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Park J, An S, Kim K, Kim JS, Jung CK, Bae JS. Diagnostic utilities of washout CYFRA 21-1 combined with washout thyroglobulin for metastatic lymph nodes in thyroid cancer: a prospective study. Sci Rep 2024; 14:7599. [PMID: 38556517 PMCID: PMC10982287 DOI: 10.1038/s41598-024-58093-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/25/2024] [Indexed: 04/02/2024] Open
Abstract
Cervical lymph node (LN) metastasis is common in differentiated thyroid cancer (DTC). This study evaluated the utility of the washout CYFRA 21-1 level, combined with the thyroglobulin (Tg) concentration, in terms of diagnosis of LN metastasis. We prospectively enrolled 53 patients who underwent thyroid surgery to treat DTC with lateral cervical LN metastases. Preoperative ultrasound guided needle localization was used to surgical sampling of specific LNs during the operation. The intraoperative washout Tg and CYFRA 21-1 levels were measured in such LNs. The Tg and CYFRA 21-1 levels differed significantly between metastatic and benign LNs. The cutoff values were 2.63 ng/mL for washout CYFRA 21-1 and 22.62 ng/mL for Tg. Combined use of the washout Tg and CYFRA 21-1 levels afforded the highest diagnostic accuracy (92.5%), better than that of individual markers. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) were 94.6%, 90.0%, 91.4%, 93.8%, respectively. The conjunction of the washout CYFRA21-1 and Tg levels enhances the diagnostic accuracy of LN metastasis in DTC patients. The washout CYFRA 21-1 level may be useful when malignancy is suspected, especially in cases where the cytology and washout Tg findings do not provide definitive results.
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Affiliation(s)
- Joonseon Park
- Department of Surgery, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Solji An
- Department of Surgery, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Kwangsoon Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jeong Soo Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ja Seong Bae
- Department of Surgery, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Park J, An S, Kim K, Bae JS, Kim JS. BRAF V600E Positivity-Dependent Effect of Age on Papillary Thyroid Cancer Recurrence Risk. Cancers (Basel) 2023; 15:5395. [PMID: 38001654 PMCID: PMC10670702 DOI: 10.3390/cancers15225395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
BRAFV600E positivity is associated with increased aggressiveness of papillary thyroid cancer (PTC), and age is an important prognostic factor. However, the association between age and BRAFV600E positivity and the recurrence risk has not been investigated. This study aimed to investigate the impact of age on recurrence between patients with BRAFV600E-positive and -negative PTC. Patients with PTC who underwent initial thyroid surgery between January 2010 and December 2018 at Seoul St. Mary's Hospital (Seoul, Republic of Korea) were retrospectively reviewed. The BRAFV600E-positive (n = 1768) and BRAFV600E-negative groups (n = 428) were divided into two subgroups: younger (<35 years) and older groups (≥55 years). In the BRAFV600E-positive group, the younger group exhibited higher lymphatic and vascular invasion rates, more positive lymph nodes, higher lymph node ratios, and higher recurrence rates than the older group (5.9% vs. 2.1%). Multivariate analysis revealed that age, lymphatic invasion, and N category were significant risk factors in the BRAFV600E-positive group. In the BRAFV600E-positive group, the younger group had a higher recurrence risk than the older group (OR, 2.528; 95% confidence interval, 1.443-4.430; p = 0.001). In the BRAFV600E-negative group, age had no impact on recurrence risk. These results contribute to tailored treatment strategies and informed patient management.
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Affiliation(s)
| | | | - Kwangsoon Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.P.); (S.A.); (J.S.B.); (J.S.K.)
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Du J, Han R, Chen C, Ma X, Shen Y, Chen J, Li F. Diagnostic Efficacy of Ultrasound, Cytology, and BRAF V600E Mutation Analysis and Their Combined Use in Thyroid Nodule Screening for Papillary Thyroid Microcarcinoma. Front Oncol 2022; 11:746776. [PMID: 35047385 PMCID: PMC8761628 DOI: 10.3389/fonc.2021.746776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 10/22/2021] [Indexed: 12/12/2022] Open
Abstract
Background Ultrasound, cytology, and BRAFV600E mutation analysis were applied as valuable tools in the differential diagnosis of thyroid nodules. The aim of the present study was to evaluate the diagnostic efficiency of the three methods and their combined use in screening for papillary thyroid microcarcinoma (PTMC). Methods A total of 1,081 patients with 1,157 thyroid nodules (0.5–1 cm in maximum diameter) classified as thyroid imaging reporting and data system (TIRADS) 4–5 were recruited. All patients underwent ultrasound, fine-needle aspiration (FNA) examination, and an additional BRAFV600E mutation test. TIRADS and Bethesda System for Reporting Thyroid Cytopathology (BSRTC) were adopted to judge the ultrasound and cytological results. The receiver operating characteristic (ROC) curve was established to assess the diagnostic values of different methods. Results Of the 1,157 nodules, 587 were benign and 570 were PTMCs. BRAFV600E mutation test had highest sensitivity (85.4%), specificity (97.1%), accuracy (91.4%), and area under the ROC curve (Az) value (0.913) among the three methods. The combination of BSRTC and BRAFV600E mutation analysis yielded a considerably high sensitivity (96.0%), accuracy (94.3%), and negative predictive value (95.9%) than either BSRTC or BRAFV600E mutation alone (P < 0.0001 for all comparisons). Of all the methods, the combined use of the three methods produced the best diagnostic performance (Az = 0.967), which was significantly higher than that (Az = 0.943) for the combination of BSRTC and BRAFV600E mutation (P < 0.0001). The diagnostic accuracy of the molecular method in the 121 nodules with indeterminate cytology was 90.1% (109/121), which was significantly higher than that of TIRADS classification, 74.4% (90/121) (P = 0.002). Conclusion The combined use of ultrasound, cytology, and BRAFV600E mutation analysis is the most efficient and objective method for diagnosing PTMC. Both BRAFV600E mutation and TIRADS classification are potentially useful adjuncts to differentiate thyroid nodules, especially indeterminate samples classified as BSRTC III.
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Affiliation(s)
- Jing Du
- Department of Ultrasound, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruijun Han
- Department of Ultrasound, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cui Chen
- Department of Ultrasound, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaowei Ma
- Department of Laboratory Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuling Shen
- Department of Head and Neck Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Chen
- Department of Head and Neck Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fenghua Li
- Department of Ultrasound, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Fu G, Chazen RS, MacMillan C, Witterick IJ. Development of a Molecular Assay for Detection and Quantification of the BRAF Variation in Residual Tissue From Thyroid Nodule Fine-Needle Aspiration Biopsy Specimens. JAMA Netw Open 2021; 4:e2127243. [PMID: 34613404 PMCID: PMC8495535 DOI: 10.1001/jamanetworkopen.2021.27243] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/09/2021] [Indexed: 12/14/2022] Open
Abstract
Importance Thyroid cancer, predominantly papillary thyroid carcinoma (PTC), is common, but an estimated 30% of ultrasonography-guided fine-needle aspiration (FNA) biopsies of thyroid nodules are indeterminate. BRAF variation, associated with poor clinicopathological characteristics, is a useful molecular marker for diagnostics. Objective To develop a sensitive molecular assay for BRAF V600E detection in remaining tissue of thyroid FNA biopsies to identify patients with cancer carrying a BRAF variation. Design, Setting, and Participants This diagnostic study used tumor tissue from surgical formalin-fixed, paraffin-embedded (FFPE) specimens and residual tissue from thyroid FNA biopsies for genomic DNA extraction. FFPE specimens served as the validation set, and residual tissue from FNA biopsies served as the test set. A molecular assay was developed for accurate detection of BRAF V600E variation using locked nucleic acid (LNA) probe-based droplet digital polymerase chain reaction (dPCR), and the assay was validated by BRAF V600E immunohistochemical staining (IHC). The study was conducted between February 2019 and May 2021. Results A total of 271 specimens, including 77 FFPE specimens (with a follow-up of 48 matched surgical specimens) and 146 residual FNA samples, were collected from 223 patients (mean [SD] age, 53.8 [15.3] years; 174 [78.0%] women; 49 [22.0%] men). The molecular assay by dPCR was first established to specifically and accurately detect and quantify wild-type BRAF and variant BRAF in DNA from human follicular thyroid carcinoma-derived FTC-133 and papillary thyroid carcinoma-derived BCPAP cells. The linearity of quantification of BRAF V600E was calculated (y = 0.7339x; R2 = 0.9996) with sensitivity at 0.02 copies/μL and reproducibility in detecting variant DNA at various dilutions(coefficient of variance in 0.3% DNA, 9.63%; coefficient of variance in 1.0% DNA, 7.41%). In validation testing, the dPCR assay and IHC staining exhibited 100% specificity in concordantly identifying BRAF V600E in PTCs (κ = 0.873; P < .001) and sensitivity of 32.0% (95% CI, 19.1% to 44.9%) in dPCR and 26.0% (95% CI, 13.1% to 38.9%) in IHC staining, with an improvement by 23.08% in dPCR compared with the IHC staining. The dPCR assay further detected BRAF V600E in 39 of 146 residual FNA specimens (26.7%). At short-term follow-up, 48 patients, including 14 of 39 patients with BRAF variation and 34 of 107 patients without BRAF variation on residual FNA specimens, underwent resection. The dPCR assay of BRAF status in the matched surgical specimens showed BRAF V600E variations in 12 patients and wild-type BRAF in 36 patients, with a high agreement to that in residual tissue of FNA specimens (κ = 0.789; P < .001). Among 14 patients with BRAF variations on residual FNA, 13 were diagnosed with PTC and 1 was diagnosed with anaplastic thyroid cancer at the thyroidectomy. Conclusions and Relevance This diagnostic study developed a sensitive molecular assay for detection and quantification of BRAF V600E variation in residual tissue from thyroid FNA biopsies to identify patients with cancer harboring BRAF V600E in a cost-effective manner, highlighting the clinical value of molecular assay of the remaining FNA tissue in the management of thyroid nodules.
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Affiliation(s)
- Guodong Fu
- Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Mount Sinai Hospital, Toronto, Canada
| | - Ronald S. Chazen
- Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Mount Sinai Hospital, Toronto, Canada
| | - Christina MacMillan
- Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Mount Sinai Hospital, Toronto, Canada
- Department of Pathology and Laboratory Medicine, Sinai Health System, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Ian J. Witterick
- Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Mount Sinai Hospital, Toronto, Canada
- Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Sinai Health System, Mount Sinai Hospital, Toronto, Canada
- Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Mount Sinai Hospital, University of Toronto, Toronto, Canada
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Park J, Lee S, Park J, Park H, Ki CS, Oh YL, Shin JH, Kim JS, Kim SW, Chung JH, Kim K, Kim TH. Proposal of a New Prognostic Model for Differentiated Thyroid Cancer with TERT Promoter Mutations. Cancers (Basel) 2021; 13:cancers13122943. [PMID: 34208345 PMCID: PMC8231155 DOI: 10.3390/cancers13122943] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 11/16/2022] Open
Abstract
The role of telomerase reverse transcriptase (TERT) promoter mutations as an independent poor prognostic factor in differentiated thyroid cancer (DTC) patients is well known, but there is no prognostic system that combines the TERT promoter mutation status with tumor-node-metastasis (TNM) stage to predict cancer-specific survival (CSS). A total of 393 patients with pathologically confirmed DTC after thyroidectomy were enrolled. After incorporating wild-type TERT and mutant TERT with stages I, II, and III/IV of the AJCC TNM system 8th edition (TNM-8), we generated six combinations and calculated 10-year and 15-year CSS and adjusted hazard ratios (HRs) for cancer-related death using Cox regression. Then, a new mortality prediction model termed TNM-8T was derived based on the CSS and HR of each combination in the four groups. Of the 393 patients, there were 27 (6.9%) thyroid cancer-related deaths during a median follow-up of 14 years. Patients with a more advanced stage had a lower survival rate (10-year CSS for TNM-8T stage 1, 2, 3, and 4: 98.7%, 93.5%, 77.3%, and 63.0%, respectively; p < 0.001). TNM-8T showed a better spread of CSS (p < 0.001) than TNM-8 (p = 0.002) in the adjusted survival curves. The C-index for mortality risk predictability was 0.880 (95% CI, 0.665-0.957) in TNM-8T and 0.827 (95% CI, 0.622-0.930) in TNM-8 (p < 0.001). TNM-8T, a new prognostic system that incorporates the TERT mutational status into TNM-8, showed superior predictability to TNM-8 in the long-term survival of DTC patients.
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Affiliation(s)
- Jun Park
- Thyroid Center, Samsung Medical Center, Division of Endocrinology and Metabolism, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.P.); (J.P.); (H.P.); (S.-W.K.); (J.-H.C.)
- Division of Endocrinology, Department of Medicine, Sahmyook Medical Center, Seoul 02500, Korea
| | - Sungjoo Lee
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Jiyun Park
- Thyroid Center, Samsung Medical Center, Division of Endocrinology and Metabolism, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.P.); (J.P.); (H.P.); (S.-W.K.); (J.-H.C.)
| | - Hyunju Park
- Thyroid Center, Samsung Medical Center, Division of Endocrinology and Metabolism, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.P.); (J.P.); (H.P.); (S.-W.K.); (J.-H.C.)
| | | | - Young-Lyun Oh
- Samsung Medical Center, Department of Pathology, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Jung-Hee Shin
- Samsung Medical Center, Department of Radiology, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Jee-Soo Kim
- Samsung Medical Center, Department of Surgery, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Sun-Wook Kim
- Thyroid Center, Samsung Medical Center, Division of Endocrinology and Metabolism, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.P.); (J.P.); (H.P.); (S.-W.K.); (J.-H.C.)
| | - Jae-Hoon Chung
- Thyroid Center, Samsung Medical Center, Division of Endocrinology and Metabolism, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.P.); (J.P.); (H.P.); (S.-W.K.); (J.-H.C.)
| | - Kyunga Kim
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
- Statistics and Data Center, Samsung Medical Center, Research Institute for Future Medicine, Seoul 06355, Korea
- Correspondence: (K.K.); (T.-H.K.); Tel.: +82-2-3410-6049 (T.-H.K.)
| | - Tae-Hyuk Kim
- Thyroid Center, Samsung Medical Center, Division of Endocrinology and Metabolism, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.P.); (J.P.); (H.P.); (S.-W.K.); (J.-H.C.)
