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Chakrabarty N, Mahajan A. Imaging Analytics using Artificial Intelligence in Oncology: A Comprehensive Review. Clin Oncol (R Coll Radiol) 2024; 36:498-513. [PMID: 37806795 DOI: 10.1016/j.clon.2023.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/09/2023] [Accepted: 09/21/2023] [Indexed: 10/10/2023]
Abstract
The present era has seen a surge in artificial intelligence-related research in oncology, mainly using deep learning, because of powerful computer hardware, improved algorithms and the availability of large amounts of data from open-source domains and the use of transfer learning. Here we discuss the multifaceted role of deep learning in cancer care, ranging from risk stratification, the screening and diagnosis of cancer, to the prediction of genomic mutations, treatment response and survival outcome prediction, through the use of convolutional neural networks. Another role of artificial intelligence is in the generation of automated radiology reports, which is a boon in high-volume centres to minimise report turnaround time. Although a validated and deployable deep-learning model for clinical use is still in its infancy, there is ongoing research to overcome the barriers for its universal implementation and we also delve into this aspect. We also briefly describe the role of radiomics in oncoimaging. Artificial intelligence can provide answers pertaining to cancer management at baseline imaging, saving cost and time. Imaging biobanks, which are repositories of anonymised images, are also briefly described. We also discuss the commercialisation and ethical issues pertaining to artificial intelligence. The latest generation generalist artificial intelligence model is also briefly described at the end of the article. We believe this article will not only enrich knowledge, but also promote research acumen in the minds of readers to take oncoimaging to another level using artificial intelligence and also work towards clinical translation of such research.
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Affiliation(s)
- N Chakrabarty
- Department of Radiodiagnosis, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Parel, Mumbai, Maharashtra, India.
| | - A Mahajan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK.
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Xu L, Haitao R, Li Z. Application of Ultrasound Shear Wave Elastography Combined With BRAFV600E Mutation for the Diagnosis of Papillary Thyroid Carcinoma. Ultrasound Q 2023; 39:199-205. [PMID: 37543733 DOI: 10.1097/ruq.0000000000000647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
ABSTRACT This prospective study aimed to investigate the combination of shear wave elastography (SWE) and BRAFV600E mutation testing for the diagnosis of papillary thyroid carcinoma (PTC). One hundred thyroid nodules with an American College of Radiology thyroid imaging reporting and data system classification of 4 or 5 were subjected to SWE measurement, BRAFV600E genotyping, fine-needle aspiration, and surgery. Nonparametric statistical tests were used to compare the differences in the elastic parameters and BRAF genotypes between benign and malignant thyroid nodules of PTC, and receiver operating characteristic curve analysis was conducted to compare the diagnostic efficacy. In addition, the correlations between elastic parameters and BRAFV600E mutation in PTC were analyzed using binary logistic regression. The SWE, BRAFV600E, and their combination exhibited sensitivities of 72.9%, 81.3%, and 85.4%, respectively, and specificities of 66.7%, 90.3%, and 86.5%, respectively, in the diagnosis of PTC ( P < 0.05). The SWE, BRAFV600E, and their combination exhibited sensitivities of 50.0%, 24.1% and 56.3%, respectively, and specificities of 89.7%, 87.5% and 82.8%, respectively, in the diagnosis of central cervical lymph node metastasis ( P < 0.05). The combined use of SWE and BRAFV600E detection had the largest area under the curve, indicating that this combination is more effective in diagnosing PTC and lymph node metastasis in the central region than either method alone. Furthermore, Emax was positively associated with the BRAFV600E genotype. In conclusion, the combination of SWE and BRAFV600E genotype detection can improve the diagnostic efficacy for PTC. Emax can predict the BRAFV600E mutation status.
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Affiliation(s)
- Li Xu
- Department of Ultrasound, Bishan Hospital of Chongqing, Bishan Hospital of Chongqing Medical University, Chongqing, China
| | - Ran Haitao
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhou Li
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Du J, Han R, Chen C, Ma X, Shen Y, Chen J, Li F. Diagnostic Efficacy of Ultrasound, Cytology, and BRAF V600E Mutation Analysis and Their Combined Use in Thyroid Nodule Screening for Papillary Thyroid Microcarcinoma. Front Oncol 2022; 11:746776. [PMID: 35047385 PMCID: PMC8761628 DOI: 10.3389/fonc.2021.746776] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 10/22/2021] [Indexed: 12/12/2022] Open
Abstract
Background Ultrasound, cytology, and BRAFV600E mutation analysis were applied as valuable tools in the differential diagnosis of thyroid nodules. The aim of the present study was to evaluate the diagnostic efficiency of the three methods and their combined use in screening for papillary thyroid microcarcinoma (PTMC). Methods A total of 1,081 patients with 1,157 thyroid nodules (0.5–1 cm in maximum diameter) classified as thyroid imaging reporting and data system (TIRADS) 4–5 were recruited. All patients underwent ultrasound, fine-needle aspiration (FNA) examination, and an additional BRAFV600E mutation test. TIRADS and Bethesda System for Reporting Thyroid Cytopathology (BSRTC) were adopted to judge the ultrasound and cytological results. The receiver operating characteristic (ROC) curve was established to assess the diagnostic values of different methods. Results Of the 1,157 nodules, 587 were benign and 570 were PTMCs. BRAFV600E mutation test had highest sensitivity (85.4%), specificity (97.1%), accuracy (91.4%), and area under the ROC curve (Az) value (0.913) among the three methods. The combination of BSRTC and BRAFV600E mutation analysis yielded a considerably high sensitivity (96.0%), accuracy (94.3%), and negative predictive value (95.9%) than either BSRTC or BRAFV600E mutation alone (P < 0.0001 for all comparisons). Of all the methods, the combined use of the three methods produced the best diagnostic performance (Az = 0.967), which was significantly higher than that (Az = 0.943) for the combination of BSRTC and BRAFV600E mutation (P < 0.0001). The diagnostic accuracy of the molecular method in the 121 nodules with indeterminate cytology was 90.1% (109/121), which was significantly higher than that of TIRADS classification, 74.4% (90/121) (P = 0.002). Conclusion The combined use of ultrasound, cytology, and BRAFV600E mutation analysis is the most efficient and objective method for diagnosing PTMC. Both BRAFV600E mutation and TIRADS classification are potentially useful adjuncts to differentiate thyroid nodules, especially indeterminate samples classified as BSRTC III.
