Management and Outcome of 141 Patients with Thyroid Nodules with Cytological Diagnosis of Indeterminate Significance
SH Lee, TS Hwang, SK Kim, HS Han, SD Lim, WS Kim, YS Ko. Konkuk University School of Medicine, Seoul, Republic of Korea; Konkuk University Medical Center, Seoul, Republic of Korea
Background: BRAFV600E mutation analysis has been proposed as a valuable adjunctive tool for refining the cytological diagnosis of thyroid nodules. To define a clinical value of BRAFV600E mutation, the surgical outcome of 141 patients harboring thyroid nodules with equivocal cytologic diagnosis was analysed in according to the FNAB and mutation results.
Design: Fine needle aspiration biopsy (FNAB) and BRAFV600E mutation analysis were performed in the routine patient care at initial presentation. Patients were managed in according to the KUMC guideline. All patients with cytological diagnosis of indeterminate significance were managed by the BRAFV600E mutation analysis results. DNA was extracted after atypical follicular cells were scraped from the cytology slide and BRAFV600E mutation was analysed by pyrosequencing method.
Results: Among 141 cases with cytological diagnosis of indeterminate significance, 45 (31.9%) cases showed BRAFV600E mutation. All 45 patients with BRAFV600E positive and indeterminate cytologic features were recommended to have an operation. Among them 23 patients underwent surgery and 21 patients had papillary carcinoma and two patients had nodular goiter. Among 96 BRAFV600E mutation negative patients, 11 patients underwent surgery and turned out to have 3 papillary carcinomas, one follicular carcinoma, one follicular adenoma, and 6 nodular hyperplasias. The patients were recommended to have surgery when the nodules were large or ultrasonography findings were worrisome. Five patients removed their nodules by their own hope.
Conclusions: We found that BRAF analysis provide a great help to make a therapeutic decision when the FNAB results are equivocal.
Tuesday, March 23, 2010 1:00 PM
Poster Session IV # 42, Tuesday Afternoon