ranging from 38% to 55%. The small sample size of most variants and fusion pairs found among ITNs, however, limits confidence in their individual PPV point estimates. Better specific reporting of genomic alterations with cytological category, histological subtype, and cancer staging would facilitate better understanding of cancer prediction, and the independent contribution of the genomic profile to prognosis.
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Affiliation(s)
- Whitney S. Goldner
- Division of Diabetes, Endocrinology, and Metabolism, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
- Address correspondence to: Whitney S. Goldner, MD, Division of Diabetes, Endocrinology, and Metabolism, Department of Internal Medicine, University of Nebraska Medical Center, 984120 Nebraska Medical Center, Omaha, NE 68198-4120
| | - Trevor E. Angell
- Division of Endocrinology, Diabetes and Metabolism, Keck School of Medicine, University of Southern California, Los Angles, California
| | | | | | - Peter M. Sadow
- Pathology Service, Massachusetts General Hospital, Boston, Massachusetts
- Department of Pathology, Harvard Medical School, Boston, Massachusetts
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Fadi A. Nabhan
- Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University Wexner Medical Center and Arthur G. James Cancer Center, Columbus, Ohio
| | - Christian Nasr
- Endocrinology and Metabolism Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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15
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Galuppini F, Fassan M, Bertazza L, Barollo S, Cascione L, Watutantrige-Fernando S, Lazzarin V, Simonato P, Vianello F, Rugge M, Mian C, Pennelli G. Programmed cell death 4 (PDCD4) as a novel prognostic marker for papillary thyroid carcinoma. Cancer Manag Res 2019; 11:7845-7855. [PMID: 31692513 PMCID: PMC6708393 DOI: 10.2147/cmar.s194344] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 07/22/2019] [Indexed: 12/26/2022] Open
Abstract
Background The primary goal of papillary thyroid cancer (PTC) management was to stratify patients at pre- and post-surgical level to identify the small proportion of cases with potentially aggressive disease. Purpose The aim of our study is to evaluate the possible role of programmed cell death 4 (PDCD4) and BRAF status as prognostic markers in PTC. Patients and methods We investigate programmed cell death 4 (PDCD4) immunohistochemical expression in 125 consecutive PTCs with median follow-up of 75.3 months (range, 15–98 months) to verify the possible correlation between BRAF status and correlate the classical clinicopathological prognostic factors and PTC outcome with PDCD4 expression. To further support the data, miR-21 expression was tested (by quantitative real-time PCR and in situ hybridization) in a different series of 30 cases (15 PTCs BRAFwt and 15 PTCs BRAFV600E). Moreover, we validated our results using TGCA thyroid carcinoma dataset. Results We found that 59.8% of the patients showed low-grade PDCD4 nuclear expression and low-grade expression correlated with BRAF V600E. Compared with BRAF 15 wild-type tissue samples, a significant miR-21 up-regulation was associated with BRAF V600E mutations. Low-grade PDCD4 resulted, and was associated with aggressive histological variants, higher cancer size, extra-thyroidal extension, multifocality, lymph-node metastasis and lymph nodal ratio at the diagnosis. Concerning the outcome, the low-grade PDCD4 expression correlated at univariate and multivariate analysis, with lower levels of recurrence-free survival rate (RFS) and with poor outcome. Moreover, there was significant association between BRAF V600E patients with PDCD4 nuclear loss and lower RFS, whilet here was significant association between BRAF wild-type patients with PDCD4 nuclear expression and better outcome. Conclusion These results showed that PDCD4 could predict PTC outcome and that the sum of PDCD4 and BRAF alterations increases the prognostic power of BRAF mutation alone.
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Affiliation(s)
- Francesca Galuppini
- Pathology Unit, Department of Medicine (DIMED), University of Padova, Padova 35121, Italy
| | - Matteo Fassan
- Pathology Unit, Department of Medicine (DIMED), University of Padova, Padova 35121, Italy
| | - Loris Bertazza
- Endocrinology Unit, Department of Medicine (DIMED), University of Padova, Padova 35121, Italy
| | - Susi Barollo
- Endocrinology Unit, Department of Medicine (DIMED), University of Padova, Padova 35121, Italy
| | - Luciano Cascione
- Università Della Svizzera Italiana, Institute of Oncology Research and Swiss Institute of Bioinformatics , Bellinzona 6500, Switzerland
| | | | - Vanni Lazzarin
- Pathology Unit, Department of Medicine (DIMED), University of Padova, Padova 35121, Italy
| | - Paolo Simonato
- Pathology Unit, Department of Medicine (DIMED), University of Padova, Padova 35121, Italy
| | - Federica Vianello
- Department of Radiotherapy, Istituto Oncologico del Veneto, Padova 35128, Italy
| | - Massimo Rugge
- Pathology Unit, Department of Medicine (DIMED), University of Padova, Padova 35121, Italy
| | - Caterina Mian
- Endocrinology Unit, Department of Medicine (DIMED), University of Padova, Padova 35121, Italy
| | - Gianmaria Pennelli
- Pathology Unit, Department of Medicine (DIMED), University of Padova, Padova 35121, Italy
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16
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Henke LE, Pfeifer JD, Baranski TJ, DeWees T, Grigsby PW. Long-term outcomes of follicular variant vs classic papillary thyroid carcinoma. Endocr Connect 2018; 7:1226-1235. [PMID: 30352402 PMCID: PMC6240143 DOI: 10.1530/ec-18-0264] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/08/2018] [Indexed: 01/28/2023]
Abstract
The majority of papillary thyroid carcinoma (PTC) cases comprise classic papillary (C-PTC) and follicular variant (FV-PTC) histologic sub-types. Historically, clinical equivalency was assumed, but recent data suggest C-PTC may have poorer outcomes. However, large single-institution series with long-term outcomes of C-PTC and FV-PTC, using modern pathologic criteria for FV-PTC, are needed. Our objective was to compare prevalence and impact of clinicopathologic factors, including BRAF mutation status, on long-term outcomes of C-PTC and FV-PTC. We hypothesized that patients with C-PTC would have higher risk disease features and worse survival outcomes. This retrospective study included 1293 patients treated at a single, US academic institution between 1943 and 2009 with mean follow-up of 8.6 years. All patients underwent either partial or total thyroidectomy and had invasive C-PTC or FV-PTC per modern pathology criteria. Primary study measurements included differences in recurrence-free survival (RFS), disease-specific survival (DSS) and associations with clinicopathologic factors including the BRAF mutation. Compared to FV-PTC, C-PTC was associated with multiple features of high-risk disease (P < 0.05) and significantly reduced RFS and DSS. Survival differences were consistent across univariate, multivariate and Kaplan-Meier analyses. BRAF mutations were more common in C-PTC (P = 0.002). However, on Kaplan-Meier analysis, mutational status did not significantly impact RFS or DSS for patients with either histologic sub-type. C-PTC therefore indicates higher-risk disease and predicts for significantly poorer long-term outcomes when compared to FV-PTC. The nature of this difference in outcome is not explained by traditional histopathologic findings or by the BRAF mutation.
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Affiliation(s)
- Lauren E Henke
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - John D Pfeifer
- Department of Pathology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Thomas J Baranski
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Todd DeWees
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Scottsdale, Arizona, USA
| | - Perry W Grigsby
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri, USA
- Correspondence should be addressed to P W Grigsby:
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17
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Aydin AF, Vural P, Doğru-Abbasoğlu S, Çil E. The endothelin 1 and endothelin receptor A gene polymorphisms increase the risk of developing papillary thyroid cancer. Mol Biol Rep 2018; 46:199-205. [DOI: 10.1007/s11033-018-4461-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/01/2018] [Indexed: 02/02/2023]
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Kim DS, Kim DW, Heo YJ, Baek JW, Lee YJ, Choo HJ, Park YM, Park HK, Ha TK, Kim DH, Jung SJ, Park JS, Ahn KJ, Baek HJ, Kang T. Utility of including BRAF mutation analysis with ultrasonographic and cytological diagnoses in ultrasonography-guided fine-needle aspiration of thyroid nodules. PLoS One 2018; 13:e0202687. [PMID: 30118506 PMCID: PMC6097667 DOI: 10.1371/journal.pone.0202687] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/12/2018] [Indexed: 01/21/2023] Open
Abstract
This study investigated the role of BRAF mutation analysis in thyroid fine-needle aspiration (FNA) samples compared to ultrasonographic and cytological diagnoses. A total 316 patients underwent ultrasonography (US)-guided FNA with BRAFV600E mutation analysis to diagnose thyroid nodules. One hundred sixteen patients with insufficient US images (n = 6), follow-up loss (n = 43), or unknown final diagnosis (n = 67) were excluded from the study. Comparisons between US diagnoses, cytological diagnoses, and BRAF mutation analysis were performed. Of 200 thyroid nodules, there was US diagnosis with 1 false negative and 11 false positive cases, cytological diagnosis with 10 false negative and 2 false positive cases, and BRAFV600E mutation analysis with 19 false negative and 2 false positive cases. The sensitivity, specificity, positive and negative predictive values, and accuracy of BRAFV600E mutation analysis were 83.2%, 98.1%, 97.5%, 86.6%, and 91%, respectively. Of the 18 nodules with Bethesda category III, 9 were true positive, 6 were true negative, 3 was a false negative, and none were false positive on BRAF mutation analysis. In conclusion, we recommend that BRAFV600E mutation analysis only be performed for evaluating thyroid nodules with Bethesda category III, regardless of US diagnosis.