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Affiliation(s)
- Jing Du
- Department of Ultrasound, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruijun Han
- Department of Ultrasound, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cui Chen
- Department of Ultrasound, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaowei Ma
- Department of Laboratory Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuling Shen
- Department of Head and Neck Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Chen
- Department of Head and Neck Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fenghua Li
- Department of Ultrasound, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Yoon J, Lee E, Koo JS, Yoon JH, Nam KH, Lee J, Jo YS, Moon HJ, Park VY, Kwak JY. Artificial intelligence to predict the BRAFV600E mutation in patients with thyroid cancer. PLoS One 2020; 15:e0242806. [PMID: 33237975 PMCID: PMC7688114 DOI: 10.1371/journal.pone.0242806] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/09/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose To investigate whether a computer-aided diagnosis (CAD) program developed using the deep learning convolutional neural network (CNN) on neck US images can predict the BRAFV600E mutation in thyroid cancer. Methods 469 thyroid cancers in 469 patients were included in this retrospective study. A CAD program recently developed using the deep CNN provided risks of malignancy (0–100%) as well as binary results (cancer or not). Using the CAD program, we calculated the risk of malignancy based on a US image of each thyroid nodule (CAD value). Univariate and multivariate logistic regression analyses were performed including patient demographics, the American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TIRADS) categories and risks of malignancy calculated through CAD to identify independent predictive factors for the BRAFV600E mutation in thyroid cancer. The predictive power of the CAD value and final multivariable model for the BRAFV600E mutation in thyroid cancer were measured using the area under the receiver operating characteristic (ROC) curves. Results In this study, 380 (81%) patients were positive and 89 (19%) patients were negative for the BRAFV600E mutation. On multivariate analysis, older age (OR = 1.025, p = 0.018), smaller size (OR = 0.963, p = 0.006), and higher CAD value (OR = 1.016, p = 0.004) were significantly associated with the BRAFV600E mutation. The CAD value yielded an AUC of 0.646 (95% CI: 0.576, 0.716) for predicting the BRAFV600E mutation, while the multivariable model yielded an AUC of 0.706 (95% CI: 0.576, 0.716). The multivariable model showed significantly better performance than the CAD value alone (p = 0.004). Conclusion Deep learning-based CAD for thyroid US can help us predict the BRAFV600E mutation in thyroid cancer. More multi-center studies with more cases are needed to further validate our study results.
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Affiliation(s)
- Jiyoung Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, South Korea
| | - Eunjung Lee
- Department of Computational Science and Engineering, Yonsei University, Seoul, South Korea
| | - Ja Seung Koo
- Department of Pathology, Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, South Korea
| | - Kee-Hyun Nam
- Department of Surgery, Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Jandee Lee
- Department of Surgery, Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Young Suk Jo
- Department of Internal Medicine, Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Hee Jung Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, South Korea
| | - Vivian Youngjean Park
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, South Korea
| | - Jin Young Kwak
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, South Korea
- * E-mail:
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Muzza M, Colombo C, Pogliaghi G, Karapanou O, Fugazzola L. Molecular markers for the classification of cytologically indeterminate thyroid nodules. J Endocrinol Invest 2020; 43:703-716. [PMID: 31853887 DOI: 10.1007/s40618-019-01164-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 12/11/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND The diagnosis of indeterminate lesions of the thyroid is a challenge in cytopathology practice. Indeed, up to 30% of cases lack the morphological features needed to provide definitive classification. Molecular tests have been developed to assist in the diagnosis of these indeterminate cases. The first studies dealing with the preoperative molecular evaluation of FNA samples focused on the analysis of BRAFV600E or on the combined evaluation of two or three genetic alterations. The sensitivity of molecular testing was then improved through the introduction of gene panels, which became available for clinical use in the late 2000s. Two different categories of molecular tests have been developed, the 'rule-out' methods, which aim to reduce the avoidable treatment of benign nodules, and the 'rule-in' tests that have the purpose to optimize surgical management. The genetic evaluation of indeterminate thyroid nodules is predicted to improve patient care, particularly if molecular tests are used appropriately and with the awareness of their advantages and weaknesses. The main disadvantage of these tests is the cost, which makes them rarely used in Europe. To overcome this limitation, customized panels have been set up, which are able to detect the most frequent genetic alterations of thyroid cancer. CONCLUSIONS In the present review, the most recent available versions of commercial molecular tests and of custom, non-commercial panels are described. Their characteristics and accuracy in the differential diagnosis of indeterminate nodules, namely Bethesda classes III (Atypical follicular lesion of undetermined significance, AUS/FLUS) and IV (Suspicious for follicular neoplasm, FN/SFN) are fully analyzed and discussed.
