Suspicious ultrasound characteristics predict BRAF V600E-positive papillary thyroid carcinoma Journal Article


Authors: Kabaker, A. S.; Tublin, M. E.; Nikiforov, Y. E.; Armstrong, M. J.; Hodak, S. P.; Stang, M. T.; McCoy, K. L.; Carty, S. E.; Yip, L.
Article Title: Suspicious ultrasound characteristics predict BRAF V600E-positive papillary thyroid carcinoma
Abstract: BACKGROUND: Current American Thyroid Association (ATA) guidelines recommend routine cervical ultrasound (US) in thyroid nodule evaluation. Specific US characteristics can help diagnose papillary thyroid carcinoma (PTC). The aim of this blinded cohort study was to determine whether these specific US characteristics can also reliably detect the more aggressive variants of PTC that are often associated with the BRAF(V600E) mutation. METHODS: After Institutional Review Board approval, we identified a cohort of patients from January 2007 to December 2009 with histologic PTC>/=1 cm who had cervical US, initial thyroid surgery, and molecular testing for BRAF(V600E) on fine-needle aspiration biopsy or histology. Preoperative US images were evaluated by a single radiologist, who was blinded to BRAF status, for nodule size and the presence or absence of the following suspicious US features: taller-than-wide shape, ill-defined margins, hypoechogenicity, calcifications, noncystic composition, and absent halo. RESULTS: BRAF-positivity was associated with most known suspicious US findings, including taller-than-wide shape (47% vs. 7%, p/=3 suspicious US features were present, BRAF-positivity was predicted with a positive predictive value of 82%. The absence of suspicious US features together with negative BRAF testing predicted PTC without extrathyroidal extension or lymph node metastasis (negative predictive value 88%). CONCLUSIONS: With routine preoperative cervical US and molecular testing, a trained radiologist or surgeon can improve the preoperative characterization of PTC, potentially impacting risk stratification and initial surgical management.
Keywords: Female; Humans; Middle Aged; Male; Retrospective Studies; Cohort Studies; Risk Assessment; Biopsy, Fine-Needle; Predictive Value of Tests; Reproducibility of Results; Carcinoma; Single-Blind Method; Sensitivity and Specificity; Mutation/genetics; Proto-Oncogene Proteins B-raf/genetics; Thyroid Gland/pathology/ultrasonography; Thyroid Neoplasms/genetics/pathology/ultrasonography; Ultrasonography; General Surgery
Journal Title: Thyroid : official journal of the American Thyroid Association
Volume: 22
Issue: 6
ISSN: 1557-9077; 1050-7256
Publisher: Unknown  
Journal Place: United States
Date Published: 2012
Start Page: 585
End Page: 589
Language: eng
DOI/URL:
Notes: LR: 20130625; GR: UL1 RR024153/RR/NCRR NIH HHS/United States; GR: UL1 RR024153/RR/NCRR NIH HHS/United States; JID: 9104317; EC 2.7.11.1 (BRAF protein, human); EC 2.7.11.1 (Proto-Oncogene Proteins B-raf); Thyroid cancer, papillary; OID: NLM: PMC3358112; 2012/04/23 [aheadofprint]; ppublish