Can Ultrasound Be as a Surrogate Marker for Diagnosing a Papillary Thyroid Cancer? Comparison with BRAF Mutation Analysis
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: We investigated the merit of ultrasound (US) features and BRAFV600E mutationas an additional study of cytology and compared the diagnostic performances of cytology alone, cytology with US correlation, cytology with BRAFV600E mutation, and a combination of cytology, US, and BRAFV600E mutation all together. Materials and Methods: This study included 185 patients (mean age, 48.4 years; range 20--77 years) with 191 thyroid nodules who underwent US-guided fine-needle aspiration (FNA) with an additional BRAFV600E mutation test. Three radiologists highly experiencedin thyroid imaging retrospectively reviewed US images and classified each nodule into two categories (positive for malignancy or negative for malignancy). Interobservervariability (IOV) of US assessment between the three readers was estimatedusing the generalized kappa statistic of Landis and Koch. We also calculated the diagnostic performances of these studies. Results: There were 131 cases of malignancy(131/191, 68.6%) and 60 cases of benign nodules (60/191, 31.4%). In terms of IOV of US assessment, the generalized kappa value was 0.242, indicating fair agreementwas reached. The combination of cytology with BRAFV600E showed higher specificity (100%) and positive predictive value (PPV) (100%) compared to the combinationof cytology, BRAFV600E, and US (specificity 28.3%, 66.7%, 68.3%; PPV 74.6%, 86.6%, 86.8%, respectively; p<0.001). However, cytology with BRAFV600E showed lower sensitivity (84.7%) than cytology with BRAFV600E and US (96.2%, 98.5%, 95.4%, respectively; p<0.001). Conclusion: Considering the diagnostic performanceand low reproducibility of US, the combination of FNA with BRAFV600E is the most reliable and objective method for diagnosing thyroid malignancy.
Abstract
Purpose: We investigated the merit of ultrasound (US) features and BRAFV600E mutationas an additional study of cytology and compared the diagnostic performances of cytology alone, cytology with US correlation, cytology with BRAFV600E mutation, and a combination of cytology, US, and BRAFV600E mutation all together. Materials and Methods: This study included 185 patients (mean age, 48.4 years; range 20--77 years) with 191 thyroid nodules who underwent US-guided fine-needle aspiration (FNA) with an additional BRAFV600E mutation test. Three radiologists highly experiencedin thyroid imaging retrospectively reviewed US images and classified each nodule into two categories (positive for malignancy or negative for malignancy). Interobservervariability (IOV) of US assessment between the three readers was estimatedusing the generalized kappa statistic of Landis and Koch. We also calculated the diagnostic performances of these studies. Results: There were 131 cases of malignancy(131/191, 68.6%) and 60 cases of benign nodules (60/191, 31.4%). In terms of IOV of US assessment, the generalized kappa value was 0.242, indicating fair agreementwas reached. The combination of cytology with BRAFV600E showed higher specificity (100%) and positive predictive value (PPV) (100%) compared to the combinationof cytology, BRAFV600E, and US (specificity 28.3%, 66.7%, 68.3%; PPV 74.6%, 86.6%, 86.8%, respectively; p<0.001). However, cytology with BRAFV600E showed lower sensitivity (84.7%) than cytology with BRAFV600E and US (96.2%, 98.5%, 95.4%, respectively; p<0.001). Conclusion: Considering the diagnostic performanceand low reproducibility of US, the combination of FNA with BRAFV600E is the most reliable and objective method for diagnosing thyroid malignancy.
참고문헌 (25)
- Yoon JH, "The Diagnostic Accuracy of Ultrasound-Guided Fine-Needle Aspiration Biopsy and the Sonographic Differences Between Benign and Malignant Thyroid Nodules 3 cm or Larger", THYROID, 21(9), pp.993~1000 (2011), MARY ANN LIEBERT inC
- Song JY, "Reclassifying Formerly Indeterminate Thyroid FNAs Using the Bethesda System Reduces the Number of Inconclusive Cases", ACTA CYTOLOGICA, 56(2), pp.122~129 (2012), SCI PRINTERS & PUBL INC
- Moon HJ, "The Diagnostic Values of Ultrasound and Ultrasound-Guided Fine Needle Aspiration in Subcentimeter-Sized Thyroid Nodules", ANNALS OF SURGICAL ONCOLOGY, 19(1), pp.52~59 (2012), Lippincott Williams & Wilkins Ltd.
