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Exp Clin Endocrinol Diabetes 2019; 127(04): 247-254
DOI: 10.1055/a-0588-4885
Article
© Georg Thieme Verlag KG Stuttgart · New York

Significance of BRAF V600E Mutation and Cytomorphological Features for the Optimization of Papillary Thyroid Cancer Diagnostics in Cytologically Indeterminate Thyroid Nodules

Augustas Beiša
1   Vilnius University Faculty of Medicine
2   Vilnius University Hospital Santaros Klinikos
,
Mindaugas Kvietkauskas
1   Vilnius University Faculty of Medicine
2   Vilnius University Hospital Santaros Klinikos
,
Virgilijus Beiša
1   Vilnius University Faculty of Medicine
2   Vilnius University Hospital Santaros Klinikos
,
Mindaugas Stoškus
1   Vilnius University Faculty of Medicine
2   Vilnius University Hospital Santaros Klinikos
,
Elvyra Ostanevičiūtė
1   Vilnius University Faculty of Medicine
2   Vilnius University Hospital Santaros Klinikos
,
Eugenijus Jasiūnas
3   Mykolas Romeris University
,
Laimonas Griškevičius
1   Vilnius University Faculty of Medicine
2   Vilnius University Hospital Santaros Klinikos
,
Dmitrij Šeinin
4   National Center of Pathology, Affiliate of Vilnius University Hospital Santaros Klinikos
,
Auksė Šileikytė
1   Vilnius University Faculty of Medicine
,
Kęstutis Strupas
1   Vilnius University Faculty of Medicine
2   Vilnius University Hospital Santaros Klinikos
› Author Affiliations
Further Information

Publication History

received 25 November 2017
revised 18 February 2018

accepted 08 March 2018

Publication Date:
22 March 2018 (online)

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Abstract

Background Ultrasound guided fine needle aspiration biopsy with cytologic analysis is an initial step in diagnostic of thyroid nodules. Unfortunately, up to 30% of biopsies are indeterminate and diagnostic surgery is required. The aim of this study was to estimate the diagnostic value of BRAF V600E mutation status combined with cytomorphological features for diagnosis of papillary thyroid cancer (PTC) in cytologically indeterminate thyroid nodules.

Methods A prospective study analyzed patients who had ultrasound suspicious thyroid nodules, underwent fine needle aspiration and cytological examination, and were classified according to the Bethesda system. Patients from indeterminate diagnostic categories were examined for BRAF V600E mutation and 22 cytomorphological features, and underwent thyroid surgery. A binary logistic regression model was used to evaluate the diagnostic utility.

Results A total of 219 patients met study criteria. After histological examination, 77 (35.2%) patients were diagnosed with PTC and 142 (64.8%) with benign nodular thyroid disease. According to logistic regression model, significant features for PTC diagnosis were: liquid colloid consistency, papillary structures, eosinophilic colloid bodies, and BRAF V600E mutation. Risk groups classified by this model have sensitivity of 80.5% (95% CI: 69.9 to 88.7), specificity of 99.3% (95% CI: 96.1 to 100), positive predictive value of 98.4% (95% CI: 89.8 to 99.8), negative predictive value of 90.4% (95% CI: 85.7 to 93.7), and accuracy of 92.7% (95% CI: 88.4 to 95.8) for PTC diagnosis.

Conclusions Evaluation of BRAF V600E mutation status combined with cytomorphological features for diagnosis of PTC in cytologically indeterminate thyroid nodules can significantly improve diagnostic accuracy and reduce the number of diagnostic operations (calculator available at www.ptc-calc.we2host.lt).

Key words

Bethesda system - BRAF mutation - fine-needle aspiration - papillary thyroid cancer - thyroid
 

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