- Correspondence: (K.K.); (T.-H.K.); Tel.: +82-2-3410-6049 (T.-H.K.)
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Park J, Lee S, Kim K, Park H, Ki CS, Oh YL, Shin JH, Kim JS, Kim SW, Chung JH, Kim TH. TERT Promoter Mutations and the 8th Edition TNM Classification in Predicting the Survival of Thyroid Cancer Patients. Cancers (Basel) 2021; 13:cancers13040648. [PMID: 33562809 PMCID: PMC7915040 DOI: 10.3390/cancers13040648] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary In a cohort study involving 393 patients with differentiated thyroid cancer, TERT promoter mutations were found to act as an independent poor prognostic factor based on the American Joint Committee on Cancer (AJCC) tumor-node-metastasis 8th edition (TNM-8) in differentiated thyroid carcinoma (DTC) patients, regardless of the histological types or stage at diagnosis. Since the current AJCC TNM-8 is insufficient to distinguish the risk of mortality in patients with differentiated thyroid cancer, a proposal for a new survival prediction model that includes the TERT promoter mutational state is required. Abstract Our research group has previously shown that the presence of TERT promoter mutations is an independent prognostic factor, by applying the TERT mutation status to the variables of the AJCC 7th edition. This study aimed to determine if TERT mutations could be independent predictors of thyroid cancer-specific mortality based on the AJCC TNM 8th edition, with long-term follow-up. This was a retrospective study of 393 patients with pathologically confirmed differentiated thyroid carcinoma (DTC) after thyroidectomy at a tertiary Korean hospital from 1994 to 2004. The thyroid cancer-specific mortality rate was 6.9% (5.2% for papillary and 15.2% for follicular cancers). TERT promoter mutations were identified in 10.9% (43/393) of DTC cases (9.8% of papillary and 16.7% of follicular cancer) and were associated with older age (p < 0.001), the presence of extrathyroidal invasion (p < 0.001), distant metastasis (p = 0.001), and advanced stage at diagnosis (p < 0.001). The 10-year survival rate in mutant TERT was 67.4% for DTC patients (vs. 98% for wild-type; adjusted hazard ratio (HR) of 9.93, (95% CI: 3.67–26.90)) and 75% for patients with papillary cancer (vs. 99%; 18.55 (4.83–71.18)). In addition, TERT promoter mutations were related to poor prognosis regardless of histologic type (p < 0.001 for both papillary and follicular cancer) or initial stage (p < 0.001, p = 0.004, and p = 0.086 for stages I, II, and III and IV, respectively). TERT promoter mutations comprise an independent poor prognostic factor after adjusting for the clinicopathological risk factors of the AJCC TNM 8th edition, histologic type, and each stage at diagnosis, which could increase prognostic predictability for patients with DTC.
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Affiliation(s)
- Jun Park
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea; (J.P.); (H.P.); (S.W.K.); (J.H.C.)
| | - Sungjoo Lee
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea; (S.L.); (K.K.)
| | - Kyunga Kim
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea; (S.L.); (K.K.)
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06355, Korea
| | - Hyunju Park
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea; (J.P.); (H.P.); (S.W.K.); (J.H.C.)
| | | | - Young Lyun Oh
- Department of Pathology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea;
| | - Jung Hee Shin
- Department of Radiology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea;
| | - Jee Soo Kim
- Department of Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea;
| | - Sun Wook Kim
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea; (J.P.); (H.P.); (S.W.K.); (J.H.C.)
| | - Jae Hoon Chung
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea; (J.P.); (H.P.); (S.W.K.); (J.H.C.)
| | - Tae Hyuk Kim
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea; (J.P.); (H.P.); (S.W.K.); (J.H.C.)
- Correspondence: ; Tel.: +82-2-3410-6049
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Ooi LY, Nga ME. Atypia of undetermined significance/follicular lesion of undetermined significance: Asian vs. non-Asian practice, and the Singapore experience. Gland Surg 2020; 9:1764-1787. [PMID: 33224854 DOI: 10.21037/gs-20-555] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Bethesda System for Reporting Thyroid Cytopathology has paved the way for comparisons of the practice of thyroid cytology in many different regions. However, there have been comparatively few studies documenting differences between Asian and non-Asian practice. Here, we aim to compare a few key parameters between the two regions, focusing on the indeterminate category of atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS). We compared its incidence, resection rates (RRs), risk of malignancy (ROM), rate of repeat fine needle aspiration (rFNA), ROMs of cytomorphologic subcategories of nuclear atypia (AUS-N) vs. architectural atypia (AUS-A), and, finally, the incidence of papillary thyroid carcinoma (PTC) vs. follicular neoplasms (FNs) in resected AUS/FLUS cases in Asian and non-Asian regions. Where possible, these metrics were compared with the Singapore experience from a tertiary referral institution. While the incidence of AUS/FLUS was similar in both regions, we found geographical differences in the RRs and ROMs, which may reflect a higher collective threshold for surgery in Asian countries. However, both cohorts showed higher ROMs in the AUS-N subcategory as compared to the AUS-A subcategory, supporting the subclassification of the AUS/FLUS based on the presence of nuclear atypia. We also observed a higher incidence of AUS-N coupled with a higher incidence of PTC in resected AUS/FLUS nodules in Asian cohorts, while AUS-A and follicular-patterned neoplasms featured more prominently in the non-Asian cohorts. These incidences may account for the starkly different molecular approaches that we noted-in Asian (chiefly Korean and Chinese) centers, BRAF mutational analysis was favored, while gene panels and gene expression classifiers were more frequently applied in non-Asian centers (chiefly in the United States of America). Overall, the data from Singapore appears more closely aligned to non-Asian trends, despite its geographical location in Southeast Asia and its predominantly Asian population. We conclude that there is significant heterogeneity in the outcomes of the AUS/FLUS categories between and within regions, which is only partially explained by regional variations, and may also reflect different regional diagnostic and management practices. This highlights the importance of understanding the local context in the interpretation of indeterminate Bethesda categories, rather than adopting a "one-size fits all" approach.
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Affiliation(s)
- Li Yin Ooi
- Department of Pathology, National University Hospital, Singapore
| | - Min En Nga
- Department of Pathology, National University Hospital, Singapore
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Abstract
Given the long-term survival of most patients with thyroid cancer, it is very important to distinguish patients who need aggressive treatment from those who do not. Conventional clinicopathological prognostic parameters could not completely predict the final outcome of each patient. Recently, molecular marker-based risk stratification of thyroid cancer has been proposed to better estimate the cancer risk. Although BRAF mutation has drawn much attention based on its high prevalence, its association with recurrence or mortality is not clear. Recently, telomerase reverse transcriptase (TERT) promoter mutation has been identified in thyroid cancer. It increases telomerase activity, which allows cancer cells to immortalize. It was found in 10 to 20% of differentiated thyroid carcinoma and 40% of dedifferentiated thyroid carcinoma. It is highly prevalent in old age, large tumor, aggressive histology, advanced stages, and distant metastasis. It is associated with increased recurrence and mortality. Concomitant BRAF and TERT promoter mutations worsen the survival rate. Inclusion of TERT promoter mutation analysis with conventional clinicopathological evaluation can lead to better prognostication and management for individual patients.
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Affiliation(s)
- Jae Hoon Chung
- Division of Endocrinology and Metabolism, Department of Medicine and Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
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Pastoricchio M, Cubisino A, Lanzaro A, Troian M, Zanconati F, Bernardi S, Fabris B, de Manzini N, Dobrinja C. Impact of the Italian Society of Anatomic Pathology and Diagnostic Cytology Classification of Thyroid Nodules in the Treatment of Indeterminate Follicular Lesions: Five-Year Results at a Single Center. Int J Endocrinol 2020; 2020:7325260. [PMID: 32351561 PMCID: PMC7178537 DOI: 10.1155/2020/7325260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 03/03/2020] [Accepted: 03/09/2020] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Aim of the study was to assess the impact of the Italian Society of Anatomic Pathology and Diagnostic Cytology (SIAPEC) classification of 2014, on the treatment of indeterminate thyroid lesions (TIR3). METHODS We retrospectively analyzed patients undergoing thyroid surgery for TIR3 lesions between 2013 and 2018, at the General Surgery Department of Trieste University Hospital. According to the SIAPEC classification, patients were divided into TIR3A and TIR3B groups. All patients treated before 2014 underwent surgical treatment, and surgical specimens were retrospectively classified after revision of fine-needle aspiration cytology. Starting 2014, TIR3A patients were treated only when symptomatic (i.e., coexistent bilateral thyroid goiter or growing TIR3A nodules), whereas TIR3B patients always received surgical treatment. Hemithyroidectomy (HT) was the procedure of choice. Total thyroidectomy (TT) was performed in case of concurrent bilateral goiter, autoimmune thyroid disease, and/or presence of BRAF and/or RAS mutation. Lastly, we analyzed the malignancy rate in the two groups. RESULTS 29 TIR3A and 90 TIR3B patients were included in the study. HT was performed in 10 TIR3A patients and 37 TIR3B patients, respectively, with need for reoperation in 4 TIR3B (10.8%) patients due to histological findings of follicular thyroid carcinoma >1 cm. The malignancy rates were 17.2% in TIR3A and 31.1% in TIR3B, (p = 0.16). Predictability of malignancy was almost 89% in BRAF mutation and just 47% in RAS mutation. CONCLUSIONS The new SIAPEC classification in association with biomolecular markers has improved diagnostic accuracy, patient selection, and clinical management of TIR3 lesions.
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Affiliation(s)
- M. Pastoricchio
- Division of Clinical Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Trieste 34149, Italy
| | - A. Cubisino
- Division of Clinical Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Trieste 34149, Italy
| | - A. Lanzaro
- Division of Clinical Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Trieste 34149, Italy
| | - M. Troian
- Division of Clinical Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Trieste 34149, Italy
| | - F. Zanconati
- Department of Medical, Surgical and Health Sciences, Università Degli Studi di Trieste, Cattinara Teaching Hospital, Strada di Fiume 447, 34149 Trieste, Italy
| | - S. Bernardi
- Department of Medical, Surgical and Health Sciences, Università Degli Studi di Trieste, Cattinara Teaching Hospital, Strada di Fiume 447, 34149 Trieste, Italy
- Endocrinology Unit—Azienda Sanitaria Universitaria Integrata Trieste, Cattinara Teaching Hospital, Strada di Fiume 447, 34149 Trieste, Italy
| | - B. Fabris
- Department of Medical, Surgical and Health Sciences, Università Degli Studi di Trieste, Cattinara Teaching Hospital, Strada di Fiume 447, 34149 Trieste, Italy
- Endocrinology Unit—Azienda Sanitaria Universitaria Integrata Trieste, Cattinara Teaching Hospital, Strada di Fiume 447, 34149 Trieste, Italy
| | - N. de Manzini
- Division of Clinical Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Trieste 34149, Italy
| | - C. Dobrinja
- Division of Clinical Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Trieste 34149, Italy
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10
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Zhao C, Zheng J, Sun L, Xu R, Wei Q, Xu H. BRAF V600E mutation analysis in fine-needle aspiration cytology specimens for diagnosis of thyroid nodules: The influence of false-positive and false-negative results. Cancer Med 2019; 8:5577-5589. [PMID: 31397092 PMCID: PMC6745841 DOI: 10.1002/cam4.2478] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/19/2019] [Accepted: 07/26/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The accurate evaluation of BRAFV600E mutation in preoperative fine-needle aspiration cytology (FNAC) specimens is important for making management decisions in thyroid nodules (TNs). The aim of this study was to assess the false-positive and false-negative BRAFV600E mutations in thyroid FNAC specimens and their influence on diagnosis of TN. METHODS This prospective study enrolled 292 nodules in 269 patients who underwent BRAFV600E mutation analysis using amplification refractory mutation system-quantitative real-time polymerase chain reaction (ARMS-qPCR) both in FNAC specimens and formalin-fixed, paraffin-embedded (FFPE) tissue samples after surgery. The false-positive and false-negative mutations for BRAFV600E analysis using ARMS-qPCR in FNAC specimens were recorded, with reference to the results of BRAFV600E mutation analysis using ARMS-qPCR in FFPE tissue sample. Diagnostic performances of FNAC, BRAFV600E mutation analysis in FNAC specimens, BRAFV600E mutation analysis in FFPE tissue sample, and the combination of FNAC and BRAFV600E mutation analysis for predicting thyroid malignancy were assessed. RESULTS The false-positive and false-negative mutations for BRAFV600E analysis using ARMS-qPCR in FNAC specimens were 10.1% (19/189) and 7.1% (7/98), respectively. FNAC combined with preoperative BRAFV600E mutation analysis significantly increased the diagnostic sensitivity from 75.7% to 92.3%, and accuracy from 78.7% to 90.6% in comparison with FNAC alone (both P < .001). No significant differences were found between the combination of FNAC and BRAFV600E mutation analysis in FNAC specimens and the combination of FNAC and BRAFV600E mutation analysis in FFPE tissue sample (sensitivity: 92.3% vs 91.9%; accuracy: 90.6% vs 91.3%; both P > .05). CONCLUSIONS FNAC combined with preoperative BRAFV600E mutation analysis can significantly increase the diagnostic performance in comparison with FNAC alone. False-positive and false-negative BRAFV600E mutation results are found in preoperative FNAC specimens, whereas it does not affect the overall auxiliary diagnosis of TNs.