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Affiliation(s)
- M Muzza
- Division of Endocrine and Metabolic Diseases, IRCCS IstitutoAuxologicoItaliano, 20149, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, P.le Brescia 20, 20149, Milano, Italy
| | - C Colombo
- Division of Endocrine and Metabolic Diseases, IRCCS IstitutoAuxologicoItaliano, 20149, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, P.le Brescia 20, 20149, Milano, Italy
| | - G Pogliaghi
- Division of Endocrine and Metabolic Diseases, IRCCS IstitutoAuxologicoItaliano, 20149, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, P.le Brescia 20, 20149, Milano, Italy
| | - O Karapanou
- Department of Endocrinology, 401 Military Hospital, 11525, Athens, Greece
| | - L Fugazzola
- Division of Endocrine and Metabolic Diseases, IRCCS IstitutoAuxologicoItaliano, 20149, Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, P.le Brescia 20, 20149, Milano, Italy.
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Xie X, Yu Y. Effect of the location and size of thyroid nodules on the diagnostic performance of ultrasound elastography: A retrospective analysis. Clinics (Sao Paulo) 2020; 75:e1720. [PMID: 32578824 PMCID: PMC7297523 DOI: 10.6061/clinics/2020/e1720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 03/17/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Ultrasound-guided fine-needle aspiration biopsies are recommended for the detection of suspicious thyroid nodules. However, the best approach regarding suspicious ultrasound features for thyroid nodules is still unclear. This study aimed to evaluate the effect of location and size of thyroid nodules on the diagnostic performance of strain ultrasound elastography. In addition, this study evaluated whether ultrasound elastography predicts malignancy in thyroid nodules. METHODS Data regarding the size, depth, and distance from the carotid artery of nodules, the elasticity contrast index, and the nature of nodules were analyzed. RESULTS There was no significant difference in the depth (p=0.092) and the distance from the carotid artery (p=0.061) between benign and suspicious nodules. Suspicious nodules were smaller than benign nodules (p<0.0001, q=23.84) and had a higher elasticity contrast index (p<0.0001, q=21.05). The depth of nodules and the size of the nodule were not associated with the correct value of the elasticity contrast index (p>0.05 for both). The diagnostic performance of ultrasound elastography was not affected by the distance of the nodules from the carotid artery if they were located ≥15 mm from the carotid artery (p=0.5960). However, if the suspicious nodules were located <15 mm from the carotid artery, the diagnostic accuracy was hampered (p=0.006). CONCLUSIONS The strain ultrasound elastography should be carefully evaluated when small thyroid nodules are located near the carotid artery.
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Affiliation(s)
- Xinxin Xie
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China, 230022
| | - Yongqiang Yu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China, 230022
- *Corresponding author. E-mail:
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Differentiation of thyroid nodules on US using features learned and extracted from various convolutional neural networks. Sci Rep 2019; 9:19854. [PMID: 31882683 PMCID: PMC6934479 DOI: 10.1038/s41598-019-56395-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 12/11/2019] [Indexed: 11/08/2022] Open
Abstract
Thyroid nodules are a common clinical problem. Ultrasonography (US) is the main tool used to sensitively diagnose thyroid cancer. Although US is non-invasive and can accurately differentiate benign and malignant thyroid nodules, it is subjective and its results inevitably lack reproducibility. Therefore, to provide objective and reliable information for US assessment, we developed a CADx system that utilizes convolutional neural networks and the machine learning technique. The diagnostic performances of 6 radiologists and 3 representative results obtained from the proposed CADx system were compared and analyzed.
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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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Clinical Parameter for Deciding the BRAFV600E Mutation Test in Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance Thyroid Nodules: US Features According to TIRADS. Ultrasound Q 2018; 33:284-288. [PMID: 28877096 DOI: 10.1097/ruq.0000000000000313] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to investigate the usefulness of a thyroid imaging reporting and data system (TIRADS) to select thyroid nodules with atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) cytology for additional BRAF mutation testing. Three hundred three thyroid nodules were included. Statistical analysis was performed at both patient and nodule levels according to BRAF mutation positivity and clinical factors. Univariate and multivariate logistic regression analyses were performed to assess independent associations between BRAF mutation positivity and clinical factors. Of 303 AUS/FLUS nodules, 16 (5.3%) of 303 nodules had the BRAF mutation. The frequency of the BRAF mutation according to the TIRADS was 35.7% for category 5, 10.8% for category 4c, 2.5% for category 4b, 1.1% for category 4a, and 0% for category 3 nodules (P < 0.001). On multivariate analysis, BRAF mutation positivity was significantly associated with high suspicion on the TIRADS (odds ratio, 15.247; P < 0.001). In conclusion, the ultrasonography patterns of the TIRADS can be used as a clinical parameter for deciding the BRAF mutation test in thyroid nodules with AUS/FLUS cytology.