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Affiliation(s)
- Da Som Kim
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Dong Wook Kim
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
- * E-mail:
| | - Young Jin Heo
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Jin Wook Baek
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Yoo Jin Lee
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Hye Jung Choo
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Young Mi Park
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Ha Kyoung Park
- Department of General Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Tae Kwun Ha
- Department of General Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Do Hun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Soo Jin Jung
- Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Ji Sun Park
- Department of Nuclear Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Ki Jung Ahn
- Department of Radiation Oncology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, South Korea
| | - Taewoo Kang
- Department of Surgery (Busan Cancer Center), Pusan National University Hospital, Pusan National University College of Medicine, Busan, South Korea
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Ferrari SM, Fallahi P, Ruffilli I, Elia G, Ragusa F, Paparo SR, Ulisse S, Baldini E, Giannini R, Miccoli P, Antonelli A, Basolo F. Molecular testing in the diagnosis of differentiated thyroid carcinomas. Gland Surg 2018; 7:S19-S29. [PMID: 30175060 DOI: 10.21037/gs.2017.11.07] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Different genetic mutations and other molecular alterations in papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC) can be detected in fine-needle aspiration (FNA) of thyroid nodules, and can be used successfully to ameliorate cancer diagnosis and management of patients with thyroid nodules. The greatest experience has been obtained with the diagnostic use of BRAF mutation that is strongly specific for malignancy when detected using well-validated techniques. The strongest diagnostic result can be obtained testing FNA samples for a panel of mutations that typically involve TERT, BRAF, PAX8/PPARγ, RAS, and RET/PTC. Finding any of these mutations in a thyroid nodule provides strong indication for malignancy and helps to refine clinical management for a significant proportion of patients with indeterminate cytology. The use of molecular markers, as TERT, BRAF, PAX8/PPARγ, RAS, and RET/PTC, may be considered for patients with indeterminate FNA cytology (FNAC) to help guide management. In patients with indeterminate TIR3 FNA, the combination of precise molecular marker expression analysis with molecular mutations evaluations could ameliorate significantly the accuracy of cancer diagnosis. However other prospective studies are needed to identify more accurate molecular markers. Finally, the knowledge of these molecular pathways has permitted the development of new targeted therapies for aggressive TC.
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Affiliation(s)
| | - Poupak Fallahi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ilaria Ruffilli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giusy Elia
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesca Ragusa
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Salvatore Ulisse
- Department of Surgical Sciences, 'Sapienza' University of Rome, Rome, Italy
| | - Enke Baldini
- Department of Surgical Sciences, 'Sapienza' University of Rome, Rome, Italy
| | - Riccardo Giannini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Paolo Miccoli
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Alessandro Antonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fulvio Basolo
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
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20
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Lu J, Hu S, Miccoli P, Zeng Q, Liu S, Ran L, Hu C. Non-invasive diagnosis of papillary thyroid microcarcinoma: a NMR-based metabolomics approach. Oncotarget 2018; 7:81768-81777. [PMID: 27835583 PMCID: PMC5348428 DOI: 10.18632/oncotarget.13178] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 10/22/2016] [Indexed: 02/06/2023] Open
Abstract
Papillary thyroid microcarcinoma (PTMC) is a subtype of papillary thyroid carcinoma (PTC). Because its diameter is less than 10 mm, diagnosing it accurately is difficult with traditional methods such as image examinations and FNA (Fine Needle Aspiration). Investigating the metabolic changes induced by PTMC may enhance the understanding of its pathogenesis and provide important information for a new diagnosis method and treatment plan. In this study, high resolution magic angle spin (HRMAS) spectroscopy and 1H-nuclear magnetic resonance (1H-NMR) spectroscopy were used to screen metabolic changes in thyroid tissues and plasma from PTMC patients respectively. The results revealed reduced levels of fatty acids and elevated levels of several amino acids (phenylalanine, tyrosine, lactate, serine, cystine, lysine, glutamine/glutamate, taurine, leucine, alanine, isoleucine and valine) in thyroid tissues, as well as reduced levels of amino acids such as valine, tyrosine, proline, lysine, leucine and elevated levels of glucose, mannose, pyruvate and 3-hydroxybutyrate in plasma, are involved in the metabolic alterations in PTMC. In addition, a receiver operating characteristic (ROC) curve model for PTMC prediction was able to classify cases with good sensitivity and specificity using 9 significant changed metabolites in plasma. This work illustrates that the NMR-based metabolomics approach is capable of providing more sensitive diagnostic results and more systematic therapeutic information for PTMC.
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Affiliation(s)
- Jinghui Lu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, P.R. China
| | - Sanyuan Hu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, P.R. China
| | - Paolo Miccoli
- Department of General Surgery, University of Pisa, Pisa 56126, Italy
| | - Qingdong Zeng
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, P.R. China
| | - Shaozhuang Liu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, P.R. China
| | - Lin Ran
- Medical College of Shandong University, Jinan 250012, P.R. China
| | - Chunxiao Hu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, P.R. China
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Comparative analysis of diagnostic performance, feasibility and cost of different test-methods for thyroid nodules with indeterminate cytology. Oncotarget 2017; 8:49421-49442. [PMID: 28472764 PMCID: PMC5564779 DOI: 10.18632/oncotarget.17220] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/22/2017] [Indexed: 01/07/2023] Open
Abstract
Since it is impossible to recognize malignancy at fine needle aspiration (FNA) cytology in indeterminate thyroid nodules, surgery is recommended for all of them. However, cancer rate at final histology is <30%. Many different test-methods have been proposed to increase diagnostic accuracy in such lesions, including Galectin-3-ICC (GAL-3-ICC), BRAF mutation analysis (BRAF), Gene Expression Classifier (GEC) alone and GEC+BRAF, mutation/fusion (M/F) panel, alone, M/F panel+miRNA GEC, and M/F panel by next generation sequencing (NGS), FDG-PET/CT, MIBI-Scan and TSHR mRNA blood assay.We performed systematic reviews and meta-analyses to compare their features, feasibility, diagnostic performance and cost. GEC, GEC+BRAF, M/F panel+miRNA GEC and M/F panel by NGS were the best in ruling-out malignancy (sensitivity = 90%, 89%, 89% and 90% respectively). BRAF and M/F panel alone and by NGS were the best in ruling-in malignancy (specificity = 100%, 93% and 93%). The M/F by NGS showed the highest accuracy (92%) and BRAF the highest diagnostic odds ratio (DOR) (247). GAL-3-ICC performed well as rule-out (sensitivity = 83%) and rule-in test (specificity = 85%), with good accuracy (84%) and high DOR (27) and is one of the cheapest (113 USD) and easiest one to be performed in different clinical settings.In conclusion, the more accurate molecular-based test-methods are still expensive and restricted to few, highly specialized and centralized laboratories. GAL-3-ICC, although limited by some false negatives, represents the most suitable screening test-method to be applied on a large-scale basis in the diagnostic algorithm of indeterminate thyroid lesions.
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22
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Rossi M, Lupo S, Rossi R, Franceschetti P, Trasforini G, Bruni S, Tagliati F, Buratto M, Lanza G, Damiani L, Degli Uberti E, Zatelli MC. Proposal for a novel management of indeterminate thyroid nodules on the basis of cytopathological subclasses. Endocrine 2017; 57:98-107. [PMID: 27623969 DOI: 10.1007/s12020-016-1105-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/25/2016] [Indexed: 01/19/2023]
Abstract
Indeterminate thyroid nodules include heterogeneous lesions that could benefit from a differential management. Our aim is to better define the management of the Bethesda System for Reporting Thyroid Cytopathology class III and IV nodules, by identifying cytological subcategories among Bethesda System for Reporting Thyroid Cytopathology class III associated with different clinical risk, by means of ultrasound, repeated FNAB, and BRAFV600E molecular analysis. We also evaluated the outcome of nodules not operated, over a 5-year follow-up. Out of 460 nodules (269 Bethesda System for Reporting Thyroid Cytopathology class III and 191 Bethesda System for Reporting Thyroid Cytopathology class IV), 344 were operated on surgical group and 116 followed-up conservatively (follow-up group). Bethesda System for Reporting Thyroid Cytopathology class III was divided into four subcategories on the basis of cytomorphological features (III-1, III-2, III-3, III-4). Clinical risk was defined on the basis of histological, cytological, and ultrasound data. Malignancy was higher in Bethesda System for Reporting Thyroid Cytopathology class III vs. Bethesda System for Reporting Thyroid Cytopathology class IV (34.4 vs. 26.2 %; p < 0.01). Papillary thyroid carcinoma was the most frequent cancer in each Bethesda System for Reporting Thyroid Cytopathology class (35 %). BRAFV600E diagnostic accuracy was 87 %. Repeated FNAB reclassified as benign nearly 40 % of nodules, selecting patients where surgery could be spared. Significant nodule growth occurred in 13.7 % of nodules, belonging mostly to Bethesda System for Reporting Thyroid Cytopathology class III-2 and Bethesda System for Reporting Thyroid Cytopathology class IV. Overall clinical risk was higher in Bethesda System for Reporting Thyroid Cytopathology III-1, III-4, and IV classes. We propose a differential management of Bethesda System for Reporting Thyroid Cytopathology III and IV classes and related subcategories: surgery may be indicated in Bethesda System for Reporting Thyroid Cytopathology class III-1, III-4, and IV; a conservative follow-up avoiding repeated FNAB may be appropriated in class III-3, while repeated FNAB may be useful in class III-2.