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Affiliation(s)
- Chong‐Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education InstituteTongji University School of MedicineShanghaiChina
- Thyroid InstituteTongji University School of MedicineShanghaiChina
- Shanghai Center for Thyroid DiseasesShanghaiChina
| | - Jia‐Yi Zheng
- Thyroid InstituteTongji University School of MedicineShanghaiChina
- Shanghai Center for Thyroid DiseasesShanghaiChina
- Department of Pathology, Shanghai Tenth People's HospitalTongji University School of MedicineShanghaiChina
| | - Li‐Ping Sun
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education InstituteTongji University School of MedicineShanghaiChina
- Thyroid InstituteTongji University School of MedicineShanghaiChina
- Shanghai Center for Thyroid DiseasesShanghaiChina
| | - Rong‐Ying Xu
- Thyroid InstituteTongji University School of MedicineShanghaiChina
- Shanghai Center for Thyroid DiseasesShanghaiChina
- Department of Pathology, Shanghai Tenth People's HospitalTongji University School of MedicineShanghaiChina
| | - Qing Wei
- Thyroid InstituteTongji University School of MedicineShanghaiChina
- Shanghai Center for Thyroid DiseasesShanghaiChina
- Department of Pathology, Shanghai Tenth People's HospitalTongji University School of MedicineShanghaiChina
| | - Hui‐Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education InstituteTongji University School of MedicineShanghaiChina
- Thyroid InstituteTongji University School of MedicineShanghaiChina
- Shanghai Center for Thyroid DiseasesShanghaiChina
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11
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Wang Z, Sun K, Jing C, Cao H, Ma R, Wu J. Comparison of droplet digital PCR and direct Sanger sequencing for the detection of the BRAF V600E mutation in papillary thyroid carcinoma. J Clin Lab Anal 2019; 33:e22902. [PMID: 31021028 PMCID: PMC6642310 DOI: 10.1002/jcla.22902] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/27/2019] [Accepted: 03/28/2019] [Indexed: 12/19/2022] Open
Abstract
Background The BRAFV600E mutation status is a useful diagnostic and prognostic marker for papillary thyroid carcinoma (PTC). Although it is a commonly used method, Sanger sequencing has several limitations in detecting the BRAFV600E mutation. The aim of this study was to evaluate the efficiency of droplet digital PCR (ddPCR) as an alternative method for the detection of the BRAFV600E mutation in PTC patients. Methods Samples from a total of 120 patients with PTC and 30 patients with benign nodular thyroid disease who underwent thyroid surgery were collected. The BRAFV600E mutation status of the PTC patients was tested by Sanger sequencing and ddPCR. Results The BRAFV600E mutation was detected in 67 samples (44.67%) by Sanger sequencing and 92 samples (61.33%) by ddPCR. The detection of the mutation by the two methods was inconsistent in twenty‐five samples (16.67%). The sensitivity and specificity of the ddPCR method were 100% and 69.88%, respectively, and the positive predictive and negative predictive values were 72.83% and 100%, respectively. The concordance rate between the two methods in detecting the BRAFV600E mutation was 83.33%. Neither Sanger sequencing nor ddPCR detected BRAFV600E in 30 patients with benign nodular thyroid disease. The 92 samples with the BRAFV600E mutation were detected by ddPCR at a fractional abundance from 0.28% to 45.40% as follows: ≥10% (59 samples, 64.13%), 5%‐10% (8 samples, 8.70%), and ≤5% (25 samples, 27.17%). The BRAFV600E mutation was detected in all 59 samples at a fractional abundance ≥10% and in four samples at a fractional abundance from 5% to 10%, and no BRAFV600E mutation was detected at a fractional abundance ≤5% by Sanger sequencing. Conclusions ddPCR was a reliable, highly sensitive alternative method for the detection of the BRAFV600E mutation in PTC patients.
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Affiliation(s)
- Zhuo Wang
- Clinical Cancer Research Center, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | | | - Changwen Jing
- Clinical Cancer Research Center, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Haixia Cao
- Clinical Cancer Research Center, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Rong Ma
- Clinical Cancer Research Center, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Jianzhong Wu
- Clinical Cancer Research Center, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
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12
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Boufraqech M, Patel D, Nilubol N, Powers A, King T, Shell J, Lack J, Zhang L, Gara SK, Gunda V, Klubo-Gwiezdzinska J, Kumar S, Fagin J, Knauf J, Parangi S, Venzon D, Quezado M, Kebebew E. Lysyl Oxidase Is a Key Player in BRAF/MAPK Pathway-Driven Thyroid Cancer Aggressiveness. Thyroid 2019; 29:79-92. [PMID: 30398411 PMCID: PMC6352555 DOI: 10.1089/thy.2018.0424] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The BRAFV600E mutation is the most common somatic mutation in thyroid cancer. The mechanism associated with BRAF-mutant tumor aggressiveness remains unclear. Lysyl oxidase (LOX) is highly expressed in aggressive thyroid cancers, and involved in cancer metastasis. The objective was to determine whether LOX mediates the effect of the activated MAPK pathway in thyroid cancer. METHODS The prognostic value of LOX and its association with mutated BRAF was analyzed in The Cancer Genome Atlas and an independent cohort. Inhibition of mutant BRAF and the MAPK pathway, and overexpression of mutant BRAF and mouse models of BRAFV600E were used to test the effect on LOX expression. RESULTS In The Cancer Genome Atlas cohort, LOX expression was higher in BRAF-mutant tumors compared to wild-type tumors (p < 0.0001). Patients with BRAF-mutant tumors with high LOX expression had a shorter disease-free survival (p = 0.03) compared to patients with a BRAF mutation and the low LOX group. In the independent cohort, a significant positive correlation between LOX and percentage of BRAF mutated cells was found. The independent cohort confirmed high LOX expression to be associated with a shorter disease-free survival (p = 0.01). Inhibition of BRAFV600E and MEK decreased LOX expression. Conversely, overexpression of mutant BRAF increased LOX expression. The mice with thyroid-specific expression of BRAFV600E showed strong LOX and p-ERK expression in tumor tissue. Inhibition of BRAFV600E in transgenic and orthotopic mouse models significantly reduced the tumor burden as well as LOX and p-ERK expression. CONCLUSIONS The data suggest that BRAFV600E tumors with high LOX expression are associated with more aggressive disease. The biological underpinnings of the clinical findings were confirmed by showing that BRAF and the MAPK pathway regulate LOX expression.
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Affiliation(s)
- Myriem Boufraqech
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Dhaval Patel
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Naris Nilubol
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Astin Powers
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Timothy King
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jasmine Shell
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Justin Lack
- NIAID Collaborative Bioinformatics Resource (NCBR), NIAID, NIH, Bethesda, Maryland
- Advanced Biomedical Computational Science, Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Lisa Zhang
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sudheer Kumar Gara
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Viswanath Gunda
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joanna Klubo-Gwiezdzinska
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Suresh Kumar
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - James Fagin
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Jeffrey Knauf
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Sareh Parangi
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Venzon
- Biostatistics and Data Management Section, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Martha Quezado
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Electron Kebebew
- Department of Surgery and Stanford Cancer Institute, Stanford University, Stanford, California
- Address correspondence to: Electron Kebebew, MD, Stanford University, 300 Pasteur Drive, H3642, Stanford, CA 94305
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13
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Ferrari SM, Fallahi P, Ruffilli I, Elia G, Ragusa F, Paparo SR, Ulisse S, Baldini E, Giannini R, Miccoli P, Antonelli A, Basolo F. Molecular testing in the diagnosis of differentiated thyroid carcinomas. Gland Surg 2018; 7:S19-S29. [PMID: 30175060 DOI: 10.21037/gs.2017.11.07] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Different genetic mutations and other molecular alterations in papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC) can be detected in fine-needle aspiration (FNA) of thyroid nodules, and can be used successfully to ameliorate cancer diagnosis and management of patients with thyroid nodules. The greatest experience has been obtained with the diagnostic use of BRAF mutation that is strongly specific for malignancy when detected using well-validated techniques. The strongest diagnostic result can be obtained testing FNA samples for a panel of mutations that typically involve TERT, BRAF, PAX8/PPARγ, RAS, and RET/PTC. Finding any of these mutations in a thyroid nodule provides strong indication for malignancy and helps to refine clinical management for a significant proportion of patients with indeterminate cytology. The use of molecular markers, as TERT, BRAF, PAX8/PPARγ, RAS, and RET/PTC, may be considered for patients with indeterminate FNA cytology (FNAC) to help guide management. In patients with indeterminate TIR3 FNA, the combination of precise molecular marker expression analysis with molecular mutations evaluations could ameliorate significantly the accuracy of cancer diagnosis. However other prospective studies are needed to identify more accurate molecular markers. Finally, the knowledge of these molecular pathways has permitted the development of new targeted therapies for aggressive TC.
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Affiliation(s)
| | - Poupak Fallahi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ilaria Ruffilli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giusy Elia
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesca Ragusa
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Salvatore Ulisse
- Department of Surgical Sciences, 'Sapienza' University of Rome, Rome, Italy
| | - Enke Baldini
- Department of Surgical Sciences, 'Sapienza' University of Rome, Rome, Italy
| | - Riccardo Giannini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Paolo Miccoli
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Alessandro Antonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fulvio Basolo
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
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14
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Kim H, Kim BH, Kim YK, Kim JM, Oh SY, Kim EH, Lee MJ, Kim JH, Jeon YK, Kim SS, Lee BJ, Kim YK, Kim IJ. Prevalence of BRAFV600E Mutation in Follicular Variant of Papillary Thyroid Carcinoma and Non-Invasive Follicular Tumor with Papillary-Like Nuclear Features (NIFTP) in a BRAFV600E Prevalent Area. J Korean Med Sci 2018; 33:e75. [PMID: 29962924 PMCID: PMC6021356 DOI: 10.3346/jkms.2018.33.e75] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 11/29/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND BRAFV600E mutation status and prevalence of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) has not yet been reported in Korea. The aim of this study was to investigate the significance of the BRAFV600E mutation in the follicular variant of papillary thyroid carcinoma (FVPTC) and to determine the prevalence of NIFTP in BRAFV600E mutation-prevalent Korean patients. METHODS This study retrospectively analyzed 1,417 consecutive patients who underwent total thyroidectomy with routine prophylactic central lymph node dissection for papillary thyroid carcinoma (PTC). BRAFV600E mutation analysis was performed routinely using multiplex polymerase chain reaction by applying dual priming oligonucleotide. Clinicopathological characteristics and ultrasonographic findings were compared between BRAFV600E mutation-positive and -negative groups for FVPTC. Pathologists reviewed the pathology slides according to consensus diagnostic criteria for the encapsulated FVPTC and NIFTP. RESULTS The prevalence of the BRAFV600E mutation in all subtypes of PTC was 61.0% (861/1,411). FVPTC presented a BRAFV600E mutation rate of 27.3%. The FVPTC patients with BRAFV600E mutation were older than those with no BRAFV600E mutation (P = 0.021). The prevalence of NIFTP was 0.18% among all PTC patients (2/1,411) and the proportion of NIFTP among FVPTC was 9.1% (2/22). CONCLUSION The BRAFV600E mutation is prevalent in Korean patients with FVPTC in a region with high frequency of the BRAFV600E mutation and very low prevalence of NIFTP compared with that reported in western studies.
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Affiliation(s)
- Hyereen Kim
- Hyereen Kim's Internal Medicine Clinic, Yangsan, Korea
| | - Bo Hyun Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Young Keum Kim
- Department of Pathology, Pusan National University Hospital and Pusan National University School of Medicine, Busan, Korea
| | - Jeong Mi Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Seo Young Oh
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Eun Heui Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Min Jin Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Jong Ho Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Yun Kyung Jeon
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Sang Soo Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Byung Joo Lee
- Department of Otolaryngology, Pusan National University School of Medicine, Busan, Korea
| | - Yong Ki Kim
- Kim Yong Ki Internal Medicine Clinic, Busan, Korea
| | - In Joo Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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15
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de Koster EJ, de Geus-Oei LF, Dekkers OM, van Engen-van Grunsven I, Hamming J, Corssmit EPM, Morreau H, Schepers A, Smit J, Oyen WJG, Vriens D. Diagnostic Utility of Molecular and Imaging Biomarkers in Cytological Indeterminate Thyroid Nodules. Endocr Rev 2018; 39:154-191. [PMID: 29300866 DOI: 10.1210/er.2017-00133] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 12/27/2017] [Indexed: 12/21/2022]
Abstract
Indeterminate thyroid cytology (Bethesda III and IV) corresponds to follicular-patterned benign and malignant lesions, which are particularly difficult to differentiate on cytology alone. As ~25% of these nodules harbor malignancy, diagnostic hemithyroidectomy is still custom. However, advanced preoperative diagnostics are rapidly evolving.This review provides an overview of additional molecular and imaging diagnostics for indeterminate thyroid nodules in a preoperative clinical setting, including considerations regarding cost-effectiveness, availability, and feasibility of combining techniques. Addressed diagnostics include gene mutation analysis, microRNA, immunocytochemistry, ultrasonography, elastosonography, computed tomography, sestamibi scintigraphy, [18F]-2-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET), and diffusion-weighted magnetic resonance imaging.The best rule-out tests for malignancy were the Afirma® gene expression classifier and FDG-PET. The most accurate rule-in test was sole BRAF mutation analysis. No diagnostic had both near-perfect sensitivity and specificity, and estimated cost-effectiveness. Molecular techniques are rapidly advancing. However, given the currently available techniques, a multimodality stepwise approach likely offers the most accurate diagnosis, sequentially applying one sensitive rule-out test and one specific rule-in test. Geographical variations in cytology (e.g., Hürthle cell neoplasms) and tumor genetics strongly influence local test performance and clinical utility. Multidisciplinary collaboration and implementation studies can aid the local decision for one or more eligible diagnostics.