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Lee HW, Ock SY, Kim BK, Kwon SK, Choi YS, Kim JH, Jung SB. Diagnostic value of BRAFV600E mutation analysis in fine needle aspiration for evaluation of thyroid nodules. KOSIN MEDICAL JOURNAL 2018. [DOI: 10.7180/kmj.2018.33.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives Ultrasound-guided fine-needle aspiration (FNA) is routinely used in the evaluation of thyroid nodules. However, it has several pitfalls, as has been noted in nondiagnostic and indeterminate cases. This study aims to investigate the value of BRAF V600E mutation co-testing in FNA cytology. Method A total of 310 patients underwent BRAF V600E mutation co-testing in FNA cytology on thyroid nodules between June 2013 and June 2014. Of the 310 patients, 69 patients who had undergone a surgery for thyroid nodules were included in this study. The presence of the BRAF V600E mutation was determined by allele-specific polymerase chain reaction amplification of exon 15 of the BRAF gene. Results Of 69 cases, 33 (47.8%) were BRAF V600E mutation positive. The BRAF V600E mutation was not significantly associated with high-risk features such as tumor size, lymph node metastasis, and pathological stage. The respective diagnostic performance of FNA ( P = 0.02), BRAF V600E mutation ( P = 0.03), and ultrasonographic ( P = 0.00) findings was statistically significant. The sensitivity, specificity and positive predictive value of FNA was 64.9%, 83.3%, and 94.8%. The sensitivity, specificity and positive predictive value of BRAF V600E mutation was 56.1%, 91.7%, and 96.9% and the US features was 91.2%, 91.7%, and 98.1% respectively. However, sensitivity of FNA with BRAF V600E mutation (77.2%) was lower than FNA with US (92.9%) and combination all together (92.9%). Conclusion In this study, we found that US features were the most useful in preoperative differential diagnosis of thyroid nodules. BRAF V600E mutation co-testing in FNA cytology was also useful for diagnosis of thyroid tumors.
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Yang BR, Kim EK, Moon HJ, Yoon JH, Park VY, Kwak JY. Qualitative and Semiquantitative Elastography for the Diagnosis of Intermediate Suspicious Thyroid Nodules Based on the 2015 American Thyroid Association Guidelines. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1007-1014. [PMID: 29044641 DOI: 10.1002/jum.14449] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To evaluate qualitative and semiquantitative elastography for the diagnosis of intermediate suspicious thyroid nodules based on the 2015 American Thyroid Association (ATA) guidelines. METHODS Through a retrospective search of our institutional database, 746 solid thyroid nodules found on grayscale ultrasonography, strain elastography, and ultrasound-guided fine-needle aspiration between June and November 2009 were collected. Among them, 80 nodules from 80 patients with an intermediate suspicion of malignancy based on the 2015 ATA guidelines that were 10 mm or larger were recruited as the final study nodules. Elastographic findings were categorized according to the criteria of Rago et al (J Clin Endocrinol Metab 2007; 92:2917-2922) and Asteria et al (Thyroid 2008; 18:523-531), and strain ratio values were calculated and recorded. The independent 2-sample t test and χ2 test (or Fisher exact test) were used to evaluate differences in clinical parameters between benign and malignant thyroid nodules. All variables were compared by univariate and multivariate logistic regression analyses, and odds ratios with 95% confidence intervals were calculated. RESULTS Of the 80 nodules, 6 (7.5%) were malignant, and 74 (92.5%) were benign. No significant differences were observed in age, sex, nodule size, elasticity score, and strain ratio between benign and malignant nodules. No variables significantly predicted thyroid malignancy on the univariate analysis. On the multivariate logistic regression analysis, there were no independent variables associated with thyroid malignancy, including the elasticity score and strain ratio (all P > .05). CONCLUSIONS Elastographic analysis using the elasticity score and strain ratio has limited ability to characterize the benignity or malignancy of thyroid nodules with an intermediate suspicion of malignancy based on the 2015 ATA guidelines.
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Affiliation(s)
- Bo Ra Yang
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea
- Department of Radiology, Gangnam CHA Hospital, CHA University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea
| | - Vivian Y Park
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea
| | - Jin Young Kwak
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea
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Beiša A, Kvietkauskas M, Beiša V, Stoškus M, Ostanevičiūtė E, Jasiūnas E, Griškevičius L, Strupas K. The utility of the Bethesda category and its association with BRAF mutation in the prediction of papillary thyroid cancer stage. Langenbecks Arch Surg 2017; 402:227-234. [PMID: 28160058 DOI: 10.1007/s00423-017-1560-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 01/25/2017] [Indexed: 02/03/2023]
Abstract
PURPOSE This study aims to determine the utility of the Bethesda category and its association with BRAF mutation in prediction of the papillary thyroid cancer (PTC) stage. METHODS A prospective study analyzed patients who had ultrasound-suspicious thyroid nodules, underwent FNA and cytological examination, and were classified according to the Bethesda system. Patients from Undetermined Significance Or Follicular Lesion Of Undetermined Significance (AUS/FLUS), Follicular Neoplasm or Suspicious for a Follicular Neoplasm (FN/SFN), Suspicious for Malignant Cells (SMC), and Positive for Malignant Cells (PMC) groups were examined for the BRAF mutation and had a thyroid surgery. Demographical and histological features and stage of the disease were evaluated for PTC patients in accordance with the Bethesda category and its association with BRAF mutation. RESULTS Three hundred eight of all patients underwent operation. One hundred forty-three (46.4%) of them were diagnosed with PTC. In 14 (9.8%) PTC cases, FNA biopsies were classified as AUS/FLUS, 23 (16.1%) as FN/SFN, 41 (28.7%) as SMC, and 65 (45.5%) as PMC. I-II stages of PTC were diagnosed for 88 (61.5%) patients and III-IVA for 55 (38.5%). Patients from the SMC and PMC groups had larger tumors, higher incidence of lymph node metastases, classical PTC type, B-type Raf (BRAF) positive, and III-IVA stage cancer, than patients from the AUS/FLUS and FN/SFN groups. When comparing 27 (18.9%) BRAF-negative patients from the AUS/FLUS and FN/SFN groups with 116 (81.1%) BRAF-negative patients from the SMC and PMC groups and all BRAF-positive patients, the prediction of more aggressive histological features and stage was slightly improved. CONCLUSIONS Higher Bethesda categories are associated with higher stages of PTC. Association of the Bethesda category with BRAF mutation can slightly improve the value of stage prediction.