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Affiliation(s)
- Martina Rossi
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Sabrina Lupo
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
| | - Roberta Rossi
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Paola Franceschetti
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Giorgio Trasforini
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Stefania Bruni
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Federico Tagliati
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Mattia Buratto
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
| | - Giovanni Lanza
- Section of Pathology and Biomolecular Diagnostics, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
| | - Luca Damiani
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
| | - Ettore Degli Uberti
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy.
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy.
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Values of molecular markers in the differential diagnosis of thyroid abnormalities. J Cancer Res Clin Oncol 2016; 143:913-931. [PMID: 28008451 DOI: 10.1007/s00432-016-2319-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 12/02/2016] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Thyroid cancer (TC), follicular adenoma (FA) and Hashimoto's thyroiditis (HT) are three of the most frequently reported abnormalities that affect the thyroid gland. A frequent co-occurrence along with similar histopathological features is observed between TC and FA as well as between TC and HT. The conventional diagnostic methods such as histochemical analysis present complications in differential diagnosis when these abnormalities occur simultaneously. Hence, the authors recognize novel methods based on screening genetic defects of thyroid abnormalities as viable diagnostic and prognostic methods that could complement the conventional methods. METHODS We have extensively reviewed the existing literature on TC, FA and HT and also on three genes, namely braf, nras and ret/ptc, that could be used to differentially diagnose the three abnormalities. Emphasis was also given to the screening methods available to detect the said molecular markers. RESULTS AND CONCLUSION It can be conferred from the analysis of the available data that the utilization of braf, nras and ret/ptc as markers for the therapeutic evaluation of FA and HT is debatable. However, molecular screening for braf, nras and ret/ptc mutations proves to be a conclusive method that could be employed to differentially diagnose TC from HT and FA in the instance of a suspected co-occurrence. Thyroid cancer patients can be highly benefited from the screening for the said genetic markers, especially the braf gene due to its diagnostic value as well as due to the availability of personalized medicine targeted specifically for braf mutants.
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Wang Q, Yang H, Wu L, Yao J, Meng X, Jiang H, Xiao C, Wu F. Identification of Specific Long Non-Coding RNA Expression: Profile and Analysis of Association with Clinicopathologic Characteristics and BRAF Mutation in Papillary Thyroid Cancer. Thyroid 2016; 26:1719-1732. [PMID: 27758138 DOI: 10.1089/thy.2016.0024] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND In recent years, long non-coding RNAs (lncRNAs) have been shown to play a critical regulatory role in cancer biology. However, the contribution of lncRNAs to papillary thyroid cancer (PTC) remains largely unknown. METHODS RNA sequencing and quantitative reverse transcription polymerase chain reaction were used to detect and verify changes to the transcriptome profile in 12 PTC tissues compared to paired normal adjacent tissues. The statistical correlation between differentially expressed lncRNAs and clinicopathologic characteristics was analyzed, and potential lncRNA functions were predicted by examining annotations for the co-expressed mRNAs. Furthermore, the specific subgroup patterns of the PTC transcriptome remodeled by BRAF mutations were also analyzed. RESULTS A total of 188 lncRNAs and 505 mRNAs were differentially expressed in 50% or more of the PTC tissues (fold change >2; p < 0.05) as assessed by RNA-sequencing compared with paired normal adjacent tissues. Forty-seven lncRNAs and 39 mRNAs were verified in 31 pairs of PTC specimens using quantitative reverse transcription polymerase chain reaction, and the results were consistent with the RNA sequencing data. The lncRNAs NONHSAT076747 and NONHSAT122730 were associated with lymph node metastasis, and NONHSAG051968 expression was negatively correlated with tumor size. A co-expression network between differentially expressed lncRNAs and protein-coding RNAs was constructed and analyzed, and functional analysis suggested that the differentially expressed genes mainly participate in ECM-receptor interactions and the focal adhesion pathway. Furthermore, a specific PTC transcriptome subtype pattern stratified by BRAF mutation was also uncovered. The p53 signaling pathway was the most highly enriched pathway among the BRAF mutation-related genes. CONCLUSIONS This study reveals specific changes to the lncRNA profile associated with PTC, and provides new insight into its pathogenesis. The PTC-associated lncRNAs NONHSAG051968, NONHSAT076747, and NONHSAT122730 might be potential diagnostic and therapeutic targets for PTC patients, and lncRNAs with subtype-specific expression stratified by BRAF mutation might be significant in individual molecular subtypes.
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Affiliation(s)
- Qiangfeng Wang
- 1 Department of Surgical Oncology, First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, China
| | - Huanxia Yang
- 1 Department of Surgical Oncology, First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, China
| | - Lingjiao Wu
- 2 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, China
| | - Jian Yao
- 2 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, China
| | - Xiaohua Meng
- 2 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, China
| | - Han Jiang
- 3 Department of Oncology, Shaoxing Second Hospital , Shaoxing, Zhejiang, China
| | - Cheng Xiao
- 4 Department of Medical Oncology, First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, China
| | - Fusheng Wu
- 1 Department of Surgical Oncology, First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, China
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BRAF V600E mutation as a predictor of thyroid malignancy in indeterminate nodules: A systematic review and meta-analysis. Eur J Surg Oncol 2016; 43:1219-1227. [PMID: 27923591 DOI: 10.1016/j.ejso.2016.11.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/17/2016] [Accepted: 11/01/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Thyroid nodules are usually diagnosed using fine-needle aspiration (FNA). The sensitivity limitations of FNA result in 10-30% of nodules being classified as "indeterminate". The BRAFV600E mutation is associated with papillary thyroid carcinoma (PTC). We conducted a systemic review and meta-analysis to evaluate the diagnostic utility of the BRAFV600E mutation in indeterminate nodules. METHOD PUBMED and EMBASE were searched for studies testing for the BRAFV600E involving indeterminate nodules (Thy3a, Thy3f, Thy4) and containing information on final surgical histopathology. Thirty two studies involving 3150 indeterminate nodules were included in the analysis. RESULTS The overall sensitivity and specificity for BRAFV600E for the diagnosis of thyroid malignancy was 0.40 (95% CI: 0.32-0.48) and 1.00 (95% CI: 0.98-1.00) respectively. The diagnostic odds ratio (DOR) was 205.4 (95% CI: 40.1-1052). With a Fagan plot, the post-test probability of thyroid cancer, given a negative mutation was 6%, but this rose to 92% with a positive result. On subgroup analysis, for Thy3a nodules, the pooled sensitivity and specificity for thyroid malignancy was 0.21 (95% CI: 0.13-0.34) and 1.00 (95% CI: 0.98-1.00). For Thy3f nodules, the pooled sensitivity and specificity was 0.09 (95% CI: 0.03-0.20) and 1.00 (95% CI: 0.05-1.00) respectively. For Thy4 nodules, the corresponding sensitivity and specificity was 0.58 (95% CI: 0.5-0.64) and 0.99 (95% CI: 0.95-1.00) respectively. CONCLUSIONS Despite a high specificity for thyroid cancer, BRAFV600E mutation has a low overall sensitivity and therefore has a limited diagnostic value as a single screening test.
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Galuppini F, Pennelli G, Vianello F, Censi S, Zambonin L, Watutantrige-Fernando S, Manso J, Nacamulli D, Lora O, Pelizzo MR, Rugge M, Barollo S, Mian C. BRAF analysis before surgery for papillary thyroid carcinoma: correlation with clinicopathological features and prognosis in a single-institution prospective experience. ACTA ACUST UNITED AC 2016; 54:1531-9. [DOI: 10.1515/cclm-2015-0218] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 12/27/2015] [Indexed: 11/15/2022]
Abstract
AbstractBackground:Risk stratification in patients with papillary thyroid carcinoma (PTC) currently relies on postoperative parameters. Testing forBRAFmutations preoperatively may serve as a novel tool for identifying PTC patients at risk of persistence/recurrence after surgery.Methods:The study involved 185 consecutive patients with a histological diagnosis of PTC andBRAFanalysis performed on thyroid fine-needle aspiration biopsy (FNAB). We assessedBRAFstatus in FNAB specimens obtained before thyroidectomy for PTC, and examined its association with the clinicopathological characteristics identified postoperatively, and with outcome after a mean 55±15 months of follow-up.Results:One hundred and fifteen of 185 (62%) PTCs carried aBRAFmutation. Univariate analysis showed thatBRAFstatus correlated with the histological variant of PTC, cancer size, and stage at diagnosis, but not with gender, age, multifocality, or lymph node involvement.BRAF-mutated cases had a higher prevalence of persistent/recurrent disease by the end of the follow-up (11% vs. 8%), but this difference was not statistically significant. The Kaplan-Meier curve shows that among the patients with persistent/recurrent disease,BRAF-mutated patients needed a second treatment earlier than patients withBRAFwild-type, although the difference did not completely reach the statistical significance.Conclusions:Our study confirmed that preoperatively-identifiedBRAFmutation are associated with certain pathological features of PTC that correlate with prognosis. We speculate that it has a role in identifying PTCs that would generally be considered low-risk but that may reveal an aggressive behavior during their follow-up.