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Affiliation(s)
- Elizabeth J de Koster
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Olaf M Dekkers
- Department of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Jaap Hamming
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Eleonora P M Corssmit
- Department of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Abbey Schepers
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan Smit
- Department of Endocrinology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wim J G Oyen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.,Division of Radiotherapy and Imaging, Institute of Cancer Research, and Department of Nuclear Medicine, Royal Marsden Hospital, London, United Kingdom
| | - Dennis Vriens
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
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16
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Guseva NV, Jaber O, Stence AA, Sompallae K, Bashir A, Sompallae R, Bossler AD, Jensen CS, Ma D. Simultaneous detection of single-nucleotide variant, deletion/insertion, and fusion in lung and thyroid carcinoma using cytology specimen and an RNA-based next-generation sequencing assay. Cancer Cytopathol 2018; 126:158-169. [DOI: 10.1002/cncy.21963] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/03/2017] [Accepted: 10/17/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Natalya V. Guseva
- Department of Pathology; University of Iowa Hospitals and Clinics; Iowa City Iowa
| | - Omar Jaber
- Department of Pathology; King Hussein Cancer Center; Amman Jordan
| | - Aaron A. Stence
- Department of Pathology; University of Iowa Hospitals and Clinics; Iowa City Iowa
| | | | - Amani Bashir
- Department of Pathology; University of Iowa Hospitals and Clinics; Iowa City Iowa
| | | | - Aaron D. Bossler
- Department of Pathology; University of Iowa Hospitals and Clinics; Iowa City Iowa
| | - Chris S. Jensen
- Department of Pathology; University of Iowa Hospitals and Clinics; Iowa City Iowa
| | - Deqin Ma
- Department of Pathology; University of Iowa Hospitals and Clinics; Iowa City Iowa
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17
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Lee SE, Hwang TS, Choi YL, Kim WY, Han HS, Lim SD, Kim WS, Yoo YB, Kim SK. Molecular Profiling of Papillary Thyroid Carcinoma in Korea with a High Prevalence of BRAF V600E Mutation. Thyroid 2017; 27:802-810. [PMID: 28293988 DOI: 10.1089/thy.2016.0547] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The BRAFV600E mutation in papillary thyroid carcinoma (PTC) is particularly prevalent in Korea, and a considerable number of wild-type BRAF PTCs harbor RAS mutations. In addition, subsets of other genetic alterations clearly exist, but their prevalence in the Korean population has not been well studied. Recent increased insight into noninvasive encapsulated follicular variant PTC has prompted endocrine pathologists to reclassify this entity as "noninvasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP). This study analyzed the genetic alterations among the histologic variants of PTC, including NIFTP. METHODS Mutations of the BRAF and RAS genes and rearrangement of the RET/PTC1, NTRK1, and ALK genes using 769 preoperative fine-needle aspiration specimens and resected PTCs were analyzed. RESULTS Molecular alterations were found in 687 (89.3%) of 769 PTCs. BRAFV600E mutation (80.8%) was the most frequent alteration, followed by RAS mutation and RET/PTC1, NTRK1, and ALK rearrangements (5.6%, 2.1%, 0.4%, and 0%, respectively). The low prevalence of NTRK1 fusions and the absence of an ALK fusion detected in Korea may also be attributed to the higher prevalence of the BRAFV600E mutation. There were significant differences in the frequency of the genetic alterations among the histologic variants of PTC. The prevalence of NIFTP in PTC was 2.7%, and among the NIFTPs, 28.6% and 57.1% harbored BRAF and RAS mutations, respectively. Clinicopathologic factors and mutational profiles between NIFTP and encapsulated follicular variant PTC with capsular invasion group were not significantly different. CONCLUSIONS Genetic alterations in PTC vary among its different histologic variants and seem to be different in each ethnic group.
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Affiliation(s)
- Seung Eun Lee
- 1 Department of Pathology, Konkuk University School of Medicine , Seoul, Korea
| | - Tae Sook Hwang
- 1 Department of Pathology, Konkuk University School of Medicine , Seoul, Korea
| | - Yoon-La Choi
- 2 Department of Pathology and Translational genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Wook Youn Kim
- 1 Department of Pathology, Konkuk University School of Medicine , Seoul, Korea
| | - Hye Seung Han
- 1 Department of Pathology, Konkuk University School of Medicine , Seoul, Korea
| | - So Dug Lim
- 1 Department of Pathology, Konkuk University School of Medicine , Seoul, Korea
| | - Wan-Seop Kim
- 1 Department of Pathology, Konkuk University School of Medicine , Seoul, Korea
| | - Young Bum Yoo
- 3 Department of Surgery, Konkuk University School of Medicine , Seoul, Korea
| | - Suk Kyeong Kim
- 4 Department of Internal Medicine, Konkuk University School of Medicine , Seoul, Korea
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18
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Comparison Between Real-Time PCR and Pyrosequencing for Detection of BRAF V600E Mutation in Thyroid Fine-Needle Aspirates. Appl Immunohistochem Mol Morphol 2017; 25:358-365. [DOI: 10.1097/pai.0000000000000308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Ko YS, Hwang TS, Kim JY, Choi YL, Lee SE, Han HS, Kim WS, Kim SK, Park KS. Diagnostic Limitation of Fine-Needle Aspiration (FNA) on Indeterminate Thyroid Nodules Can Be Partially Overcome by Preoperative Molecular Analysis: Assessment of RET/PTC1 Rearrangement in BRAF and RAS Wild-Type Routine Air-Dried FNA Specimens. Int J Mol Sci 2017; 18:ijms18040806. [PMID: 28417935 PMCID: PMC5412390 DOI: 10.3390/ijms18040806] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/28/2017] [Accepted: 04/07/2017] [Indexed: 01/21/2023] Open
Abstract
Molecular markers are helpful diagnostic tools, particularly for cytologically indeterminate thyroid nodules. Preoperative RET/PTC1 rearrangement analysis in BRAF and RAS wild-type indeterminate thyroid nodules would permit the formulation of an unambiguous surgical plan. Cycle threshold values according to the cell count for detection of the RET/PTC1 rearrangement by real-time reverse transcription-polymerase chain reaction (RT-PCR) using fresh and routine air-dried TPC1 cells were evaluated. The correlation of RET/PTC1 rearrangement between fine-needle aspiration (FNA) and paired formalin-fixed paraffin-embedded (FFPE) specimens was analyzed. RET/PTC1 rearrangements of 76 resected BRAF and RAS wild-type classical PTCs were also analyzed. Results of RT-PCR and the Nanostring were compared. When 100 fresh and air-dried TPC1 cells were used, expression of RET/PTC1 rearrangement was detectable after 35 and 33 PCR cycles, respectively. The results of RET/PTC1 rearrangement in 10 FNA and paired FFPE papillary thyroid carcinoma (PTC) specimens showed complete correlation. Twenty-nine (38.2%) of 76 BRAF and RAS wild-type classical PTCs had RET/PTC1 rearrangement. Comparison of RET/PTC1 rearrangement analysis between RT-PCR and the Nanostring showed moderate agreement with a κ value of 0.56 (p = 0.002). The RET/PTC1 rearrangement analysis by RT-PCR using routine air-dried FNA specimen was confirmed to be technically applicable. A significant proportion (38.2%) of the BRAF and RAS wild-type PTCs harbored RET/PTC1 rearrangements.
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Affiliation(s)
- Young Sin Ko
- Diagnostic Pathology Center, Seegene Medical Foundation, Seoul KS013, Korea.
- Molecular Genetics and Pathology, Department of Medicine, Graduate School of Konkuk University, Seoul KS013, Korea.
| | - Tae Sook Hwang
- Molecular Genetics and Pathology, Department of Medicine, Graduate School of Konkuk University, Seoul KS013, Korea.
- Department of Pathology, Konkuk University School of Medicine, Seoul KS013, Korea.
| | - Ja Yeon Kim
- Department of Pathology, Konkuk University School of Medicine, Seoul KS013, Korea.
| | - Yoon-La Choi
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul KS013, Korea.
| | - Seung Eun Lee
- Department of Pathology, Konkuk University Medical Center, Seoul KS013, Korea.
| | - Hye Seung Han
- Molecular Genetics and Pathology, Department of Medicine, Graduate School of Konkuk University, Seoul KS013, Korea.
- Department of Pathology, Konkuk University School of Medicine, Seoul KS013, Korea.
| | - Wan Seop Kim
- Molecular Genetics and Pathology, Department of Medicine, Graduate School of Konkuk University, Seoul KS013, Korea.
- Department of Pathology, Konkuk University School of Medicine, Seoul KS013, Korea.
| | - Suk Kyeong Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul KS013, Korea.
| | - Kyoung Sik Park
- Department of Surgery, Konkuk University School of Medicine, Seoul KS013, Korea.
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Rossi ED, Martini M, Bizzarro T, Schmitt F, Longatto-Filho A, Larocca LM. Somatic mutations in solid tumors: a spectrum at the service of diagnostic armamentarium or an indecipherable puzzle? The morphological eyes looking for BRAF and somatic molecular detections on cyto-histological samples. Oncotarget 2017; 8:3746-3760. [PMID: 27738305 PMCID: PMC5356915 DOI: 10.18632/oncotarget.12564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/03/2016] [Indexed: 12/12/2022] Open
Abstract
This review article deals with the analysis and the detection of the morphological features associated with somatic mutations, mostly BRAFV600E mutation, on both cytological and histological samples of carcinomas. Few authors demonstrated that some architectural and specific cellular findings (i.e. polygonal eosinophilic cells defined as "plump cells" and sickle-shaped nuclei) are able to predict BRAF V600E mutation in both cytological and histological samples of papillary thyroid carcinoma (PTC) as well as in other carcinomas. In the current review article we evaluated the first comprehensive analysis of the morphological prediction of BRAFV600E and other somatic mutations in different malignant lesions with the description of the possible mechanisms beneath these morphologic features. The detection of predictive morphological features, mostly on FNAC, may add helpful information to the stratification of the malignant risk and personalized management of cancers. Additionally, the knowledge of the molecular mechanism of different oncogenic drivers can lead to the organ-specific triaging selection of cases and can provide significant insight for targeted therapies in different malignant lesions.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, “Agostino Gemelli” School of Medicine, Rome, Italy
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, “Agostino Gemelli” School of Medicine, Rome, Italy
| | - Tommaso Bizzarro
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, “Agostino Gemelli” School of Medicine, Rome, Italy
| | - Fernando Schmitt
- Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal
- Department of Medicine and Pathology, Laboratoire National de Santé, Luxembourg
| | - Adhemar Longatto-Filho
- Department of Pathology, Laboratory of Medical Investigation, University of São Paulo School of Medicine, Brazil
- Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Molecular Oncology Research Center, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, “Agostino Gemelli” School of Medicine, Rome, Italy
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21
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Jang MH, Kim S, Hwang DY, Kim WY, Lim SD, Kim WS, Hwang TS, Han HS. BRAF-Mutated Colorectal Cancer Exhibits Distinct Clinicopathological Features from Wild-Type BRAF-Expressing Cancer Independent of the Microsatellite Instability Status. J Korean Med Sci 2017; 32:38-46. [PMID: 27914130 PMCID: PMC5143296 DOI: 10.3346/jkms.2017.32.1.38] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/15/2016] [Indexed: 12/21/2022] Open
Abstract
In patients with colorectal cancer (CRC), the BRAF V600E mutation has been reported to be associated with several clinicopathological features and poor survival. However, the prognostic implications of BRAF V600E mutation and the associated clinicopathological characteristics in CRCs remain controversial. Therefore, we reviewed various clinicopathological features, including BRAF status, in 349 primary CRCs and analyzed the relationship between BRAF status and various clinicopathological factors, including overall survival. Similar to previous studies conducted in Eastern countries, the incidence of the BRAF V600E mutation in the current study was relatively low (5.7%). BRAF-mutated CRC exhibits distinct clinicopathological features from wild-type BRAF-expressing cancer independent of the microsatellite instability (MSI) status. This mutation was significantly associated with a proximal tumor location (P = 0.002); mucinous, signet ring cell, and serrated tumor components (P < 0.001, P = 0.003, and P = 0.008, respectively); lymphovascular invasion (P = 0.004); a peritumoral lymphoid reaction (P = 0.009); tumor budding (P = 0.046); and peritoneal seeding (P = 0.012). In conclusion, the incidence of the BRAF V600E mutation was relatively low in this study. BRAF-mutated CRCs exhibited some clinicopathological features which were also frequently observed in MSI-H CRCs, such as a proximal location; mucinous, signet ring cell, and serrated components; and marked peritumoral lymphoid reactions.
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Affiliation(s)
- Min Hye Jang
- Department of Pathology, Konkuk University School of Medicine, Seoul, Korea
| | - Sehun Kim
- Department of Pathology, Konkuk University School of Medicine, Seoul, Korea
| | - Dae Yong Hwang
- Department of Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Wook Youn Kim
- Department of Pathology, Konkuk University School of Medicine, Seoul, Korea
| | - So Dug Lim
- Department of Pathology, Konkuk University School of Medicine, Seoul, Korea
| | - Wan Seop Kim
- Department of Pathology, Konkuk University School of Medicine, Seoul, Korea
| | - Tea Sook Hwang
- Department of Pathology, Konkuk University School of Medicine, Seoul, Korea
| | - Hye Seung Han
- Department of Pathology, Konkuk University School of Medicine, Seoul, Korea.