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Affiliation(s)
- Augustas Beiša
- Centre of Abdominal Surgery, Vilnius University, Santariškių 2, 08406, Vilnius, Lithuania.
| | - Mindaugas Kvietkauskas
- Centre of Abdominal Surgery, Vilnius University, Santariškių 2, 08406, Vilnius, Lithuania
| | - Virgilijus Beiša
- Centre of Abdominal Surgery, Vilnius University, Santariškių 2, 08406, Vilnius, Lithuania
| | - Mindaugas Stoškus
- Centre of Haematology, Oncology and Transfusion Medicine, Vilnius University, Vilnius, Lithuania
| | | | | | - Laimonas Griškevičius
- Centre of Haematology, Oncology and Transfusion Medicine, Vilnius University, Vilnius, Lithuania.,Centre of Internal, Family Medicine and Oncology, Vilnius University, Vilnius, Lithuania
| | - Kęstutis Strupas
- Centre of Abdominal Surgery, Vilnius University, Santariškių 2, 08406, Vilnius, Lithuania
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Classifier Model Based on Machine Learning Algorithms: Application to Differential Diagnosis of Suspicious Thyroid Nodules via Sonography. AJR Am J Roentgenol 2016; 207:859-864. [DOI: 10.2214/ajr.15.15813] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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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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Nam SJ, Yoo J, Lee HS, Kim EK, Moon HJ, Yoon JH, Kwak JY. Quantitative Evaluation for Differentiating Malignant and Benign Thyroid Nodules Using Histogram Analysis of Grayscale Sonograms. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:775-782. [PMID: 26969596 DOI: 10.7863/ultra.15.05055] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/27/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To evaluate the diagnostic value of histogram analysis using grayscale sonograms for differentiation of malignant and benign thyroid nodules. METHODS From July 2013 through October 2013, 579 nodules in 563 patients who had undergone ultrasound-guided fine-needle aspiration were included. For the grayscale histogram analysis, pixel echogenicity values in regions of interest were measured as 0 to 255 (0, black; 255, white) with in-house software. Five parameters (mean, skewness, kurtosis, standard deviation, and entropy) were obtained for each thyroid nodule. With principal component analysis, an index was derived. Diagnostic performance rates for the 5 histogram parameters and the principal component analysis index were calculated. RESULTS A total of 563 patients were included in the study (mean age ± SD, 50.3 ± 12.3 years;range, 15-79 years). Of the 579 nodules, 431 were benign, and 148 were malignant. Among the 5 parameters and the principal component analysis index, the standard deviation (75.546 ± 14.153 versus 62.761 ± 16.01; P < .001), kurtosis (3.898 ± 2.652 versus 6.251 ± 9.102; P < .001), entropy (0.16 ± 0.135 versus 0.239 ± 0.185; P < .001), and principal component analysis index (-0.386±0.774 versus 0.134 ± 0.889; P < .001) were significantly different between the malignant and benign nodules. With the calculated cutoff values, the areas under the curve were 0.681 (95% confidence interval, 0.643-0.721) for standard deviation, 0.661 (0.620-0.703) for principal component analysis index, 0.651 (0.607-0.691) for kurtosis, 0.638 (0.596-0.681) for entropy, and 0.606 (0.563-0.647) for skewness. The subjective analysis of grayscale sonograms by radiologists alone showed an area under the curve of 0.861 (0.833-0.888). CONCLUSIONS Grayscale histogram analysis was feasible for differentiating malignant and benign thyroid nodules but did not show better diagnostic performance than subjective analysis performed by radiologists. Further technical advances will be needed to objectify interpretations of thyroid grayscale sonograms.