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Cañadas-Garre M, Becerra-Massare P, Moreno Casares A, Calleja-Hernández MÁ, Llamas-Elvira JM. Relevance of BRAF and NRAS mutations in the primary tumor and metastases of papillary thyroid carcinomas. Head Neck 2016; 38:1772-1779. [PMID: 27299298 DOI: 10.1002/hed.24517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Multifocality of papillary thyroid carcinoma (PTC) is common. BRAF and NRAS mutations are the most frequent genetic alterations in PTC. The purpose of this study was to determine the distribution and relevance of BRAFT1799A and NRAS mutations in PTC. METHODS BRAFT1799A and NRAS mutations were evaluated in 195 intrathyroid or metastatic foci from 29 patients with multifocal PTC. RESULTS BRAFT1799A mutation was positive in 46.7% of the 59 intrathyroid and 136 metastatic foci (91/195 foci). Heterogeneous BRAF pattern was observed in 51.7% patients (15/29 patients). Irrespective of BRAF status at diagnosis (thyroid or nodes), all patients with recurrent PTC presented BRAF-mutated metastases during follow-up. All foci were negative for NRAS mutations. CONCLUSION BRAF but not NRAS mutations were heterogeneously distributed among primary tumor, nodal sites, and recurrent disease. The BRAF status of metastases generated during the follow-up can differ from the status of foci at diagnosis. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1772-1779, 2016.
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Affiliation(s)
- Marisa Cañadas-Garre
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Patricia Becerra-Massare
- UGC Anatomía Patológica, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Antonia Moreno Casares
- Department of Clinical Analysis and Immunology, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Miguel Ángel Calleja-Hernández
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - José Manuel Llamas-Elvira
- Nuclear Medicine Department, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Granada, Spain
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Su X, Jiang X, Xu X, Wang W, Teng X, Shao A, Teng L. Diagnostic value of BRAF (V600E)-mutation analysis in fine-needle aspiration of thyroid nodules: a meta-analysis. Onco Targets Ther 2016; 9:2495-509. [PMID: 27175084 PMCID: PMC4854268 DOI: 10.2147/ott.s101800] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Fine-needle aspiration (FNA) is a reliable method for preoperative diagnosis of thyroid nodules; however, about 10%–40% nodules are classified as indeterminate. The BRAFV600E mutation is the most promising marker for thyroid FNA. This meta-analysis was conducted to investigate the diagnostic value of BRAFV600E analysis in thyroid FNA, especially the indeterminate cases. Systematic searches were performed in PubMed, Web of Science, Scopus, Ovid, Elsevier, and the Cochrane Library databases for relevant studies prior to June 2015, and a total of 88 studies were ultimately included in this meta-analysis. Compared with FNA cytology, the synergism of BRAFV600E testing increased the diagnostic sensitivity from 81.4% to 87.4% and decreased the false-negative rate from 8% to 5.2%. In the indeterminate group, the mutation rate of BRAFV600E was 23% and varied in different subcategories (43.2% in suspicious for malignant cells [SMC], 13.77% in atypia of undetermined significance/follicular lesion of undetermined significance [AUS/FLUS], and 4.43% in follicular neoplasm/suspicious for follicular neoplasm [FN/SFN]). The sensitivity of BRAFV600E analysis was higher in SMC than that in AUS/FLUS and FN/SFN cases (59.4% vs 40.1% vs 19.5% respectively), while specificity was opposite (86.1% vs 99.5% vs 99.7% respectively). The areas under the summary receiver-operating characteristic curve also confirmed the diagnostic value of BRAFV600E testing in SMC and AUS/FLUS rather than FN/SFN cases. Therefore, BRAFV600E analysis can improve the diagnostic accuracy of thyroid FNA, especially indeterminate cases classified as SMC, and select malignancy to guide the extent of surgery.
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Affiliation(s)
- Xingyun Su
- Department of Surgical Oncology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Xiaoxia Jiang
- Department of Surgical Oncology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Xin Xu
- Department of Surgical Oncology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Weibin Wang
- Department of Surgical Oncology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Xiaodong Teng
- Department of Pathology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Anwen Shao
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Lisong Teng
- Department of Surgical Oncology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
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Akabane H, Sullivan RJ. The Future of Molecular Analysis in Melanoma: Diagnostics to Direct Molecularly Targeted Therapy. Am J Clin Dermatol 2016; 17:1-10. [PMID: 26518880 DOI: 10.1007/s40257-015-0159-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Melanoma is a malignancy of pigment-producing cells that is driven by a variety of genetic mutations and aberrations. In most cases, this leads to upregulation of the mitogen-activated protein kinase (MAPK) pathway through activating mutations of upstream mediators of the pathway including BRAF and NRAS. With the advent of effective MAPK pathway inhibitors, including the US FDA-approved BRAF inhibitors vemurafenib and dabrafenib and MEK inhibitor trametinib, molecular analysis has become an integral part of the care of patients with metastatic melanoma. In this article, the key molecular targets and strategies to inhibit these targets therapeutically are presented, and the techniques of identifying these targets, in both tissue and blood, are discussed.
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Affiliation(s)
- Hugo Akabane
- Department of Medicine, Metrowest Medical Center, Framingham, MA, USA
| | - Ryan J Sullivan
- Center for Melanoma, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, MA, 02114, USA.
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Wang Z, Chen JQ, Liu JL, Qin XG. Clinical impact of BRAF mutation on the diagnosis and prognosis of papillary thyroid carcinoma: a systematic review and meta-analysis. Eur J Clin Invest 2016; 46:146-57. [PMID: 26648183 DOI: 10.1111/eci.12577] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 11/29/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND The possible role of BRAF(V) (600E) mutation in the diagnosis and prognosis of papillary thyroid carcinoma (PTC) remains controversial. A systematic review to investigate the diagnostic and prognostic role of BRAF(V) (600E) mutation in patients with PTC is urgently needed. METHODS A systematic review of relevant literatures was performed in PubMed, EMBASE and CENTRAL. The incremental accuracy (IA) of fine needle aspiration biopsy plus BRAF(V) (600E) mutation analysis over fine needle aspiration biopsy alone, and the statistical data about the association of BRAF(V) (600E) mutation and the prognosis of PTC (risk ratios (RR) for dichotomous data, standard mean differences for continuous data and hazard ratios (HRs) for disease-free survival (DFS) were pooled. Subgroup analysis was performed to explain the heterogeneities. RESULTS A total of 67 studies were included. The pooled IA was 2% (95% confidence interval (CI): 0·5-4%). The pooled RR for gender, multifocality, lymph node metastasis, extrathyroidal invasion and pathological stage was 1·11 (95% CI: 0·98-1·25), 1·17 (95% CI: 1·09-1·24), 1·36 (95% CI: 1·20-1·53), 1·60 (95% CI: 1·41-1·82), and 1·49 (95% CI: 1·33-1·68), respectively. The pooled standard mean differences for age and tumour size were 0·14 (95% CI: 0·04-0·23) and 0·21 (95% CI: 0·1-0·32), respectively. The pooled HR for DFS was 1·96 (95% CI: 1·62-2·37). Subgroup analysis showed that these statistical results were affected by the geographical background of patients, study design and detection methods. CONCLUSIONS BRAF(V) (600E) mutation analysis can not only be used in the diagnosis of PTC, but can also predict its prognosis.
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Affiliation(s)
- Zhen Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jun-Qiang Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jin-Lu Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xin-Gan Qin
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Gagliano T, Gentilin E, Tagliati F, Benfini K, Di Pasquale C, Feo C, Falletta S, Riva E, degli Uberti E, Zatelli MC. Inhibition of epithelial growth factor receptor can play an important role in reducing cell growth and survival in adrenocortical tumors. Biochem Pharmacol 2015; 98:639-48. [DOI: 10.1016/j.bcp.2015.10.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 10/15/2015] [Indexed: 12/13/2022]
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Zhang YZ, Xu T, Cui D, Li X, Yao Q, Gong HY, Liu XY, Chen HH, Jiang L, Ye XH, Zhang ZH, Shen MP, Duan Y, Yang T, Wu XH. Value of TIRADS, BSRTC and FNA-BRAF V600E mutation analysis in differentiating high-risk thyroid nodules. Sci Rep 2015; 5:16927. [PMID: 26597052 PMCID: PMC4657033 DOI: 10.1038/srep16927] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/22/2015] [Indexed: 11/09/2022] Open
Abstract
The thyroid imaging reporting and data system (TIRADS) and Bethesda system for reporting thyroid cytopathology (BSRTC) have been used for interpretation of ultrasound and fine-needle aspiration cytology (FNAC) results of thyroid nodules. BRAF(V600E) mutation analysis is a molecular tool in diagnosing thyroid carcinoma. Our objective was to compare the diagnostic value of these methods in differentiating high-risk thyroid nodules. Total 220 patients with high-risk thyroid nodules were recruited in this prospective study. They all underwent ultrasound, FNAC and BRAF(V600E) mutation analysis. The sensitivity and specificity of TIRADS were 73.1% and 88.4%. BSRTC had higher specificity (97.7%) and similar sensitivity (77.6%) compared with TIRADS. The sensitivity and specificity of BRAF(V600E) mutation (85.1%, 100%) were the highest. The combination of BSRTC and BRAF(V600E) mutation analysis significantly increased the efficiency, with 97.8% sensitivity, 97.7% specificity. In patients with BSRTC I-III, the mutation rate of BRAF(V600E) was 64.5% in nodules with TIRADS 4B compared with 8.4% in nodules with TIRADS 3 or 4A (P < 0.001). Our study indicated that combination of BSRTC and BRAF(V600E) mutation analysis bears a great value in differentiating high-risk thyroid nodules. The TIRADS is useful in selecting high-risk patients for FNAB and patients with BSRTC I-III for BRAF(V600E) mutation analysis.