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22
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Min KW, Kim WS, Jang SJ, Choi YD, Chang S, Jung SH, Kim L, Roh MS, Lee CS, Shim JW, Kim MJ, Lee GK. MassARRAY, pyrosequencing, and PNA clamping for EGFR mutation detection in lung cancer tissue and cytological samples: a multicenter study. J Cancer Res Clin Oncol 2016; 142:2209-16. [PMID: 27535566 DOI: 10.1007/s00432-016-2211-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 07/25/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Testing for epidermal growth factor receptor (EGFR) mutation is an important process in the therapeutic plan of patients with lung cancer. Recently, MassARRAY, based on matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, has been shown to be a useful method for somatic mutation analysis with pyrosequencing and peptide nucleic acid clamping (PNAc). METHODS A total of 107 tissues and 67 cytological samples, which were confirmed to have lung adenocarcinoma at nine hospitals in Korea, were collected. Among the MassARRAY, pyrosequencing, and PNAc, the concordance rates and sensitivity of EGFR mutation detection were analyzed and validated in comparative tissue and cytological specimens. RESULTS The concordance rate between pyrosequencing and PNAc was higher than that between MassARRAY and either of the pyrosequencing and PNAc in both tissue and cytological samples. In a comparison of diagnostic performance, MassARRAY (sensitivity: 85.7 %) was higher than pyrosequencing (74.3 %) and PNAc (70 %) in tissue, although pyrosequencing (80.5 %) was more highly sensitive, compared to MassARRAY (70.7 %) and PNAc (70.7 %) in terms of cytology. Unexpectedly, use of MassARRAY resulted in a significantly different EGFR mutation detection rate between tissue and cytological samples. CONCLUSIONS When used for the detection of EGFR mutations, MassARRAY was more sensitive than pyrosequencing or PNA clamping in tissue, but not in cytological samples. In EGFR mutation detection between tissues and cytology, PNAc showed relatively higher concordance than MassARRAY or pyrosequencing.
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Affiliation(s)
- Kyueng-Whan Min
- Department of Pathology, Hanyang University Guri Hospital, Hanyang University College of Medicine, 153, Gyeongchun-ro, Guri-si, Gyeonggi-do, 11923, South Korea
| | - Wan-Seop Kim
- Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea.
| | - Se Jin Jang
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olymphic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Yoo Duk Choi
- Department of Pathology, Chonnam National University Hospital, Chonnam National University Medical School, 160, Baekseo-ro, Dong-gu, Gwangju, 61469, South Korea
| | - Sunhee Chang
- Department of Pathology, Inje Unversity Ilsan Paik Hospital, Inje University School of Medicine, 170, Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, 10380, South Korea
| | - Soon Hee Jung
- Department of Pathology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20, Ilsan-ro, Wonju-si, Gangwon-do, 26426, South Korea
| | - Lucia Kim
- Department of Pathology, Inha University Hospital, Inha University School of Medicine, 27, Inhang-ro, Jung-gu, Incheon, 22332, South Korea
| | - Mee-Sook Roh
- Department of Pathology, Dong-A University Hospital, Dong-A University College of Medicine, 26, Daesingongwon-ro, Seo-gu, Busan, 49201, South Korea
| | - Choong Sik Lee
- Department of Pathology, Chungnam National University Hospital, Chungnam National University College of Medicine, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Jung Weon Shim
- Department of Pathology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, South Korea
| | - Mi Jin Kim
- Department of Pathology, Yeungnam University Medical Center, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu, 42415, South Korea
| | - Geon Kook Lee
- Department of Pathology, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, South Korea
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23
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Kim SK, So Y, Chung HW, Yoo YB, Park KS, Hwang TS, Kim B, Lee WW. Analysis of predictability of F-18 fluorodeoxyglucose-PET/CT in the recurrence of papillary thyroid carcinoma. Cancer Med 2016; 5:2756-2762. [PMID: 27539659 PMCID: PMC5083728 DOI: 10.1002/cam4.867] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/22/2016] [Accepted: 07/25/2016] [Indexed: 11/19/2022] Open
Abstract
Whether preoperative F-18 fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) can predict recurrence of papillary thyroid carcinoma (PTC) remains unclear. Herein, we evaluated the potential of primary tumor FDG avidity for the prediction of tumor recurrence in PTC patients. A total of 412 PTC patients (72 males, 340 females; age: 47.2 ± 12.2 years; range: 17-84 years) who underwent FDG-PET/CT prior to total thyroidectomy (n = 350), subtotal thyroidectomy (n = 2), or lobectomy (n = 60) from 2007 to 2011 were analyzed. The predictive ability for recurrence was investigated among various clinicopathological factors, BRAFV600E mutation, and preoperative FDG avidity of the primary tumor using Kaplan-Meier (univariate) and Cox proportional hazards regression (multivariate) analyses. Of the 412 patients, 19 (4.6%) experienced recurrence, which was confirmed either by pathology (n = 17) or high serum thyroglobulin level (n = 2), during a mean follow-up period of 43.9 ± 16.6 months. Of the 412 patients, 237 (57.5%) had FDG-avid tumors (maximum standardized uptake value, 7.1 ± 7.0; range: 1.6-50.5). Kaplan-Meier analysis revealed that tumor size (P = 0.0054), FDG avidity of the tumor (P = 0.0049), extrathyroidal extension (P = 0.0212), and lymph node (LN) stage (P < 0.0001) were significant predictors for recurrence. However, only LN stage remained a significant predictor in the multivariate analysis (P < 0.0001). Patients with FDG-avid tumors had higher LN stage (P < 0.0001), larger tumor size (P < 0.0001), and more frequent extrathyroidal extension (P < 0.0001). In conclusion, FDG avidity of the primary tumor in preoperative FDG-PET/CT could not predict the recurrence of PTC. LN stage was the only identified predictor of PTC recurrence.
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Affiliation(s)
- Suk Kyeong Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Young So
- Department of Nuclear Medicine, Konkuk University School of Medicine, Seoul, Korea.
- Bioimaging Translational Open Innovation Center, Konkuk University School of Medicine, Seoul, Korea.
| | - Hyun Woo Chung
- Department of Nuclear Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Young Bum Yoo
- Department of Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Kyung Sik Park
- Department of Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Tae Sook Hwang
- Department of Pathology, Konkuk University School of Medicine, Seoul, Korea
| | - Bokyung Kim
- Bioimaging Translational Open Innovation Center, Konkuk University School of Medicine, Seoul, Korea
- Department of Physiology, Konkuk University School of Medicine, Seoul, Korea
| | - Won Woo Lee
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea
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24
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Kim SK, Park I, Hur N, Lee JH, Choe JH, Kim JH, Kim JS. Routine Level 2b Dissection may be Recommended Only in N1b Papillary Thyroid Carcinoma with Three- or Four-Level Lateral Lymph Node Metastasis. Ann Surg Oncol 2016; 23:694-700. [DOI: 10.1245/s10434-016-5521-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Indexed: 11/18/2022]
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Kim SK, Park I, Woo JW, Lee JH, Choe JH, Kim JH, Kim JS. Total thyroidectomy versus lobectomy in conventional papillary thyroid microcarcinoma: Analysis of 8,676 patients at a single institution. Surgery 2016; 161:485-492. [PMID: 27593085 DOI: 10.1016/j.surg.2016.07.037] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 07/19/2016] [Accepted: 07/27/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Because there is a controversy regarding the management of papillary thyroid microcarcinoma, the purpose of this study was to compare lobectomy with total thyroidectomy as a primary operative treatment for papillary thyroid microcarcinoma. Loco-regional recurrence in the contralateral remnant lobe can be managed safely by completion thyroidectomy via the previous scar. However, reoperation for operation bed (thyroidectomy site) or regional lymph node (central or lateral) recurrence generally is associated with morbidity. Therefore, we analyzed overall loco-regional recurrence and loco-regional recurrence outside of the contralateral remnant lobe separately. METHODS We retrospectively reviewed 8,676 conventional patients with papillary thyroid microcarcinoma who underwent thyroidectomy. RESULTS Lobectomy was performed in 3,289 (37.9%) patients, and total thyroidectomy was performed in 5,387 (62.1%) patients. Total thyroidectomy significantly decreased the risk of overall loco-regional recurrence (adjusted hazard ratio 0.398, P < .001). However, total thyroidectomy did not significantly decrease the risk of loco-regional recurrence outside of the contralateral remnant lobe (adjusted hazard ratio 0.880, P = .640). Particularly in conventional papillary thyroid microcarcinoma patients with multifocality, total thyroidectomy significantly decreased the risk of overall loco-regional recurrence (adjusted hazard ratio 0.284, P = .002) and loco-regional recurrence outside of the contralateral remnant lobe (adjusted hazard ratio 0.342, P = .020). CONCLUSION Although lobectomy is associated with contralateral remnant lobe recurrence, lobectomy did not increase the risk of loco-regional recurrence outside of the contralateral remnant lobe in patients with papillary thyroid microcarcinoma, except in those with multifocality. Because recurrence in the contralateral remnant lobe can be managed safely by completion thyroidectomy, lobectomy may be a safe operative option for select patients with papillary thyroid microcarcinoma without multifocality.
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Affiliation(s)
- Seo Ki Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Inhye Park
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung-Woo Woo
- Department of Surgery, Changwon Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Changwon, South Korea
| | - Jun Ho Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Jun-Ho Choe
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung-Han Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jee Soo Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Lee SE, Hwang TS, Choi YL, Han HS, Kim WS, Jang MH, Kim SK, Yang JH. Prognostic Significance of TERT Promoter Mutations in Papillary Thyroid Carcinomas in a BRAF(V600E) Mutation-Prevalent Population. Thyroid 2016; 26:901-10. [PMID: 27184112 DOI: 10.1089/thy.2015.0488] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The role of telomerase reverse transcriptase (TERT) promoter mutations in differentiated thyroid cancer has been well established. These mutations have a significantly higher prevalence in aggressive thyroid tumors, including widely invasive oncocytic carcinomas, poorly differentiated carcinomas, and anaplastic thyroid carcinomas. Interestingly, in some studies, TERT mutations were found to be more common in tumors with a BRAF(V600E) mutation. However, mutational analysis of TERT promoter mutations in thyroid tumors has not been previously performed for patients in Korea, where the BRAF(V600E) mutation in papillary thyroid carcinoma (PTC) is particularly prevalent. This study analyzed TERT promoter mutations in various thyroid tumors and examined their relationship with clinicopathologic factors and the BRAF(V600E) mutation in PTC cases. METHODS Using 242 preoperative fine-needle aspiration biopsy specimens (including 207 PTCs) with confirmed histopathological diagnosis of the biopsied thyroid nodules, the TERT promoter status (C228T and C250T) was analyzed, and the relationship with clinicopathologic factors and the BRAF(V600E) mutation in PTC cases was examined. RESULTS Of 242 patients, 14.5% (30/207), 26.7% (4/15), 50% (1/2), and 60% (2/5) of PTCs, follicular thyroid carcinomas, poorly differentiated carcinomas, and anaplastic thyroid carcinomas harbored a TERT(C228T) mutation, respectively. The TERT(C228T) mutation was associated with recurrence (p = 0.03). However, no association with other clinicopathologic factors in PTC was found. Coexistence of TERT(C228T) and BRAF(V600E) mutations was found in 13.0% of PTCs and was significantly associated with older age and advanced stage compared with the group negative for either mutation. The TERT(C228T) mutation status was an independent prognostic factor for recurrence-free survival (hazard ratio = 3.08 [confidence interval 1.042-9.079]; p = 0.042) in patients with PTC in multivariate analysis. CONCLUSIONS Identification of TERT promoter mutations in preoperative fine-needle aspiration biopsy specimens may help in better characterizing the prognosis and triaging thyroid cancer patients for appropriate treatment.
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Affiliation(s)
- Seung Eun Lee
- 1 Department of Pathology, Konkuk University School of Medicine , Seoul, Korea
| | - Tae Sook Hwang
- 1 Department of Pathology, Konkuk University School of Medicine , Seoul, Korea
| | - Yoon-La Choi
- 4 Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Hye Seung Han
- 1 Department of Pathology, Konkuk University School of Medicine , Seoul, Korea
| | - Wan Seop Kim
- 1 Department of Pathology, Konkuk University School of Medicine , Seoul, Korea
| | - Min Hye Jang
- 1 Department of Pathology, Konkuk University School of Medicine , Seoul, Korea
| | - Suk Kyeong Kim
- 2 Department of Internal Medicine, Konkuk University School of Medicine , Seoul, Korea
| | - Jung Hyun Yang
- 3 Department of Surgery, Konkuk University School of Medicine , Seoul, Korea
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27
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Rossi ED, Bizzarro T, Martini M, Capodimonti S, Cenci T, Fadda G, Schmitt F, Larocca LM. Morphological features that can predict BRAF V600E -mutated carcinoma in paediatric thyroid cytology. Cytopathology 2016; 28:55-64. [PMID: 27256275 DOI: 10.1111/cyt.12350] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE BRAFV600E represents the most common diagnostic marker in papillary thyroid carcinoma (PTC). A few papers have demonstrated the correlation between BRAFV600E and specific morphological findings on PTCs in the adult population. This is the first reported series investigating cytological morphological parameters in paediatric thyroid carcinoma. METHODS One hundred and nineteen paediatric samples (56 male and 63 female patients), diagnosed in the period between April 2013 and July 2015, were enrolled in the study. Fifteen patients with inadequate results were excluded. Cytological cases were processed with liquid-based cytology (LBC). BRAFV600E and immunocytochemistry for the VE1 antibody were performed on LBC. RESULTS The diagnostic series included 10 mutated and 94 wild-type (WT) cases. Twenty two percent surgical samples showed 96% cytohistological concordance. The morphological analysis revealed plump cells (abundant eosinophilic cytoplasm and PTC nuclei) in all 10 mutated cases with only four cases showing a focal (less than 20% of the cells) plump component. None of the WT showed plump cells. A sickle nuclear shape was seen only in the mutated cases. VE1 yielded 100% positivity on mutated cases with three cytohistological discrepancies. CONCLUSIONS The BRAFV600E mutation is also seen in paediatric cytology and the morphological features showed a high accuracy as both predictive mutational parameters and a helpful aid in management mainly of the aggressive BRAFV600E mutated carcinomas.