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Affiliation(s)
- Se Jin Nam
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jaeheung Yoo
- Yonsei University, College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Kwak
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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16
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Kim GR, Kim EK, Kim SJ, Ha EJ, Yoo J, Lee HS, Hong JH, Yoon JH, Moon HJ, Kwak JY. Evaluation of Underlying Lymphocytic Thyroiditis With Histogram Analysis Using Grayscale Ultrasound Images. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:519-526. [PMID: 26887447 DOI: 10.7863/ultra.15.04014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 06/23/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate diagnostic performance of histogram analysis using grayscale ultrasound (US) images in the diagnosis of lymphocytic thyroiditis. METHODS Three radiologists reviewed a total of 505 US images and classified the images according to the presence/existence of lymphocytic thyroiditis. After 2 months, each reviewer repeated the process with the same 505 images in a randomly mixed order. The intraobserver and interobserver variability was analyzed with a generalized κ value. Four histogram parameters (mean value, standard deviation, skewness, and kurtosis) were obtained, and an index was calculated from principal component analysis. Diagnostic performances were compared. RESULTS Of 505 patients, 125 (24.8%) had lymphocytic thyroiditis, and 380 (75.2%) had normal thyroid parenchyma on pathologic analysis. The κ value for intraobserver variance ranged from -0.002 to 0.781, and the overall κ values for interobserver variance were 0.570 and 0.214 in the first and second tests, respectively. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for the 3 reviewers versus the principal component analysis index were 28.0% to 83.2%, 43.7% to 82.6%, 53.5% to 79.0%, 24.6% to 56.2%, and 75.2% to 88.9% versus 58.4%, 72.4%, 68.9%, 41.0%, and 84.1%. CONCLUSIONS Histogram analysis of grayscale US images provided confirmable and quantitative information about lymphocytic thyroiditis and was comparable with performers' assessments in diagnostic performance.
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Affiliation(s)
- Ga Ram Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea (G.R.K., E.-K.K., J.H.Y., H.J.M., J.Y.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (S.J.K.); Department of Radiology, Ajou University School of Medicine, Suwon, Korea (E.J.H.); Yonsei University College of Medicine, Seoul, Korea (J.Y.); and Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea (H.S.L., J.H.H.)
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea (G.R.K., E.-K.K., J.H.Y., H.J.M., J.Y.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (S.J.K.); Department of Radiology, Ajou University School of Medicine, Suwon, Korea (E.J.H.); Yonsei University College of Medicine, Seoul, Korea (J.Y.); and Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea (H.S.L., J.H.H.)
| | - Soo Jin Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea (G.R.K., E.-K.K., J.H.Y., H.J.M., J.Y.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (S.J.K.); Department of Radiology, Ajou University School of Medicine, Suwon, Korea (E.J.H.); Yonsei University College of Medicine, Seoul, Korea (J.Y.); and Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea (H.S.L., J.H.H.)
| | - Eun Ju Ha
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea (G.R.K., E.-K.K., J.H.Y., H.J.M., J.Y.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (S.J.K.); Department of Radiology, Ajou University School of Medicine, Suwon, Korea (E.J.H.); Yonsei University College of Medicine, Seoul, Korea (J.Y.); and Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea (H.S.L., J.H.H.)
| | - Jaeheung Yoo
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea (G.R.K., E.-K.K., J.H.Y., H.J.M., J.Y.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (S.J.K.); Department of Radiology, Ajou University School of Medicine, Suwon, Korea (E.J.H.); Yonsei University College of Medicine, Seoul, Korea (J.Y.); and Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea (H.S.L., J.H.H.)
| | - Hye Sun Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea (G.R.K., E.-K.K., J.H.Y., H.J.M., J.Y.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (S.J.K.); Department of Radiology, Ajou University School of Medicine, Suwon, Korea (E.J.H.); Yonsei University College of Medicine, Seoul, Korea (J.Y.); and Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea (H.S.L., J.H.H.)
| | - Jung Hwa Hong
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea (G.R.K., E.-K.K., J.H.Y., H.J.M., J.Y.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (S.J.K.); Department of Radiology, Ajou University School of Medicine, Suwon, Korea (E.J.H.); Yonsei University College of Medicine, Seoul, Korea (J.Y.); and Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea (H.S.L., J.H.H.)
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea (G.R.K., E.-K.K., J.H.Y., H.J.M., J.Y.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (S.J.K.); Department of Radiology, Ajou University School of Medicine, Suwon, Korea (E.J.H.); Yonsei University College of Medicine, Seoul, Korea (J.Y.); and Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea (H.S.L., J.H.H.)
| | - Hee Jung Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea (G.R.K., E.-K.K., J.H.Y., H.J.M., J.Y.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (S.J.K.); Department of Radiology, Ajou University School of Medicine, Suwon, Korea (E.J.H.); Yonsei University College of Medicine, Seoul, Korea (J.Y.); and Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea (H.S.L., J.H.H.)
| | - Jin Young Kwak
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea (G.R.K., E.-K.K., J.H.Y., H.J.M., J.Y.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (S.J.K.); Department of Radiology, Ajou University School of Medicine, Suwon, Korea (E.J.H.); Yonsei University College of Medicine, Seoul, Korea (J.Y.); and Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea (H.S.L., J.H.H.).