- Nikiforov YE, "Molecular genetics and diagnosis of thyroid cancer", Nat Rev Endocrinol, 7, pp.569~580 (2011)
- Yip L, "Cost impact of molecular testing for indeterminate thyroid nodule fine-needle aspiration biopsies", J Clin Endocrinol Metab, 97, pp.1905~1912 (2012)
- Lee EJ, "The BRAF(V600E) mutation is associated with malignant ultrasonographic features in thyroid nodules", Clin Endocrinol (Oxf), 75, pp.844~850 (2011)
- Li H, "Cost-effectiveness of a novel molecular test for cytologically indeterminate thyroid nodules", J Clin Endocrinol Metab, 96, pp.E1719~E1726 (2011)
- Kwak JY, "BRAFV600E mutation testing in fine needle aspirates of thyroid nodules: potential value of real-time PCR", Ann Clin Lab Sci, 42, pp.258~265 (2012)
- Kim DW, "Role of Ultrasound Diagnosis in Assessing and Managing Thyroid Nodules With Inadequate Cytology", AMERICAN JOURNAL OF ROENTGENOLOGY, 197, pp.1213~1219 (2011), AMER ROENTGEN RAY SOC
- Kwak JY, "How to combine ultrasound and cytological information in decision making about thyroid nodules", European Radiology, 19(8), pp.1923~1931 (2009), Springer Verlag
- Choi YS, "Clinical and Ultrasonographic Findings Affecting Nondiagnostic Results upon the Second Fine Needle Aspiration for Thyroid Nodules", ANNALS OF SURGICAL ONCOLOGY, 19(7), pp.2304~2309 (2012), Lippincott Williams & Wilkins Ltd.
- Choi SH, "Interobserver and Intraobserver Variations in Ultrasound Assessment of Thyroid Nodules", THYROID, 20, pp.167~172 (2010), MARY ANN LIEBERT INC
- Kim HG, "Man to man training: Can it help improve the diagnostic performances and interobserver variabilities of thyroid ultrasonography in residents?", EUROPEAN JOURNAL OF RADIOLOGY, 81(3), pp.352~356 (2012), ELSEVIER IRELAND LTD
- Moon WJ, "Benign and malignant thyroid nodules: US differentiation--multicenter retrospective study", Radiology, 247, pp.762~770 (2008)
- American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, "Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer", Thyroid, 19, pp.1167~1214 (2009)
- Gharib H, "American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules", Endocr Pract, 12, pp.63~102 (2006)
- Landis JR, "The measurement of observer agreement for categorical data", Biometrics, 33, pp.159~174 (1977)
- Moses W, "Molecular testing for somatic mutations improves the accuracy of thyroid fine-needle aspiration biopsy", World J Surg, 34, pp.2589~2594 (2010)
- Nikiforov YE, "Molecular testing for mutations in improving the fine-needle aspiration diagnosis of thyroid nodules", J Clin Endocrinol Metab, 94, pp.2092~2098 (2009)
- Romei C, "Modifications in the papillary thyroid cancer gene profile over the last 15 years", J Clin Endocrinol Metab, 97, pp.E1758~E1765 (2012)
- Kim SK, "Surgical results of thyroid nodules according to a management guideline based on the BRAF(V600E) mutation status", J Clin Endocrinol Metab, 96, pp.658~664 (2011)
- Nam SY, "BRAF V600E mutation analysis of thyroid nodules needle aspirates in relation to their ultrasongraphic classification: a potential guide for selection of samples for molecular analysis", Thyroid, 20, pp.273~279 (2010)
- Moon WJ, "BRAF Mutation Analysis and Sonography as Adjuncts to Fine-Needle Aspiration Cytology of Papillary Thyroid Carcinoma: Their Relationships and Roles", AMERICAN JOURNAL OF ROENTGENOLOGY, 198(3), pp.668~674 (2012), AMER ROENTGEN RAY SOC
- 김성헌, "Observer Variability and the Performance between Faculties and Residents: US Criteria for Benign and Malignant Thyroid Nodules", Korean Journal of Radiology, 11(2), pp.149~155 (2010), 대한영상의학회
- 서희정, "Anaplastic Thyroid Cancer: Ultrasonographic Findings and the Role of Ultrasonography-Guided Fine Needle Aspiration Biopsy", Yonsei Medical Journal, 54(6), pp.1400~1406 (2013), 연세대학교의과대학[DOI]