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Affiliation(s)
- E D Rossi
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - T Bizzarro
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - M Martini
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - S Capodimonti
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - T Cenci
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - G Fadda
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - F Schmitt
- Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal.,Laboratorie National de Sante, Dudelange, Luxembourg
| | - L M Larocca
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
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Kim SK, Woo JW, Park I, Lee JH, Choe JH, Kim JH, Kim JS. Influence of Body Mass Index and Body Surface Area on the Behavior of Papillary Thyroid Carcinoma. Thyroid 2016; 26:657-66. [PMID: 26959390 DOI: 10.1089/thy.2015.0632] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Previous studies have examined the relationship between body mass index (BMI) and the behavior of papillary thyroid carcinomas (PTC). However, the results are inconsistent. The purpose of this study was to clarify the association between PTC behavior and anthropometric parameters including BMI and body surface area (BSA). METHODS This study retrospectively reviewed 5081 PTC patients who underwent total thyroidectomy with bilateral central neck dissection between January 2002 and June 2015. Because of sexual dimorphism in obesity, analyses were conducted separately for men and women. The World Health Organization BMI classification was used to classify patients as normal (18.5 ≤ BMI <25 kg/m(2)), overweight (25 ≤ BMI <30 kg/m(2)), or obese (BMI ≥30 kg/m(2)). Since no consensus for BSA categorization exists, enrolled patients were grouped into BSA quartiles by sex: women BSA1 (BSA <1.52 m(2)), BSA2 (1.52 ≤ BSA <1.59 m(2)), BSA3 (1.59 ≤ BSA <1.67 m(2)), and BSA4 (BSA ≥1.67 m(2)); and men BSA1 (BSA <1.77 m(2)), BSA2 (1.77 ≤ BSA <1.86 m(2)), BSA3 (1.86 ≤ BSA <1.96 m(2)), and BSA4 (BSA ≥1.96 m(2)). RESULTS In women, overweight (adjusted odds ratio [OR] = 1.187, p = 0.042) and obese (adjusted OR = 2.231, p < 0.001) were independent predictors for multiplicity. Furthermore, overweight (adjusted OR = 1.237, p = 0.012) and obese (adjusted OR = 1.789, p = 0.005) were independent predictors for extrathyroidal extension (ETE). However, higher BMI was not an independent predictor for bilaterality or central lymph node metastasis (CLNM). In addition, higher BSA-BSA3 (adjusted OR = 1.205, p = 0.049) and BSA4 (adjusted OR = 1.524, p < 0.001)-was an independent predictor for multiplicity. However, higher BSA was not a predictor for bilaterality, ETE, or CLNM. In men, higher BMI and BSA were not predictors for multiplicity, bilaterality, ETE, or CLNM. CONCLUSIONS In women with PTC, higher BMI was an independent predictor for multiplicity and ETE. Furthermore, higher BSA was an independent predictor for multiplicity. However, BMI and BSA were not predictors for the PTC behavior in men.
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Affiliation(s)
- Seo Ki Kim
- 1 Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
| | - Jung-Woo Woo
- 2 Department of Surgery, Changwon Gyeongsang National University Hospital, Gyeongsang National University School of Medicine , Changwon, South Korea
| | - Inhye Park
- 1 Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
| | - Jun Ho Lee
- 3 Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine , Changwon, South Korea
| | - Jun-Ho Choe
- 1 Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
| | - Jung-Han Kim
- 1 Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
| | - Jee Soo Kim
- 1 Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
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Su X, Jiang X, Xu X, Wang W, Teng X, Shao A, Teng L. Diagnostic value of BRAF (V600E)-mutation analysis in fine-needle aspiration of thyroid nodules: a meta-analysis. Onco Targets Ther 2016; 9:2495-509. [PMID: 27175084 PMCID: PMC4854268 DOI: 10.2147/ott.s101800] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Fine-needle aspiration (FNA) is a reliable method for preoperative diagnosis of thyroid nodules; however, about 10%–40% nodules are classified as indeterminate. The BRAFV600E mutation is the most promising marker for thyroid FNA. This meta-analysis was conducted to investigate the diagnostic value of BRAFV600E analysis in thyroid FNA, especially the indeterminate cases. Systematic searches were performed in PubMed, Web of Science, Scopus, Ovid, Elsevier, and the Cochrane Library databases for relevant studies prior to June 2015, and a total of 88 studies were ultimately included in this meta-analysis. Compared with FNA cytology, the synergism of BRAFV600E testing increased the diagnostic sensitivity from 81.4% to 87.4% and decreased the false-negative rate from 8% to 5.2%. In the indeterminate group, the mutation rate of BRAFV600E was 23% and varied in different subcategories (43.2% in suspicious for malignant cells [SMC], 13.77% in atypia of undetermined significance/follicular lesion of undetermined significance [AUS/FLUS], and 4.43% in follicular neoplasm/suspicious for follicular neoplasm [FN/SFN]). The sensitivity of BRAFV600E analysis was higher in SMC than that in AUS/FLUS and FN/SFN cases (59.4% vs 40.1% vs 19.5% respectively), while specificity was opposite (86.1% vs 99.5% vs 99.7% respectively). The areas under the summary receiver-operating characteristic curve also confirmed the diagnostic value of BRAFV600E testing in SMC and AUS/FLUS rather than FN/SFN cases. Therefore, BRAFV600E analysis can improve the diagnostic accuracy of thyroid FNA, especially indeterminate cases classified as SMC, and select malignancy to guide the extent of surgery.
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Affiliation(s)
- Xingyun Su
- Department of Surgical Oncology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Xiaoxia Jiang
- Department of Surgical Oncology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Xin Xu
- Department of Surgical Oncology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Weibin Wang
- Department of Surgical Oncology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Xiaodong Teng
- Department of Pathology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Anwen Shao
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Lisong Teng
- Department of Surgical Oncology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
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Kim SK, Park I, Woo JW, Lee JH, Choe JH, Kim JH, Kim JS. Predictive Factors for Lymph Node Metastasis in Papillary Thyroid Microcarcinoma. Ann Surg Oncol 2016; 23:2866-73. [PMID: 27075321 DOI: 10.1245/s10434-016-5225-0] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Because lymph node (LN) metastasis has been proven to be a predictor for locoregional recurrence (LRR) in papillary thyroid microcarcinoma (PTMC), better knowledge about the predictors for LN metastasis in PTMC is required. METHODS We retrospectively reviewed 5656 PTMC patients who underwent total thyroidectomy and central neck dissection and/or lateral neck dissection between January 1997 and June 2015. RESULTS Male gender (adjusted odds ratio [OR] 2.332), conventional variant (adjusted OR 4.266), tumor size >0.5 cm (adjusted OR 1.753), multiplicity (adjusted OR 1.168), bilaterality (adjusted OR 1.177), and extrathyroidal extension (ETE) (adjusted OR 1.448) were independent predictors for high prevalence of central LN metastasis (CLNM), whereas per 10-year age increment (adjusted OR 0.760) and chronic lymphocytic thyroiditis (adjusted OR 0.791) were independent predictors for low prevalence of CLNM. In addition, male gender (adjusted OR 1.489), tumor size >0.5 cm (adjusted OR 1.295), multiplicity (adjusted OR 1.801), ETE (adjusted OR 1.659), and CLNM (adjusted OR 4.359) were independent predictors for high prevalence of lateral LN metastasis (LLNM), whereas per 10-year age increment (adjusted OR 0.838) was an independent predictor for low prevalence of LLNM. There was a statistically significant difference in LRR with regard to nodal stage (p < 0.001). CONCLUSIONS Meticulous perioperative evaluation of LN metastasis is required for PTMC patients with the above predictors.
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Affiliation(s)
- Seo Ki Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Inhye Park
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung-Woo Woo
- Department of Surgery, Changwon Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Changwon, South Korea
| | - Jun Ho Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Jun-Ho Choe
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung-Han Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jee Soo Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Choi SH, Baek JH, Lee JH, Choi YJ, Ha EJ, Song DE, Kim JK, Chung KW, Kim TY, Kim WB, Shong YK. Initial clinical experience with BRAF(V600E) mutation analysis of core-needle biopsy specimens from thyroid nodules. Clin Endocrinol (Oxf) 2016. [PMID: 26215382 DOI: 10.1111/cen.12866] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The accurate diagnosis of thyroid nodules is important for making management decisions. The purpose of this study was to evaluate the feasibility of core-needle biopsy with BRAF(V600E) mutation analysis (CNB + BRAF(V600E) ) and to compare the clinical usefulness of CNB + BRAF(V600E) and fine-needle aspiration with BRAF(V600E) mutation analysis (FNA + BRAF(V600E) ) in the diagnosis of thyroid malignancy. DESIGN, PATIENTS AND MEASUREMENTS The results of BRAF(V600E) mutation analyses of 820 nodules from 820 patients (153 men, 667 women; mean age, 51·1 years), who underwent CNB + BRAF(V600E) (n = 256) or FNA + BRAF(V600E) (n = 564) between January 2011 and March 2012 were retrospectively evaluated. The feasibility of CNB + BRAF(V600E) was assessed by comparing its rate of detection of BRAF(V600E) mutations and positive predictive value with those of FNA + BRAF(V600E) . The clinical usefulness of CNB + BRAF(V600E) was determined by comparing rates of inconclusive results, the additional value of BRAF(V600E) mutation analysis, diagnostic surgery and diagnostic performance with those of FNA + BRAF(V600E) . RESULTS CNB + BRAF(V600E) and FNA + BRAF(V600E) had similar rates of BRAF(V600E) mutation detection (66·3% vs 64·4%, P = 0·883) and positive predictive value (100·0% vs 96·6%, P = 0·135). CNB + BRAF(V600E) had a significantly higher diagnostic accuracy rate (95·7% vs 85·9%, P < 0·001), and significantly lower rates of inconclusive results (8·2% vs 51·8%, P < 0·001), and diagnostic surgery (8·9% vs 22·3%, P = 0·006), than FNA + BRAF(V600E) . CONCLUSIONS The greater diagnostic performance of CNB + BRAF(V600E) and its lower rate of inconclusive results than FNA + BRAF(V600E) suggest that CNB + BRAF(V600E) can reduce rates of preventable diagnostic surgery.
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Affiliation(s)
- Sang Hyun Choi
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Young Jun Choi
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Eun Ju Ha
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
- Department of Radiology, Ajou University School of Medicine, Yeongtong-Gu, Suwon, Korea
| | - Dong Eun Song
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Jae Kyun Kim
- Department of Radiology, Chung-Ang University College of Medicine, Dongjak-gu, Seoul, Korea
| | - Ki-Wook Chung
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Tae Yong Kim
- Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Won Bae Kim
- Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Young Kee Shong
- Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
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Min KW, Kim WS, Jang SJ, Choi YD, Chang S, Jung SH, Kim L, Roh MS, Lee CS, Shim JW, Kim MJ, Lee GK. Comparison of EGFR mutation detection between the tissue and cytology using direct sequencing, pyrosequencing and peptide nucleic acid clamping in lung adenocarcinoma: Korean multicentre study. QJM 2016; 109:167-73. [PMID: 26031706 DOI: 10.1093/qjmed/hcv103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The importance of sensitive methods for the detection of epidermal growth factor receptor (EGFR) mutation is emphasized. The aim of this study is to perform comparative and concordance analyses of direct sequencing, pyrosequencing and peptide nucleic acid (PNA) clamping for detecting EGFR gene mutations using archived tissue and cytology specimens. METHODS Samples from a total of 112 cases, which were diagnosed with adenocarcinoma of the lung at nine hospitals in Korea were collected. Using the above three methods, the concordance rates of EGFR mutations in exons 18, 19, 20 and 21 were analysed and validated in comparative tissue and cytology specimens. RESULTS Comparison of EGFR mutation detection between the tissue and cytology had a high concordance rate. The diagnostic performance of pyrosequencing and PNA clamping in tissue was higher than that of direct sequencing as well as cytology. Additionally, among some of the patients who had EGFR wild type by single method, EGFR mutations were detected by other methods. Cytology specimens had a diagnostic performance for the detection of EGFR mutations. CONCLUSIONS Cytology specimens had a diagnostic performance for the detection of EGFR mutations that was comparable to that of tissues. For detecting EGFR mutations, pyrosequencing or PNA clamping was more sensitive than direct sequencing. In EGFR mutation negative patients who are difficult to obtain tissue, repeating test using pyrosequencing or PNA clamping is recommended to improve the detection rate of EGFR mutation than only one, especially in cytology.