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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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Application of Texture Analysis in the Differential Diagnosis of Benign and Malignant Thyroid Nodules: Comparison With Gray-Scale Ultrasound and Elastography. AJR Am J Roentgenol 2015; 205:W343-51. [DOI: 10.2214/ajr.14.13825] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kwon HJ, Kim EK, Kwak JY. Cytomorphologic features in thyroid nodules read as "suspicious for malignancy" on cytology may predict thyroid cancers with the BRAF mutation. Pathol Res Pract 2015; 211:671-6. [PMID: 26187369 DOI: 10.1016/j.prp.2015.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/26/2015] [Accepted: 06/22/2015] [Indexed: 01/24/2023]
Abstract
Some morphologic parameters have been studied to help predict the BRAF(V600E) mutation using cytopathologic specimens, which can indicate which nodules should undergo further testing. The aim of this study was to investigate the value of cytomorphologic parameters to predict the BRAF(V600E) mutation in nodules read as "suspicious for malignancy" on cytology. This study included 142 resected nodules which were diagnosed as "suspicious for malignancy" on cytology in 142 patients. At our institution, BRAF(V600E) mutation analysis was performed at the request of the referring clinicians based on the clinical features of the patients, or the judgment of the radiologists performing US-FNA because suspicious US features were observed on the targeted nodule during this study period. Cytology smears were re-reviewed to assess the presence and amount of polygonal eosinophilic (plump) cells and microfollicles, and the presence of intranuclear pseudoinclusions, irregular nuclear membranes, nuclear grooves, sickles cells, psammoma bodies, and cystic changes. We evaluated the diagnostic performances of the cytomorphologic features to predict the BRAF(V600E) mutation. Polygonal eosinophilic (plump) cells, microfollicles, intranuclear pseudoinclusions, sickle cells, and cystic changes were significantly associated with the BRAF(V600E) mutation. The mutation was not present in all 6 thyroid nodules with microfollicles larger than 20% on cytology. Additionally, polygonal eosinophilic (plump) cells larger than 20%, cystic changes, and sickle cells on cytology had a high specificity of 95%, 96.7%, and 81.7%, respectively. Excluding 6 nodules with microfollicles larger than 20% on cytology, there were 82 (60.3%) nodules with the BRAF(V600E) mutation among the 136 nodules. Among the 136 nodules, there were 95 nodules with polygonal eosinophilic (plump) cells larger than 20%, cystic changes, or sickle cells on cytology. Of the 95 nodules, 69 (72.6%) had the mutation. Cytomorphologic features can help select nodules for the BRAF(V600E) mutation test among nodules read as "suspicious for malignancy" on cytology.
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Affiliation(s)
- Hyeong Ju Kwon
- Department of Pathology, Yonsei University, College of Medicine, Republic of Korea; Department of Pathology, Yonsei University Wonju College of Medicine, Republic of Korea
| | - Eun-Kyung Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University, College of Medicine, Republic of Korea
| | - Jin Young Kwak
- Department of Radiology, Research Institute of Radiological Science, Yonsei University, College of Medicine, Republic of Korea.
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Park VY, Kim EK, Lee HS, Moon HJ, Yoon JH, Kwak JY. Real-Time PCR Cycle Threshold Values for the BRAFV600E Mutation in Papillary Thyroid Microcarcinoma May Be Associated With Central Lymph Node Metastasis: A Retrospective Study. Medicine (Baltimore) 2015; 94:e1149. [PMID: 26181555 PMCID: PMC4617062 DOI: 10.1097/md.0000000000001149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Papillary thyroid microcarcinoma (PTMC) usually has excellent prognosis, but a small subset shows aggressive behavior. Although the B-Raf proto-oncogene, serine/threonine kinase (BRAF)V600E mutation is the most common oncogenic alteration in PTMCs, it is frequently heterogeneously distributed within tumors. The aim of this study was to investigate the association of the BRAFV600E mutation found in fine needle aspirates from PTMCs with known clinicopathologic prognostic factors, based on both its presence and a quantitative approach that uses cycle threshold (Ct) values obtained by a real-time PCR technique. The 460 PTMC patients were included, with 367 patients having the BRAFV600E mutation. Clinicopathologic variables were compared between patients with and without the BRAFV600E mutation. BRAFV600E Ct values were compared according to clinicopathologic prognostic factors. Multivariate analyses were performed to evaluate factors predicting extrathyroidal extension and central and lateral lymph node metastasis (LNM). Each analysis used either the BRAFV600E mutation status or the Ct value as an independent variable for all the study patients and the 367 BRAFV600E-positive patients. Receiver-operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of BRAFV600E Ct values in predicting central and lateral LNM. The BRAFV600E mutation status was not associated with clinicopathologic prognostic factors among the 460 PTMC patients. Of the 367 BRAFV600E-positive patients, Ct values were significantly lower in patients with central and lateral LNM (P < 0.001, P = 0.007). The Ct value was the only independent factor to predict central LNM (OR 0.918, P = 0.025). The area under the ROC curve (AUC) for diagnosing central LNM was 0.623 (sensitivity, 50.0%; specificity, 71.9%) and for diagnosing lateral LNM, it was 0.796 (sensitivity, 71.4%; specificity, 94.7%). In conclusion, real-time PCR Ct values for the BRAFV600E mutation obtained from fine needle aspirates can be associated with central LNM in PTMC patients. Although BRAFV600E Ct values did not reach statistical significance for predicting lateral LNM in our study, further validation through larger studies can be used to overcome any possible type-II errors. With further studies, Ct values for the BRAFV600E mutation obtained from fine needle aspirates may have important implications for predicting both central and lateral LNM in patients with PTMCs.