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Affiliation(s)
- Yu-zhi Zhang
- Department of Endocrinology, the First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Ting Xu
- Department of Endocrinology, the First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Dai Cui
- Department of Endocrinology, the First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Xiao Li
- Department of Pathology, the First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Qing Yao
- Department of Pathology, the First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Hai-yan Gong
- Department of Ultrasound, the First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Xiao-yun Liu
- Department of Endocrinology, the First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Huan-huan Chen
- Department of Endocrinology, the First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Lin Jiang
- Department of Endocrinology, the First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Xin-hua Ye
- Department of Ultrasound, the First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Zhi-hong Zhang
- Department of Pathology, the First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Mei-ping Shen
- Department of General Surgery, the First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Yu Duan
- Department of Endocrinology, the First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Tao Yang
- Department of Endocrinology, the First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Xiao-hong Wu
- Department of Endocrinology, the First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
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Fnais N, Soobiah C, AL-Qahtani K, Hamid JS, Perrier L, Straus SE, Tricco AC. Diagnostic value of fine needle aspiration BRAFV600E mutation analysis in papillary thyroid cancer: a systematic review and meta-analysis. Hum Pathol 2015; 46:1443-54. [DOI: 10.1016/j.humpath.2015.06.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 05/20/2015] [Accepted: 06/03/2015] [Indexed: 01/15/2023]
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BRAF p.Val600Glu (V600E) mutation detection in thyroid fine needle aspiration cell block samples: a feasibility study. Pathology 2015; 47:432-8. [DOI: 10.1097/pat.0000000000000273] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Zhao H, Zhang ZH, Zhou B, Xiao T, Pan QJ, Guo HQ. Detection of BRAF c.1799T > A (p.V600E) mutation using residual routine fine-needle aspiration specimens of papillary thyroid carcinoma. Diagn Cytopathol 2015; 43:786-90. [PMID: 26152656 DOI: 10.1002/dc.23302] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 04/10/2015] [Accepted: 06/19/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND BRAF p.V600E mutation is the most common genetic alteration in papillary thyroid cancer (PTC) and has been used as a diagnostic and prognostic marker in PTC. The aim of this study was to investigate the utility of preoperative BRAF p.V600E mutation analysis as an adjunctive diagnostic and prognostic tool to routine fine-needle aspiration (FNA). METHODS Specimens were collected from thyroid nodules by FNA. Cytology diagnosis and BRAF p.V600E testing were performed on these specimens. Molecular and cytological results were correlated with histology outcomes. RESULTS A total of 195 patients with thyroid nodules were enrolled, including 25 benign lesions and 170 PTCs. BRAF p.V600E testing was successfully performed in all specimens. The combination of BRAF p.V600E testing and cytology improved the sensitivity of cytology from 70% to 85.3% (P = 0.001). This significant increase in sensitivity was due to the detection of PTC by BRAF p.V600E testing in the nodules with atypical or suspicious PTC cytology results. Patients with BRAF p.V600E-positive tumors were significantly older than those who did not harbor mutations (45.6 years vs. 39.8 years, P = 0.002). No correlations between BRAF p.V600E mutation and other clinical-pathology parameters were observed. CONCLUSIONS Detection of BRAF p.V600E mutation can be successfully carried out using residual liquid-based materials. It can be performed as a diagnostic tool to supplement traditional thyroid FNA, especially in cases with atypical or suspicious PTC. However, the role of BRAF p.V600E in guidance of the extent of thyroidectomy and nodal clearance requires further study.
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Affiliation(s)
- Huan Zhao
- Department of Pathology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Zhi-hui Zhang
- Department of Pathology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Bin Zhou
- Department of Pathology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Ting Xiao
- State Key Laboratory of Molecular Oncology, Department of Etiology and Carcinogenesis, Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Qin-jing Pan
- Department of Pathology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Hui-qin Guo
- Department of Pathology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
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Kim SK, Lee JH, Woo JW, Park I, Choe JH, Kim JH, Kim JS. Prediction Table and Nomogram as Tools for Diagnosis of Papillary Thyroid Carcinoma: Combined Analysis of Ultrasonography, Fine-Needle Aspiration Biopsy, and BRAF V600E Mutation. Medicine (Baltimore) 2015; 94:e760. [PMID: 26020381 PMCID: PMC4616401 DOI: 10.1097/md.0000000000000760] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Although ultrasonography (US)-guided fine-needle aspiration biopsy (FNAB) is the most reliable diagnostic modality for evaluating thyroid nodules, 10% to 40% of FNAB samples yield indeterminate findings. The BRAF V600E mutation, a highly specific molecular marker for papillary thyroid carcinoma (PTC), well known for its prognostic value, has dubious diagnostic value because of its low sensitivity. Novel strategies are clearly needed to distinguish PTC, which represents the majority of thyroid malignancies, from other thyroid nodules. The records of 3297 patients with surgically proven PTC were retrospectively reviewed. A prediction table and nomogram were designed using a combination of diagnostic parameters for US, FNAB, and the BRAF V600E mutation. For the nomogram, parameters were proportionally assigned 0 to 100 points according to their regression coefficient for PTC. The probability of PTC for thyroid nodules with intermediate-risk (IR) US and atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) FNAB was significantly dependent on BRAF V600E mutation status based on our prediction table (negative, 29.2% vs positive, 87.5%; P < 0.001). By our nomogram, the probability of PTC for thyroid nodules with IR US, AUS/FLUS FNAB, and positive BRAF V600E mutation was approximately 85% to 90%. We strongly recommend preoperative evaluation of the BRAF V600E mutation in indeterminate thyroid nodules. The prediction table and nomogram developed in this study could help clinicians and patients easily assess the probability of PTC in the preoperative period.
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Affiliation(s)
- Seo Ki Kim
- From the Division of Breast and Endocrine Surgery (SKK, J-WW, IP, J-HC, J-HK, JSK), Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and Division of Breast and Endocrine Surgery (JHL), Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
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Sambugaro S, Di Ruvo M, Ambrosio MR, Pellegata NS, Bellio M, Guerra A, Buratto M, Foschini MP, Tagliati F, degli Uberti E, Zatelli MC. Early onset acromegaly associated with a novel deletion in CDKN1B 5'UTR region. Endocrine 2015; 49:58-64. [PMID: 25645465 DOI: 10.1007/s12020-015-0540-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 01/23/2015] [Indexed: 10/24/2022]
Abstract
Genetic alterations frequently are involved in the development of a pituitary adenoma in young age. We here characterize the functional role of a deletion in CDKN1B 5'-UTR region (c.-29_-26delAGAG) identified in an acromegalic patient that developed a growth hormone in pituitary adenoma during childhood. Our results show that the identified novel heterozygous deletion in the CDKN1B 5'-UTR region associates with a reduction in CDKN1B mRNA levels, a predicted altered secondary mRNA structure, and a reduced CDKN1B 5'-UTR transcriptional activity in vitro. The patient displayed loss of heterozygosity in the same CDKN1B 5'-UTR region at tissue level and the 5'UTR region containing the deleted sequence encompasses a GRE. These findings indicate that the identification of functional alterations of newly discovered genetic derangements need to be fully characterized and always correlated with the clinical manifestations.
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Affiliation(s)
- Silvia Sambugaro
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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Henke LE, Pfeifer JD, Ma C, Perkins SM, DeWees T, El-Mofty S, Moley JF, Nussenbaum B, Haughey BH, Baranski TJ, Schwarz JK, Grigsby PW. BRAF mutation is not predictive of long-term outcome in papillary thyroid carcinoma. Cancer Med 2015; 4:791-9. [PMID: 25712893 PMCID: PMC4472201 DOI: 10.1002/cam4.417] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/15/2014] [Accepted: 12/24/2014] [Indexed: 02/07/2023] Open
Abstract
The BRAF mutation occurs commonly in papillary thyroid carcinoma (PTC). Previous investigations of its utility to predict recurrence-free survival (RFS) and disease-specific survival (DSS) have reported conflicting results and its role remains unclear. The purpose of this retrospective study was to determine the incidence of the BRAF mutation and analyze its relationship to clinicopathologic risk factors and long-term outcomes in the largest, single-institution American cohort to date. BRAF mutational status was determined in 508 PTC patients using RFLP analysis. The relationships between BRAF mutation status, patient and tumor characteristics, RFS, and DSS were analyzed. The BRAF mutation was present in 67% of patients. On multivariate analysis, presence of the mutation predicted only for capsular invasion (HR, 1.7; 95% CI, 1.1–2.6), cervical lymph node involvement (HR, 1.7; 95% CI, 1.1–2.7), and classic papillary histology (HR, 1.8; 95% CI 1.1–2.9). There was no significant relationship between the BRAF mutation and RFS or DSS, an observation that was consistent across univariate, multivariate, and Kaplan–Meier analyses. This is the most extensive study to date in the United States to demonstrate that BRAF mutation is of no predictive value for recurrence or survival in PTC. We found correlations of BRAF status and several clinicopathologic characteristics of high-risk disease, but limited evidence that the mutation correlates with more extensive or aggressive disease. This analysis suggests that BRAF is minimally prognostic in PTC. However, prevalence of the BRAF mutation is 70% in the general population, providing the opportunity for targeted therapy.