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Affiliation(s)
- Kyueng-Whan Min
- From the Department of Pathology, Konkuk University School of Medicine, Seoul
| | - Wan-Seop Kim
- From the Department of Pathology, Konkuk University School of Medicine, Seoul,
| | - Se Jin Jang
- Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Yoo Duk Choi
- Chonnam National University Medical School, Gwangju
| | | | | | - Lucia Kim
- Inha University School of Medicine, Incheon
| | | | - Choong Sik Lee
- Chungnam National University College of Medicine, Daejeon
| | | | - Mi Jin Kim
- Yeungnam University College of Medicine, Daegu, and
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Kim SK, Woo JW, Lee JH, Park I, Choe JH, Kim JH, Kim JS. Prophylactic Central Neck Dissection Might Not Be Necessary in Papillary Thyroid Carcinoma: Analysis of 11,569 Cases from a Single Institution. J Am Coll Surg 2016; 222:853-64. [PMID: 27113516 DOI: 10.1016/j.jamcollsurg.2016.02.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/01/2016] [Accepted: 02/02/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND The benefits of prophylactic central neck dissection (pCND) remain controversial in clinically node-negative (cN0) papillary thyroid carcinoma (PTC). The purpose of this study was to investigate the clinical impact of pCND with a large group of cN0 PTC patients. STUDY DESIGN A total of 11,569 cN0 PTC patients who underwent thyroidectomy between January 1997 and June 2015 were investigated. Using Cox multivariate analysis, the prognostic impact of pCND was assessed using subset analyses according to various clinicopathologic conditions. Using propensity score matching, various surgical morbidities were assessed under adjusted conditions. RESULTS Of 11,569 cN0 PTC patients, 8,735 (75.5%) underwent pCND. Prophylactic CND did not significantly decrease the risk of locoregional recurrence in cN0 PTC patients (adjusted hazard ratio [HR] = 0.874; p = 0.392). In addition, pCND did not significantly decrease the risk of locoregional recurrence in various surgical extents (lobectomy and ipsilateral pCND [adjusted HR = 0.636; p = 0.131], total thyroidectomy and ipsilateral pCND [adjusted HR = 0.775; p = 0.164], and total thyroidectomy and bilateral pCND [adjusted HR = 1.041; p = 0.821]). However, surgical morbidities, such as temporary vocal cord palsy (5.6% vs 2.5%; p = 0.001), temporary hypoparathyroidism (30.8% vs 16.7%; p < 0.001), and permanent hypoparathyroidism (3.5% vs 1.7%; p < 0.001) were significantly more frequent in the pCND(+) group. CONCLUSIONS Given the lack of proven benefits and the clear evidence of morbidities, pCND cannot be recommended as a routine procedure. We suggest that CND be reserved for therapeutic situations.
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Affiliation(s)
- Seo Ki Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung-Woo Woo
- Department of Surgery, Changwon Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Changwon, South Korea
| | - Jun Ho Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Inhye Park
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jun-Ho Choe
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung-Han Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jee Soo Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Wang Z, Chen JQ, Liu JL, Qin XG. Clinical impact of BRAF mutation on the diagnosis and prognosis of papillary thyroid carcinoma: a systematic review and meta-analysis. Eur J Clin Invest 2016; 46:146-157. [PMID: 26648183 DOI: 10.1111/eci.12577] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 11/29/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND The possible role of BRAF(V) (600E) mutation in the diagnosis and prognosis of papillary thyroid carcinoma (PTC) remains controversial. A systematic review to investigate the diagnostic and prognostic role of BRAF(V) (600E) mutation in patients with PTC is urgently needed. METHODS A systematic review of relevant literatures was performed in PubMed, EMBASE and CENTRAL. The incremental accuracy (IA) of fine needle aspiration biopsy plus BRAF(V) (600E) mutation analysis over fine needle aspiration biopsy alone, and the statistical data about the association of BRAF(V) (600E) mutation and the prognosis of PTC (risk ratios (RR) for dichotomous data, standard mean differences for continuous data and hazard ratios (HRs) for disease-free survival (DFS) were pooled. Subgroup analysis was performed to explain the heterogeneities. RESULTS A total of 67 studies were included. The pooled IA was 2% (95% confidence interval (CI): 0·5-4%). The pooled RR for gender, multifocality, lymph node metastasis, extrathyroidal invasion and pathological stage was 1·11 (95% CI: 0·98-1·25), 1·17 (95% CI: 1·09-1·24), 1·36 (95% CI: 1·20-1·53), 1·60 (95% CI: 1·41-1·82), and 1·49 (95% CI: 1·33-1·68), respectively. The pooled standard mean differences for age and tumour size were 0·14 (95% CI: 0·04-0·23) and 0·21 (95% CI: 0·1-0·32), respectively. The pooled HR for DFS was 1·96 (95% CI: 1·62-2·37). Subgroup analysis showed that these statistical results were affected by the geographical background of patients, study design and detection methods. CONCLUSIONS BRAF(V) (600E) mutation analysis can not only be used in the diagnosis of PTC, but can also predict its prognosis.
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Affiliation(s)
- Zhen Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jun-Qiang Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jin-Lu Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xin-Gan Qin
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Kim WY, Oh SY, Kim H, Hwang TS. DNA degradation in liquid-based cytology and its comparison with conventional smear. Diagn Cytopathol 2016; 44:450-8. [PMID: 26801351 DOI: 10.1002/dc.23441] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 12/04/2015] [Accepted: 01/06/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND In fine needle aspiration biopsy (FNAB) of thyroid nodules, LBC is adopted in most of the hospitals and clinics in Korea for its convenience. BRAF mutation test has been introduced as an important ancillary test, but its applicability has not been completely proven with LBC samples. METHODS Five aspirates from thyroidectomy specimens were simultaneously processed into LBC and CS slides, in which BRAF mutation tests were performed using three primer sets with PCR products of 72, 164, and 226 base pairs (bp) at 6, 9, and 12 months after processing. In addition, BRAF mutation tests were performed in nine clinical samples that had been prepared by LBC or CS and stored for 3-5 years after processing. RESULTS At 9 months after processing, LBC failed to provide DNA of sufficient quality for PCR, whereas CS succeeded with primers for amplifying a 226 bp fragment. Furthermore, CS had successful amplification of DNA despite a delay of more than 1 year. The failure of DNA amplification in LBC was overcome by using primers to amplify shorter PCR products, suggesting that DNA degradation occurred in LBC. However, false positive or negative results were observed in primers for amplifying shorter size. The kind of preservative solutions used in LBC did not affect test results. CONCLUSION LBC may have disadvantages in long-term DNA preservation because of its accelerated DNA degradation compared with alcohol-fixed CS. Using primers to amplify shorter size fragments might be helpful in mitigating loss of signal due to DNA degradation in LBC.
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Affiliation(s)
- Wook Youn Kim
- Department of Pathology, the Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Seo Young Oh
- Department of Pathology, Konkuk University Medical Center, Seoul, Korea
| | - Hyunkyung Kim
- Department of Pathology, the Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Tae Sook Hwang
- Department of Pathology, the Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
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Role of BRAF V600E mutation as an indicator of the extent of thyroidectomy and lymph node dissection in conventional papillary thyroid carcinoma. Surgery 2015; 158:1500-11. [DOI: 10.1016/j.surg.2015.05.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/24/2015] [Accepted: 05/26/2015] [Indexed: 12/15/2022]
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Zhou L, Patel KN. The management of thyroid nodules and cancer in the molecular era. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2015. [DOI: 10.2217/ije.15.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The incidence of thyroid cancer is increasing worldwide. Current standards in the diagnosis and management of thyroid cancer are limited by the uncertainty of fine-needle aspiration samples that are indeterminate in nature. Molecular markers have the potential to improve the accuracy of thyroid fine-needle aspiration and to aid the physician in giving a more accurate diagnosis and prognosis. This paper summarizes the various molecular markers currently available.
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Affiliation(s)
- Ling Zhou
- Division of Endocrine Surgery, Department of Surgery, Biochemistry & Otolaryngology, Thyroid Cancer Interdisciplinary Program, NYU Langone Medical Center, 530 First Avenue, Suite 6H, NY 10016, USA
| | - Kepal N Patel
- Division of Endocrine Surgery, Department of Surgery, Biochemistry & Otolaryngology, Thyroid Cancer Interdisciplinary Program, NYU Langone Medical Center, 530 First Avenue, Suite 6H, NY 10016, USA
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Lee SH, Kim WS, Choi YD, Seo JW, Han JH, Kim MJ, Kim L, Lee GK, Lee CH, Oh MH, Kim GY, Sung SH, Lee KY, Chang SH, Rho MS, Kim HK, Jung SH, Jang SJ. Analysis of Mutations in Epidermal Growth Factor Receptor Gene in Korean Patients with Non-small Cell Lung Cancer: Summary of a Nationwide Survey. J Pathol Transl Med 2015; 49:481-8. [PMID: 26459407 PMCID: PMC4696529 DOI: 10.4132/jptm.2015.09.14] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 09/13/2015] [Accepted: 09/14/2015] [Indexed: 11/17/2022] Open
Abstract
Background: Analysis of mutations in the epidermal growth factor receptor gene (EGFR) is important for predicting response to EGFR tyrosine kinase inhibitors. The overall rate of EGFR mutations in Korean patients is variable. To obtain comprehensive data on the status of EGFR mutations in Korean patients with lung cancer, the Cardiopulmonary Pathology Study Group of the Korean Society of Pathologists initiated a nationwide survey. Methods: We obtained 1,753 reports on EGFR mutations in patients with lung cancer from 15 hospitals between January and December 2009. We compared EGFR mutations with patient age, sex, history of smoking, histologic diagnosis, specimen type, procurement site, tumor cell dissection, and laboratory status. Results: The overall EGFR mutation rate was 34.3% in patients with non-small cell lung cancer (NSCLC) and 43.3% in patients with adenocarcinoma. EGFR mutation rate was significantly higher in women, never smokers, patients with adenocarcinoma, and patients who had undergone excisional biopsy. EGFR mutation rates did not differ with respect to patient age or procurement site among patients with NSCLC. Conclusions EGFR mutation rates and statuses were similar to those in published data from other East Asian countries.
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Affiliation(s)
- Sang Hwa Lee
- Department of Pathology, Konkuk University School of Medicine, Seoul, Korea
| | - Wan Seop Kim
- Department of Pathology, Konkuk University School of Medicine, Seoul, Korea
| | - Yoo Duk Choi
- Chonnam National University Medical School, Gwangju, Korea
| | - Jeong Wook Seo
- Seoul National University College of Medicine, Seoul, Korea
| | - Joung Ho Han
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Jin Kim
- Yeungnam University College of Medicine, Daegu, Korea
| | - Lucia Kim
- Inha University College of Medicine, Incheon, Korea
| | | | - Chang Hun Lee
- Busan National University School of Medicine, Busan, Korea
| | - Mee Hye Oh
- Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Gou Young Kim
- Kyung Hee University School of Medicine, Seoul, Korea
| | - Sun Hee Sung
- Ewha Womans University School of Medicine, Seoul, Korea
| | - Kyo Young Lee
- Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | | | - Mee Sook Rho
- Dong-A University College of Medicine, Busan, Korea
| | | | - Soon Hee Jung
- Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Se Jin Jang
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Fnais N, Soobiah C, AL-Qahtani K, Hamid JS, Perrier L, Straus SE, Tricco AC. Diagnostic value of fine needle aspiration BRAFV600E mutation analysis in papillary thyroid cancer: a systematic review and meta-analysis. Hum Pathol 2015; 46:1443-54. [DOI: 10.1016/j.humpath.2015.06.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 05/20/2015] [Accepted: 06/03/2015] [Indexed: 01/15/2023]
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Kim SK, Lee JH, Woo JW, Park I, Choe JH, Kim JH, Kim JS. BRAF V600E mutation: Differential impact on central lymph node metastasis by tumor size in papillary thyroid carcinoma. Head Neck 2015; 38 Suppl 1:E1203-9. [PMID: 26268700 DOI: 10.1002/hed.24192] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/17/2015] [Accepted: 07/03/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The necessity of prophylactic central neck dissection is one of debating issues in the treatment of papillary thyroid carcinoma (PTC). In a previous study, the predictive value of BRAF mutation for lymph node metastasis was only significant in 0.5 to 1.0 cm PTC. Thus, we assess the predictive value of BRAF mutation for central lymph node metastasis according to tumor size. METHODS Medical records of 3107 patients with PTC who underwent thyroidectomy with central neck dissection were retrospectively reviewed. RESULTS BRAF mutation was a predictor for central lymph node metastasis in 2.0 to 4.0 cm PTC (odds ratio [OR] = 3.494; p = .002). Although BRAF mutation was associated with central lymph node metastasis in 0.5 to 1.0 cm PTC in univariate analysis (OR = 1.334; p = .047), this significance was not observed in multivariate analysis (OR = 1.232; p = .163). BRAF mutation was not associated with central lymph node metastasis in other tumor sizes. CONCLUSION Prophylactic central neck dissection could be considered in 2.0 to 4.0 cm PTC with positive BRAF mutation. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1203-E1209, 2016.