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Affiliation(s)
- Vivian Y Park
- From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital (VYP, E-KK, HJM, JHY, JYK); and Biostatistics Collaboration Unit, Medical Research Center, Yonsei University, College of Medicine, Seoul, Korea (HSL)
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Kim SY, Kim EK, Kwak JY, Moon HJ, Yoon JH. What to do with thyroid nodules showing benign cytology and BRAF(V600E) mutation? A study based on clinical and radiologic features using a highly sensitive analytic method. Surgery 2015; 157:354-61. [PMID: 25616949 DOI: 10.1016/j.surg.2014.09.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 09/04/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND BRAF(V600E) mutation analysis has been used as a complementary diagnostic tool to ultrasonography-guided, fine-needle aspiration (US-FNA) in the diagnosis of thyroid nodule with high specificity reported up to 100%. When highly sensitive analytic methods are used, however, false-positive results of BRAF(V600E) mutation analysis have been reported. In this study, we investigated the clinical, US features, and outcome of patients with thyroid nodules with benign cytology but positive BRAF(V600E) mutation using highly sensitive analytic methods from US-FNA. METHODS This study included 22 nodules in 22 patients (3 men, 19 women; mean age, 53 years) with benign cytology but positive BRAF(V600E) mutation from US-FNA. US features were categorized according to the internal components, echogenicity, margin, calcifications, and shape. Suspicious US features included markedly hypoechogenicity, noncircumscribed margins, micro or mixed calcifications, and nonparallel shape. Nodules were considered to have either concordant or discordant US features to benign cytology. Medical records and imaging studies were reviewed for final cytopathology results and outcomes during follow-up. RESULTS Among the 22 nodules, 17 nodules were reviewed. Fifteen of 17 nodules were malignant, and 2 were benign. The benign nodules were confirmed as adenomatous hyperplasia with underlying lymphocytic thyroiditis and a fibrotic nodule with dense calcification. Thirteen of the 15 malignant nodules had 2 or more suspicious US features, and all 15 nodules were considered to have discordant cytology considering suspicious US features. Five nodules had been followed with US or US-FNA without resection, and did not show change in size or US features on follow-up US examinations. CONCLUSION BRAF(V600E) mutation analysis is a highly sensitive diagnostic tool in the diagnosis of papillary thyroid carcinomas. In the management of thyroid nodules with benign cytology but positive BRAF(V600E) mutation, thyroidectomy should be considered in nodules which have 2 or more suspicious US features and are considered discordant on image-cytology correlation.
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Affiliation(s)
- Soo-Yeon Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea
| | - Jin Young Kwak
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea.
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Yoon JH, Lee HS, Kim EK, Moon HJ, Kwak JY. Thyroid Nodules: Nondiagnostic Cytologic Results according to Thyroid Imaging Reporting and Data System before and after Application of the Bethesda System. Radiology 2015; 276:579-87. [PMID: 25848904 DOI: 10.1148/radiol.15142308] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE To compare the malignancy rates and the effectiveness of the Thyroid Imaging Reporting and Data System (TIRADS) for risk stratification of nodules with nondiagnostic results classified before and after application of the Bethesda System for Reporting Thyroid Cytopathology. MATERIALS AND METHODS This retrospective study was approved by an institutional review board, with waiver of informed consent. A total of 763 patients with 790 thyroid nodules and nondiagnostic cytologic results were included (mean age ± standard deviation, 52.3 years ± 11.5), 485 nodules from the pre-Bethesda period (from March 2007 to December 2008) and 305 nodules from the post-Bethesda period (from May 2011 to May 2012). A TIRADS category was assigned to each thyroid nodule on the basis of the number of features that appeared suspicious for cancer at ultrasonography (US). Malignancy rates and TIRADS categories during the two periods were compared. Correlation between TIRADS category and malignancy risk between the two periods was evaluated and compared. RESULTS The malignancy rates of nodules with nondiagnostic cytologic results were not significantly different between the two periods (P = .148). Malignancy risk of TIRADS category 3, 4a, 4b, 4c, and 5 was 1.8%, 5.7%, 4.1%, 29.8%, and 16.7%, for the pre-Bethesda period, and 1.6%, 3.0%, 7.1%, 16.3%, and 25.0% for the post-Bethesda period, respectively. Near-perfect correlation was seen between the TIRADS category and malignancy risk in the post-Bethesda period (r = 0.961, P = .009), while no significant correlation was found in the pre-Bethesda period (r = 0.731, P = .161). CONCLUSION Malignancy risk stratification with TIRADS was more effective for nodules with nondiagnostic cytologic results classified according to the Bethesda System. When these Bethesda-classified nodules with nondiagnostic results are evaluated as TIRADS category 3 or 4a, they may be treated conservatively with follow-up US, but when other cytologic classifications are applied, follow-up US and fine- needle aspiration must be considered for nodules showing one or more features suspicious for cancer at US.
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Affiliation(s)
- Jung Hyun Yoon
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (J.H.Y., E.K.K., H.J.M., J.Y.K.), and Biostastistics Collaboration Unit, Medical Research Center (H.S.L.), Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752 Seoul, Korea
| | - Hye Sun Lee
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (J.H.Y., E.K.K., H.J.M., J.Y.K.), and Biostastistics Collaboration Unit, Medical Research Center (H.S.L.), Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752 Seoul, Korea
| | - Eun-Kyung Kim
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (J.H.Y., E.K.K., H.J.M., J.Y.K.), and Biostastistics Collaboration Unit, Medical Research Center (H.S.L.), Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752 Seoul, Korea
| | - Hee Jung Moon
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (J.H.Y., E.K.K., H.J.M., J.Y.K.), and Biostastistics Collaboration Unit, Medical Research Center (H.S.L.), Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752 Seoul, Korea
| | - Jin Young Kwak
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (J.H.Y., E.K.K., H.J.M., J.Y.K.), and Biostastistics Collaboration Unit, Medical Research Center (H.S.L.), Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752 Seoul, Korea
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