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Affiliation(s)
- Lauren E Henke
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - John D Pfeifer
- Department of Pathology, Washington University School of Medicine, St. Louis, Missouri
| | - Changquing Ma
- Department of Pathology, Washington University School of Medicine, St. Louis, Missouri
| | - Stephanie M Perkins
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Todd DeWees
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Samir El-Mofty
- Department of Pathology, Washington University School of Medicine, St. Louis, Missouri
| | - Jeffrey F Moley
- Section of Endocrine and Oncologic Surgery, Department of General Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Brian Nussenbaum
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri
| | - Bruce H Haughey
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri
| | - Thomas J Baranski
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - Julie K Schwarz
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Perry W Grigsby
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.,Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri
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Zatelli MC, Tagliati F, Di Ruvo M, Castermans E, Cavazzini L, Daly AF, Ambrosio MR, Beckers A, degli Uberti E. Deletion of exons 1-3 of the MEN1 gene in a large Italian family causes the loss of menin expression. Fam Cancer 2015; 13:273-80. [PMID: 24522746 DOI: 10.1007/s10689-014-9702-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Multiple endocrine neoplasia type 1 (MEN1) syndrome is an autosomal dominant disease, characterized by parathyroid adenomas, endocrine gastroenteropancreatic tumors and pituitary adenomas, due to inactivating mutations of the MEN1 gene (chromosome 11q13). MEN1 mutations are mainly represented by nonsense, deletions/insertions, splice site or missense mutations that can be detected by direct sequencing of genomic DNA. However, MEN1 patients with large heterozygous deletions may escape classical genetic screening and may be misidentified as phenocopies, thereby hindering proper clinical surveillance. We employed a real-time polymerase chain reaction application, the TaqMan copy number variation assay, to evaluate a family in which we failed to identify an MEN1 mutation by direct sequencing, despite a clear clinical diagnosis of MEN1 syndrome. Using the TaqMan copy number variation assay we identified a large deletion of the MEN1 gene involving exons 1 and 2, in three affected family members, but not in the other nine family members that were to date clinically unaffected. The same genetic alteration was not found in a group of ten unaffected subjects, without family history of endocrine tumors. The MEN1 deletion was further confirmed by multiplex ligation-dependent probe amplification, which showed the deletion extended from exon 1 to exon 3. This new approach allowed us to correctly genetically diagnose three clinical MEN1 patients that were previously considered as MEN1 phenocopies. More importantly, we excluded the presence of genetic alterations in the unaffected family members. These results underline the importance of using a variety of available biotechnology approaches when pursuing a genetic diagnosis in a clinically suggestive setting of inherited endocrine cancer.
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Affiliation(s)
- Maria Chiara Zatelli
- Section of Endocrinology, Department of Medical Sciences, University of Ferrara, Via Savonarola 9, 44100, Ferrara, Italy,
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Rossi M, Buratto M, Tagliati F, Rossi R, Lupo S, Trasforini G, Lanza G, Franceschetti P, Bruni S, degli Uberti E, Zatelli MC. Relevance of BRAF(V600E) mutation testing versus RAS point mutations and RET/PTC rearrangements evaluation in the diagnosis of thyroid cancer. Thyroid 2015; 25:221-8. [PMID: 25333496 PMCID: PMC4322031 DOI: 10.1089/thy.2014.0338] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND A molecular profile including BRAF and RAS mutations as well as RET/PTC rearrangement evaluation has been proposed to provide an accurate presurgical assessment of thyroid nodules and to reduce the number of unnecessary diagnostic surgeries, sparing patients' health and saving healthcare resources. However, the application of such molecular analyses may provide different results among different centers and populations in real-life settings. Our aims were to evaluate the diagnostic utility of assessing the presence of BRAF and RAS mutations and RET/PTC1 and RET/PTC3 rearrangements in all cytological categories in an Italian group of thyroid nodule patients assessed prospectively, and to understand whether and which mutation testing might be helpful in cytologically indeterminate nodules. METHODS A total of 911 patients were submitted to ultrasound and fine-needle aspiration biopsy examination. Cytological evaluation was performed in parallel with molecular testing and compared to pathological results in 940 thyroid nodules, including 140 indeterminate lesions. RESULTS BRAF mutation testing provided the best contribution to cancer diagnosis, allowing the disease to be detected at an early stage, and identifying indeterminate nodules in which diagnostic lobectomy could be spared. On the contrary, RAS and RET/PTC analysis did not further increase diagnostic sensitivity for thyroid cancer. In addition, we found RET/PTC rearrangements in benign lesions, indicating that this molecular marker might not be useful for the detection of thyroid cancer. CONCLUSION BRAF(V600E) mutation analysis is superior to RAS point mutations and evaluation of RET/PTC rearrangements in the diagnosis of thyroid cancer, even in indeterminate lesions.
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Affiliation(s)
- Martina Rossi
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Mattia Buratto
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Federico Tagliati
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Roberta Rossi
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Sabrina Lupo
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Giorgio Trasforini
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Giovanni Lanza
- Section of Pathology and Biomolecular Diagnostics, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Paola Franceschetti
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Stefania Bruni
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Ettore degli Uberti
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
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41
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Panka DJ, Buchbinder E, Giobbie-Hurder A, Schalck AP, Montaser-Kouhsari L, Sepehr A, Lawrence DP, McDermott DF, Cohen R, Carlson A, Wargo JA, Merritt R, Seery VJ, Hodi FS, Gunturi A, Fredrick D, Atkins MB, Iafrate AJ, Flaherty KT, Mier JW, Sullivan RJ. Clinical utility of a blood-based BRAF(V600E) mutation assay in melanoma. Mol Cancer Ther 2014; 13:3210-8. [PMID: 25319388 PMCID: PMC4258469 DOI: 10.1158/1535-7163.mct-14-0349] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BRAF inhibitors (BRAFi) have led to clinical benefit in patients with melanoma. The development of a blood-based assay to detect and quantify BRAF levels in these patients has diagnostic, prognostic, and predictive capabilities that could guide treatment decisions. Blood BRAF(V600E) detection and quantification were performed on samples from 128 patients with stage II (19), III (67), and IV (42) melanoma. Tissue BRAF analysis was performed in all patients with stage IV disease and in selected patients with stage II and III disease. Clinical outcomes were correlated to initial BRAF levels as well as BRAF level dynamics. Serial analysis was performed on 17 stage IV melanoma patients treated with BRAFi and compared with tumor measurements by RECIST. The assay was highly sensitive (96%) and specific (95%) in the stage IV setting, using a blood level of 4.8 pg as "positive." BRAF levels typically decreased following BRAFi. A subset of these patients (5) had an increase in BRAF(V600E) values 42 to 112 days before clinical or radiographic disease progression (PD). From 86 patients with resected, stage II or III melanoma, 39 had evidence of disease relapse (45.3%). Furthermore, BRAF mutation in the blood after surgical resection in these patients was not associated with a difference in relapse risk, although tissue BRAF status was only available for a subset of patients. In summary, we have developed a highly sensitive and specific, blood-based assay to detect BRAF(V600) mutation in patients with melanoma.
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Affiliation(s)
- David J Panka
- Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | | | | | | | | | - Alireza Sepehr
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | - Rachel Cohen
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | - Ryan Merritt
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | | | - Michael B Atkins
- Georgetown-Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | | | | | - James W Mier
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
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42
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Park AY, Son EJ, Kim JA, Youk JH, Park YJ, Park CS, Chang HS. Associations of the BRAF(V600E) mutation with sonographic features and clinicopathologic characteristics in a large population with conventional papillary thyroid carcinoma. PLoS One 2014; 9:e110868. [PMID: 25337709 PMCID: PMC4206441 DOI: 10.1371/journal.pone.0110868] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 09/19/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the association of the BRAF(V600E) mutation with sonographic features and clinicopathologic characteristics in a large population with conventional papillary thyroid carcinoma (PTC). METHODS We retrospectively reviewed the sonographic features, clinicopathologic characteristics, and presence of the BRAF(V600E) mutation in 688 patients who underwent thyroidectomy for conventional PTC between January and July 2010 at a single institution. The incidence of the BRAF(V600E) mutation was calculated. The sonographic features and clinicopathologic characteristics were compared between BRAF-positive and BRAF-negative patients. BRAF-positive patients were subdivided into those with papillary thyroid microcarcinoma (the PTMC group) and those with PTC larger than 10 mm (the PTC>10 mm group), and their sonographic features were compared. RESULTS The BRAF(V600E) mutation was detected in 69.2% of patients (476 of 688). Sonographic features were not significantly different between BRAF-positive and BRAF-negative PTC, nor between PTMC and PTC>10 mm groups. The BRAF(V600E) mutation was associated with male sex (P = 0.028), large tumor size, extrathyroidal extension, central and lateral lymph node metastasis, and advanced tumor stage (P<0.0001). CONCLUSION The BRAF(V600E)mutation was significantly associated with several poor clinicopathologic characteristics, but was not associated with sonographic features, regardless of tumor size. We recommend that patients with a thyroid nodule with any suspicious sonographic feature undergo preoperative BRAF(V600E) testing for risk stratification and to guide the initial surgical approach in PTC.
