What to do with thyroid nodules showing benign cytology and BRAFV600E mutation? A study based on clinical and radiologic features using a highly sensitive analytic method

Soo Yeon Kim, Eun Kyung Kim, Jin Young Kwak, Hee Jung Moon, Jung Hyun Yoon

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background BRAFV600E 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 BRAFV600E 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 BRAFV600E 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 BRAFV600E 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 BRAFV600E 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 BRAFV600E mutation, thyroidectomy should be considered in nodules which have 2 or more suspicious US features and are considered discordant on image-cytology correlation.

Original languageEnglish
Pages (from-to)354-361
Number of pages8
JournalSurgery (United States)
Volume157
Issue number2
DOIs
Publication statusPublished - 2015 Feb 1

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All Science Journal Classification (ASJC) codes

  • Surgery

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