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Affiliation(s)
- Ah Young Park
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Eun Ju Son
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
- * E-mail:
| | - Jeong-Ah Kim
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Ji Hyun Youk
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Yun Joo Park
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
- Department of Radiology, Soonchunghyang University Hospital, Soonchunghyang University College of Medicine, Seoul, Republic of Korea
| | - Cheong Soo Park
- Department of Surgery, Thyroid Cancer Center, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Hang Seok Chang
- Department of Surgery, Thyroid Cancer Center, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
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43
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Agretti P, Niccolai F, Rago T, De Marco G, Molinaro A, Scutari M, Di Cosmo C, Di Coscio G, Vitale M, Maccheroni M, Vitti P, Tonacchera M. BRAF mutation analysis in thyroid nodules with indeterminate cytology: our experience on surgical management of patients with thyroid nodules from an area of borderline iodine deficiency. J Endocrinol Invest 2014; 37:1009-14. [PMID: 25194426 DOI: 10.1007/s40618-014-0166-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 08/19/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Fine-needle aspiration (FNA) with cytologic evaluation is the most reliable tool for malignancy prediction in thyroid nodules, but cytologic diagnosis remains indeterminate for 12-18 % of nodules. BRAF V600E mutation has been reported to show a high specificity for malignant thyroid nodules and the use of this marker to refine indeterminate FNA cytology results may be a useful diagnostic adjunctive tool in the pre-operative evaluation of thyroid nodules. The aim of this study was to estimate the prevalence of BRAF exon 15 mutation (V600E) and its clinical value as a diagnostic tool in a series of thyroid nodules with indeterminate cytology from an area of borderline iodine deficiency. SUBJECTS AND METHODS One hundred and fifty-three thyroid samples obtained by FNA of thyroid nodules from 151 patients were subjected to the analysis of BRAF V600E mutation by direct sequencing. In the study 54 nodules with indeterminate cytology, 56 benign and 43 malignant thyroid nodules were included. RESULTS V600E BRAF gene mutation was demonstrated in 19/43 malignant nodules, in 0/56 benign nodules and in only 1/54 indeterminate nodules that, after histology, turned out to be at a papillary thyroid carcinoma. CONCLUSIONS The application of BRAF exon 15 analysis showed limitations when applied to discriminate thyroid nodules with indeterminate cytology if wild-type BRAF is found, and there is no role for avoiding diagnostic thyroid surgery.
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Affiliation(s)
- P Agretti
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
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44
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Jara SM, Bhatnagar R, Guan H, Gocke CD, Ali SZ, Tufano RP. Utility ofBRAFmutation detection in fine-needle aspiration biopsy samples read as “suspicious for papillary thyroid carcinoma”. Head Neck 2014; 37:1788-93. [DOI: 10.1002/hed.23829] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 05/24/2014] [Accepted: 06/29/2014] [Indexed: 01/21/2023] Open
Affiliation(s)
- Sebastian M. Jara
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology Head and Neck Surgery; Johns Hopkins University, School of Medicine; Baltimore Maryland
| | - Ramneesh Bhatnagar
- Division of Cytopathology, Department of Pathology; Johns Hopkins University, School of Medicine; Baltimore Maryland
- Department of Pathology; University of Maryland; School of Medicine Baltimore Maryland
| | - Hui Guan
- Division of Cytopathology, Department of Pathology; Johns Hopkins University, School of Medicine; Baltimore Maryland
- Department of Pathology; Wayne State University; School of Medicine Detroit Michigan
| | - Christopher D. Gocke
- Division of Molecular Pathology, Department of Pathology; Johns Hopkins University, School of Medicine; Baltimore Maryland
| | - Syed Z. Ali
- Division of Cytopathology, Department of Pathology; Johns Hopkins University, School of Medicine; Baltimore Maryland
| | - Ralph P. Tufano
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology Head and Neck Surgery; Johns Hopkins University, School of Medicine; Baltimore Maryland
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45
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Seo JY, Kim EK, Kwak JY. Additional BRAF mutation analysis may have additional diagnostic value in thyroid nodules with "suspicious for malignant" cytology alone even when the nodules do not show suspicious US features. Endocrine 2014; 47:283-9. [PMID: 24452872 DOI: 10.1007/s12020-013-0150-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 12/16/2013] [Indexed: 01/21/2023]
Abstract
The BRAF(V600E) mutation test has been more effective in thyroid nodules with suspicious US features than ones without suspicious features. Therefore, we investigated the role of the BRAF(V600E) mutation as an additional study to cytology in diagnosing a thyroid nodule without suspicious US features. This study was performed at Severance hospital from December 2010 through February 2012. During this period, 2,650 patients with 2,918 nodules underwent FNA with an additional BRAF(V600E) mutation test. Among them, we excluded thyroid nodules with suspicious US features. Finally, 485 thyroid nodules in 466 patients (mean age 50.3 years; range 9-80 years) were included in this study. We compared the differences between patients with malignant and benign thyroid nodules. We evaluated the detection rates of the BRAF(V600E) mutation according to the Bethesda System for Reporting Thyroid Cytopathology (BSRTC). There were 60 (60/485, 12.4 %) malignant and 425 (425/485, 87.6 %) benign nodules. The detection rate of the BRAF(V600E) mutation in thyroid nodules without suspicious US features was only 6.6 % (32/485). Most had malignant cytology (62.5 %, 20/32). For nodules without malignant cytology, only 12 nodules (2.6 %, 12/462) had the BRAF mutation. Among the 12 nodules, nine nodules were suspicious for malignancy on cytology. Additional BRAF mutation analysis shows additional diagnostic value in thyroid nodules with "suspicious for malignant" cytology alone even when the nodules do not show suspicious US features. Therefore, the test should be selectively performed in thyroid nodules without suspicious US features, considering cost-effectiveness as well as diagnostic accuracy.
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Affiliation(s)
- Jae Young Seo
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
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46
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Capelli L, Marfisi C, Puccetti M, Saragoni L, De Paola F, Zaccaroni A, Chiadini E, Gagliardi L, Ferretti G, Zoli W, Ulivi P. Role of BRAF molecular analysis in the management of papillary thyroid carcinoma: analysis of cytological and histological samples. Cytopathology 2014; 26:297-302. [PMID: 25123949 DOI: 10.1111/cyt.12199] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although fine needle aspiration (FNA) is the standard diagnostic test for the characterization of a suspicious thyroid nodule, in some cases cytological evaluation is inconclusive. The aim of this study was to determine the role of BRAF mutation in aiding diagnosis and to verify whether archival cytological samples could be suitable for molecular analysis. METHODS Eighty-five patients with suspicious (Thy4) or follicular (Thy3) lesions on cytology were resubmitted to a second FNA for BRAF mutation analysis. Of these, 56 subsequently underwent surgery. The usefulness of archival samples for molecular analysis was also studied in a second cohort of 42 patients with a confirmed diagnosis of papillary thyroid carcinoma for whom both archived paraffin-embedded histological samples and cytological smears were available. A further 15 patients with paired fresh FNA and archived cytological and histological samples were recruited. RESULTS BRAF mutation was found in the fresh FNA samples from 10 of 56 patients who had surgery with previous inconclusive cytology (4/45, 9%, Thy3 and 6/11, 55%, Thy4). The BRAF test showed a specificity and positive predictive value of 100% (26/26 and 10/10, respectively), sensitivity of 33% (10/30) and negative predictive value of 57% (26/46). There was absolute concordance between the BRAF results obtained with 42 histological and cytological archived samples. BRAF analysis on 15 archived cytological samples showed absolute concordance with histology, whereas there was one false negative on the matched fresh FNA. CONCLUSION BRAF analysis is a highly specific test that can facilitate cytological diagnosis in some cases and can also be performed on archived cytological samples.
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Affiliation(s)
- L Capelli
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - C Marfisi
- Endocrine Surgery Unit, Morgagni-Piernatoni Hospital, Forlì, Italy
| | - M Puccetti
- Pathology Unit, S. Maria delle Croci Hospital, Ravenna, Italy
| | - L Saragoni
- Pathology Unit, Morgagni-Piernatoni Hospital, Forlì, Italy
| | - F De Paola
- Pathology Unit, Morgagni-Piernatoni Hospital, Forlì, Italy
| | - A Zaccaroni
- Endocrine Surgery Unit, Morgagni-Piernatoni Hospital, Forlì, Italy
| | - E Chiadini
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - L Gagliardi
- Endocrinology Unit, Morgagni-Piernatoni Hospital, Forlì, Italy
| | - G Ferretti
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - W Zoli
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - P Ulivi
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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47
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Radkay LA, Chiosea SI, Seethala RR, Hodak SP, LeBeau SO, Yip L, McCoy KL, Carty SE, Schoedel KE, Nikiforova MN, Nikiforov YE, Ohori NP. Thyroid nodules with KRAS mutations are different from nodules with NRAS and HRAS mutations with regard to cytopathologic and histopathologic outcome characteristics. Cancer Cytopathol 2014; 122:873-82. [PMID: 25132659 DOI: 10.1002/cncy.21474] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/14/2014] [Accepted: 07/21/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND Mutations in the RAS gene in the thyroid gland result in the activation of signaling pathways and are associated with a follicular growth pattern and the probability of a carcinoma outcome ranging from 74% to 87%. In the current study, the authors investigated the cytopathologic and histopathologic features of common RAS mutation subtypes. METHODS Malignant, indeterminate, and selected benign thyroid cytology cases were tested prospectively for the presence of NRAS61, HRAS61, and KRAS12/13 mutations. For each case, the Bethesda System for thyroid cytopathology diagnosis, additional cytologic descriptors, and surgical pathology outcomes were documented. The Fisher exact test and Wilcoxon 2-sample test were used for statistical comparison between the groups. RESULTS A total of 204 thyroid fine-needle aspiration cases with RAS mutations (93.6% of which were associated with indeterminate cytopathology diagnoses) and corresponding surgical pathology resection specimens were identified. The KRAS12/13 mutation was associated with a significantly lower carcinoma outcome (41.7%) when compared with HRAS61 (95.5%) and NRAS61 (86.8%) mutations (P<.0001). Furthermore, oncocytic change was observed in a significantly higher percentage of cytology and resection specimens with KRAS12/13 mutations (66.7% and 75.0%, respectively) in comparison with those with HRAS61 (4.5% and 4.5%, respectively) and NRAS61 (15.4% and 14.7%, respectively) mutations (P<.0001). RAS mutations also were identified in cases of poorly differentiated carcinoma (NRAS61), anaplastic carcinoma (HRAS61), and medullary thyroid carcinoma (HRAS61 and KRAS12/13). CONCLUSIONS Subclassification of RAS mutations in conjunction with cytopathologic evaluation improves presurgical risk stratification, provides better insight into lesional characteristics, and may influence patient management. In particular, KRAS12/13-mutated thyroid nodules were found to be different from HRAS61-mutated and NRAS61-mutated nodules with regard to cytopathologic and surgical outcome characteristics.
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Affiliation(s)
- Lisa A Radkay
- Department of Pathology, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania
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48
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Carcoforo P, Portinari M, Feggi L, Panareo S, De Troia A, Zatelli MC, Trasforini G, Degli Uberti E, Forini E, Feo CV. Radio-guided selective compartment neck dissection improves staging in papillary thyroid carcinoma: a prospective study on 345 patients with a 3-year follow-up. Surgery 2014; 156:147-57. [PMID: 24929764 DOI: 10.1016/j.surg.2014.03.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 03/26/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Prospective uncontrolled study to investigate in papillary thyroid carcinoma (PTC) patients: (1) Distribution of lymph node metastases within the neck compartments, (2) factors predicting lymph nodes metastases, and (3) disease recurrence after thyroidectomy associated with radio-guided selective compartment neck dissection (RSCND). METHODS We studied 345 consecutive PTC patients operated on between February 2004 and October 2011 at the S. Anna University Hospital, Ferrara (Italy). Patients with cervical lymph node metastases on preoperative ultrasonography and fine needle aspiration cytology were excluded. All patients underwent total thyroidectomy associated with SLN identification followed by RSCND in the SLN compartment, without SLN frozen section. RESULTS In patients with lymph node metastases, metastatic nodes were not in the central neck compartment in 22.6% of the cases. The presence of infiltrating or multifocal PTC was a predicting factor for lymph nodes metastases. The median follow-up was 35.5 months. RSCND was associated with a false-negative rate of 1.1%, a persistent disease rate of 0.6%, and a recurrent disease rate of 0.9%. The permanent dysphonia rate was 1.3%. CONCLUSION RSCND associated with total thyroidectomy may improve: (1) the locoregional lymph node staging, and (2) the identification of the site of lymphatic drainage within the neck compartments. Thus, considering the high false-negative rate of sentinel lymph node biopsy (SLNB), a radio-guided technique in PTC patients may guide the lymphadenectomy (ie, RSCND) to increase the metastatic yield and improve staging of the disease rather than avoid prophylactic lymphadenectomy (ie, SLNB).
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Affiliation(s)
- Paolo Carcoforo
- Section of Clinica Chirurgica, Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, S. Anna University Hospital, Ferrara, Italy
| | - Mattia Portinari
- Section of Clinica Chirurgica, Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, S. Anna University Hospital, Ferrara, Italy.
| | - Luciano Feggi
- Unit of Nuclear Medicine, Department of Diagnostic Imaging, S. Anna University Hospital, Ferrara, Italy
| | - Stefano Panareo
- Unit of Nuclear Medicine, Department of Diagnostic Imaging, S. Anna University Hospital, Ferrara, Italy
| | - Alessandro De Troia
- Section of Clinica Chirurgica, Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, S. Anna University Hospital, Ferrara, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology, Department of Medical Sciences, S. Anna University Hospital, Ferrara, Italy
| | - Giorgio Trasforini
- Section of Endocrinology, Department of Medical Sciences, S. Anna University Hospital, Ferrara, Italy
| | - Ettore Degli Uberti
- Section of Endocrinology, Department of Medical Sciences, S. Anna University Hospital, Ferrara, Italy
| | - Elena Forini
- Unit of Statistics, S. Anna University Hospital, Ferrara, Italy
| | - Carlo V Feo
- Section of Clinica Chirurgica, Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, S. Anna University Hospital, Ferrara, Italy
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Eszlinger M, Hegedüs L, Paschke R. Ruling in or ruling out thyroid malignancy by molecular diagnostics of thyroid nodules. Best Pract Res Clin Endocrinol Metab 2014; 28:545-57. [PMID: 25047205 DOI: 10.1016/j.beem.2014.01.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Routine morphologic cytology is the basis for any kind of (integrated) molecular FNA diagnostics. The rule out (gene expression classifier) approach requires confirmation by independent studies, whereas the rule in approach (detection of BRAF, NRAS, HRAS, and KRAS and PAX8/PPARG- and RET/PTC rearrangements) has been investigated by several groups with overall reproducible results. Moreover, molecular screening for point mutations and rearrangements is feasible in routine air-dried FNA smears, offering several advantages over obtaining additional fresh FNA material. The current panel of somatic mutations (rule in approach) for indeterminate FNAs clarifies only a subgroup of indeterminate FNAs. Therefore, further markers are urgently needed that can reliably identify the malignant, but mutation negative and especially the many benign nodules, among the indeterminate FNAs. miRNA markers and the targeted next generation sequencing (NGS) technology do have the potential to identify those nodules that are mutation negative by current approaches.
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Affiliation(s)
- Markus Eszlinger
- Division of Endocrinology and Nephrology, University of Leipzig, Liebigstr. 21, D-04103 Leipzig, Germany.
| | - László Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark.
| | - Ralf Paschke
- Division of Endocrinology and Nephrology, University of Leipzig, Liebigstr. 20, D-04103 Leipzig, Germany.
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50
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Henke LE, Perkins SM, Pfeifer JD, Ma C, Chen Y, DeWees T, Grigsby PW. BRAF V600E mutational status in pediatric thyroid cancer. Pediatr Blood Cancer 2014; 61:1168-72. [PMID: 24677749 DOI: 10.1002/pbc.24935] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 12/18/2013] [Indexed: 01/27/2023]
Abstract
BACKGROUND Clinical outcome of papillary thyroid carcinoma (PTC) in children differs significantly from that of adults. There is no clear explanation of this difference although previous studies have demonstrated a lower prevalence of the BRAF(V600E) mutation in PTC of children. However, data are limited due to the rarity of this diagnosis. BRAF(V600E) mutation prevalence and its relationship with outcome in pediatric PTC remain unclear. PROCEDURE BRAF(V600E) mutational status was determined in 27 PTC patients less than 22 years of age using restriction fragment length polymorphism (RFLP) analysis. The relationship between BRAF(V600E) mutation status, patient and tumor characteristics as well as progression-free survival (PFS) were analyzed. RESULTS BRAF(V600E) was present in 63% of patients and occurred more often in male patients versus females (P = 0.033). Presence of the mutation did not correlate with any difference in extent of disease at diagnosis, tumor size, capsular invasion, vascular invasion, soft tissue invasion, or margin status. At 10 years, PFS for BRAF(V600E) positive versus negative patients was 55.5% versus 70.0%, respectively (P = 0.48). Overall survival was 100% and median follow-up was 13.9 years. CONCLUSIONS This study of pediatric PTC demonstrates that BRAF(V600E) mutations occur in children at a rate comparable to adults. We found a correlation of BRAF(V600E) with the male gender, but no evidence that the mutation correlates with more extensive or aggressive disease. This analysis suggests that differences in disease course of PTC in children versus adults are not strongly dependent upon the presence of the BRAF(V600E) mutation.
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Affiliation(s)
- Lauren E Henke
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
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