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Affiliation(s)
- Seo Ki Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jun Ho Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Jung-Woo Woo
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Inhye Park
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jun-Ho Choe
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung-Han Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jee Soo Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Choi SH, Baek JH, Lee JH, Choi YJ, Song DE, Chung KW, Kim TY, Shong YK. Evaluation of the Clinical Usefulness of BRAFV600E Mutation Analysis of Core-Needle Biopsy Specimens in Thyroid Nodules with Previous Atypia of Undetermined Significance or Follicular Lesions of Undetermined Significance Results. Thyroid 2015; 25:897-903. [PMID: 25978151 DOI: 10.1089/thy.2014.0606] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND The accurate diagnosis of thyroid nodules is important for making management decisions. The purpose of this study is to evaluate the clinical usefulness of BRAF(V600E) mutation analysis with core-needle biopsy (CNB+BRAF(V600E)) in thyroid nodules with previous atypia of undetermined significance (AUS) or follicular lesions of undetermined significance (FLUS) results. MATERIALS AND METHODS From January 2011 to December 2012, 590 CNB+BRAF(V600E) mutation analyses were performed. We analyzed 200 nodules from 200 patients with previous AUS/FLUS results (22 men, 178 women; mean age, 48.6 years). The clinical usefulness of CNB+BRAF(V600E) was assessed by comparing the rates of conclusive results, the additional value of BRAF(V600E) mutation analysis, diagnostic performances, and therapeutic/diagnostic surgery results with those of CNB alone. For the subgroup analysis, the study patients were divided into those with nodules with previous AUS results and those with previous FLUS results. RESULTS All CNB+BRAF(V600E) procedures were well-tolerated. CNB+BRAF(V600E) did not show significantly better diagnostic performance than CNB alone in thyroid nodules with previous AUS/FLUS results. However, the conclusive result rate of CNB+BRAF(V600E) was improved in thyroid nodules with previous AUS/FLUS results (76.5% vs. 73.0%, p=0.016), especially with previous AUS results (81.1% vs. 76.4%, p=0.031). Of the 56 previous AUS result thyroid nodules with surgical management, BRAF(V600E) mutation analysis led to therapeutic surgery in 5.4% by decreasing unnecessary diagnostic surgery. CONCLUSIONS In general, CNB+BRAF(V600E) did not show significantly higher diagnostic accuracy than CNB alone. Although CNB+BRAF(V600E) may add additional value in nodules with previous AUS results, routinely adding BRAF(V600E) mutation analysis to CNB is not recommended.
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Affiliation(s)
- Sang Hyun Choi
- 1 Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine , Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Jung Hwan Baek
- 1 Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine , Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Jeong Hyun Lee
- 1 Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine , Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Young Jun Choi
- 1 Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine , Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Dong Eun Song
- 2 Department of Pathology, University of Ulsan College of Medicine , Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Ki-Wook Chung
- 3 Department of Surgery, University of Ulsan College of Medicine , Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Tae Yong Kim
- 4 Department of Endocrinology and Metabolism, University of Ulsan College of Medicine , Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Young Kee Shong
- 4 Department of Endocrinology and Metabolism, University of Ulsan College of Medicine , Asan Medical Center, Songpa-Gu, Seoul, Korea
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Marino M, Monzani ML, Brigante G, Cioni K, Madeo B, Santi D, Maiorana A, Bettelli S, Moriondo V, Pignatti E, Bonacini L, Carani C, Rochira V, Simoni M. High-Resolution Melting Is a Sensitive, Cost-Effective, Time-Saving Technique for BRAF V600E Detection in Thyroid FNAB Washing Liquid: A Prospective Cohort Study. Eur Thyroid J 2015; 4:73-81. [PMID: 26279992 PMCID: PMC4521072 DOI: 10.1159/000430092] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 04/09/2015] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE The diagnostic accuracy of thyroid fine needle aspiration biopsy (FNAB) can be improved by the combination of cytological and molecular analysis. In this study, washing liquids of FNAB (wFNAB) were tested for the BRAF V600E mutation, using the sensitive and cost-effective technique called high-resolution melting (HRM). The aim was to demonstrate the feasibility of BRAF analysis in wFNAB and its diagnostic utility, combined with cytology. DESIGN Prospective cohort study. METHODS 481 patients, corresponding to 648 FNAB samples, were subjected to both cytological (on cells smeared onto a glass slide) and molecular analysis (on fluids obtained washing the FNAB needle with 1 ml of saline) of the same aspiration. BRAF V600E analysis was performed by HRM after methodological validation for application to wFNAB (technique sensitivity: 5.4%). RESULTS The cytological results of the FNAB were: 136 (21%) nondiagnostic (THY1); 415 (64%) benign (THY2); 80 (12.4%) indeterminate (THY3); 9 (1.4%) suspicious for malignancy (THY4); 8 (1.2%) diagnostic of malignancy (THY5). The BRAF V600E mutation was found in 5 THY2, 2 THY3, 6 THY4 and 6 THY5 samples. Papillary carcinoma diagnosis was histologically confirmed in all BRAF+ thyroidectomized patients. BRAF combined with cytology improved the diagnostic value compared to cytology alone in a subgroup of 74 operated patients. CONCLUSIONS HRM was demonstrated to be a feasible method for BRAF analysis in wFNAB. Thanks to its sensitivity and cost-effectiveness, it might be routinely used on a large scale in clinical practice. In perspective, standby wFNAB samples could be analyzed a posteriori in case of indeterminate cytology and/or suspicious findings on ultrasound.
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Affiliation(s)
- Marco Marino
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Center for Genomic Research, University of Modena and Reggio Emilia, Italy
| | - Maria Laura Monzani
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Azienda USL of Modena, Modena, Italy
| | - Giulia Brigante
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Azienda USL of Modena, Modena, Italy
| | - Katia Cioni
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Azienda USL of Modena, Modena, Italy
| | - Bruno Madeo
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Azienda USL of Modena, Modena, Italy
| | - Daniele Santi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Azienda USL of Modena, Modena, Italy
| | - Antonino Maiorana
- Department of Diagnostic and Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Italy
| | - Stefania Bettelli
- Department of Diagnostic and Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Italy
| | - Valeria Moriondo
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Center for Genomic Research, University of Modena and Reggio Emilia, Italy
| | - Elisa Pignatti
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Center for Genomic Research, University of Modena and Reggio Emilia, Italy
| | - Lara Bonacini
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Azienda USL of Modena, Modena, Italy
| | - Cesare Carani
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Azienda USL of Modena, Modena, Italy
- *Vincenzo Rochira, MD, PhD, Unit of Endocrinology, NOCSAE, Via Giardini 1355, IT-41126 Modena (Italy), E-Mail
| | - Manuela Simoni
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Center for Genomic Research, University of Modena and Reggio Emilia, Italy
- Azienda USL of Modena, Modena, Italy
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Kim SK, Lee JH, Woo JW, Park I, Choe JH, Kim JH, Kim JS. Prediction Table and Nomogram as Tools for Diagnosis of Papillary Thyroid Carcinoma: Combined Analysis of Ultrasonography, Fine-Needle Aspiration Biopsy, and BRAF V600E Mutation. Medicine (Baltimore) 2015; 94:e760. [PMID: 26020381 PMCID: PMC4616401 DOI: 10.1097/md.0000000000000760] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Although ultrasonography (US)-guided fine-needle aspiration biopsy (FNAB) is the most reliable diagnostic modality for evaluating thyroid nodules, 10% to 40% of FNAB samples yield indeterminate findings. The BRAF V600E mutation, a highly specific molecular marker for papillary thyroid carcinoma (PTC), well known for its prognostic value, has dubious diagnostic value because of its low sensitivity. Novel strategies are clearly needed to distinguish PTC, which represents the majority of thyroid malignancies, from other thyroid nodules. The records of 3297 patients with surgically proven PTC were retrospectively reviewed. A prediction table and nomogram were designed using a combination of diagnostic parameters for US, FNAB, and the BRAF V600E mutation. For the nomogram, parameters were proportionally assigned 0 to 100 points according to their regression coefficient for PTC. The probability of PTC for thyroid nodules with intermediate-risk (IR) US and atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) FNAB was significantly dependent on BRAF V600E mutation status based on our prediction table (negative, 29.2% vs positive, 87.5%; P < 0.001). By our nomogram, the probability of PTC for thyroid nodules with IR US, AUS/FLUS FNAB, and positive BRAF V600E mutation was approximately 85% to 90%. We strongly recommend preoperative evaluation of the BRAF V600E mutation in indeterminate thyroid nodules. The prediction table and nomogram developed in this study could help clinicians and patients easily assess the probability of PTC in the preoperative period.
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Affiliation(s)
- Seo Ki Kim
- From the Division of Breast and Endocrine Surgery (SKK, J-WW, IP, J-HC, J-HK, JSK), Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and Division of Breast and Endocrine Surgery (JHL), Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
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Oh SY, Lee HT. Evaluation of Pyrosequencing Method for a BRAFV600E Mutation Test. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2015. [DOI: 10.15324/kjcls.2015.47.1.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Seo Young Oh
- Department of Pathology, Konkuk University Medical Center, Seoul 143-729, Korea
- Department of Animal Biotechnology, College of Animal Bioscience & Technology Konkuk University, Seoul 143-729, Korea
| | - Hoon Taek Lee
- Department of Animal Biotechnology, College of Animal Bioscience & Technology Konkuk University, Seoul 143-729, Korea
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Preoperative RAS mutational analysis is of great value in predicting follicular variant of papillary thyroid carcinoma. BIOMED RESEARCH INTERNATIONAL 2015; 2015:697068. [PMID: 25648502 PMCID: PMC4306358 DOI: 10.1155/2015/697068] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 10/11/2014] [Indexed: 01/21/2023]
Abstract
Follicular variant of papillary thyroid carcinoma (FVPTC), particularly the encapsulated subtype, often causes a diagnostic dilemma. We reconfirmed the molecular profiles in a large number of FVPTCs and investigated the efficacy of the preoperative mutational analysis in indeterminate thyroid nodules. BRAF V600E/K601E and RAS mutational analysis was performed on 187 FVPTCs. Of these, 132 (70.6%) had a point mutation in one of the BRAF V600E (n = 57), BRAF K601E (n = 11), or RAS (n = 64) genes. All mutations were mutually exclusive. The most common RAS mutations were at NRAS codon 61. FNA aspirates from 564 indeterminate nodules were prospectively tested for BRAF and RAS mutation and the surgical outcome was correlated with the mutational status. Fifty-seven and 47 cases were positive for BRAF and RAS mutation, respectively. Twenty-seven RAS-positive patients underwent surgery and all except one patient had FVPTC. The PPV and accuracy of RAS mutational analysis for predicting FVPTC were 96% and 84%, respectively. BRAF or RAS mutations were present in more than two-thirds of FVPTCs and these were mutually exclusive. BRAF mutational analysis followed by N, H, and KRAS codon 61 mutational analysis in indeterminate thyroid nodules would streamline the management of patients with malignancies, mostly FVPTC.
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Universal BRAF State Detection by the Pyrosequencing®-Based U-BRAF(V⁶⁰⁰) Assay. Methods Mol Biol 2015; 1315:63-82. [PMID: 26103892 DOI: 10.1007/978-1-4939-2715-9_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Malignant melanoma is a highly aggressive type of malignancy with considerable metastatic potential and frequent resistance to cytotoxic agents. BRAF mutant protein was recently recognized as therapeutic target in metastatic melanoma.We present the newly developed U-BRAF(V600) approach (Patent No. 12153477.0-1404)-a universal Pyrosequencing(®)-based assay for mutation detection within the activation segment in exon 15 of human BRAF. We identified five different BRAF mutations in a single assay analyzing 75 different formalin-fixed paraffin-embedded samples of cutaneous melanoma metastases from 29 patients. All mutant variants were quantitatively detectable by the newly developed U-BRAF(V600) assay. These results were confirmed by ultra-deep sequencing. In contrast to all other BRAF state detection methods, the U-BRAF(V600) assay is capable of automated quantitative identification of at least 36 previously published BRAF mutations. Under the precaution of a minimum of 5 % mutated cells in a background of wild-type cells, the U-BRAF(V600) assay design completely excludes false-negative wild-type results. The corresponding algorithm for classification of BRAF-mutated variants is provided in this chapter together with a detailed step-by-step protocol for the Pyrosequencing reaction.The single-reaction format and automation of data analysis make our approach suitable for the assessment of large clinical cohorts. Therefore, we suggest U-BRAF(V600) assay as a powerful sequencing-based diagnostic tool to automatically identify BRAF status.
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Jung JW, Choi JY, Lee KE, Park KW. Immunohistochemical and Molecular Markers Associated with Differentiated Thyroid Carcinoma. ACTA ACUST UNITED AC 2015. [DOI: 10.11106/cet.2015.8.1.50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Jun Woo Jung
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Kwi Won Park
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
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Kim HK, Lee JS, Park MH, Cho JS, Yoon JH, Kim SJ, Kang HC. Tumorigenesis of papillary thyroid cancer is not BRAF-dependent in patients with acromegaly. PLoS One 2014; 9:e110241. [PMID: 25329702 PMCID: PMC4201528 DOI: 10.1371/journal.pone.0110241] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 09/12/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Several studies have reported a high frequency of papillary thyroid cancer (PTC) in patients with acromegaly. The aim of this study was to determine the prevalence and predictors of thyroid cancer in patients with acromegaly and to investigate the frequency of the BRAFV600E mutation in PTC patients with and without acromegaly. MATERIALS AND METHODS We conducted a retrospective study of 60 patients with acromegaly. Thyroid ultrasonography (US) and US-guided fine needle aspiration were performed on nodules with sonographic features of malignancy. We selected 16 patients with non-acromegalic PTC as a control group. The BRAFV600E mutation was analyzed in paraffin-embedded surgical specimens of PTC by real-time polymerase chain reaction, and tumor specimens from patients with PTC were stained immunohistochemically with an antibody against insulin-like growth factor-1 receptor β (IGF-1Rβ). RESULTS Thyroid cancer was found in 15 (25.0%) patients. No differences in age, sex, initial growth hormone (GH) and IGF-1 percentage of the upper limit of normal values or treatment modalities were observed between patients with and without PTC. Acromegaly was active in 12 of 15 patients at the time of PTC diagnosis; uncontrolled acromegaly had a significantly higher frequency in the PTC group (60%) than in the non-PTC group (28.9%) (p = 0.030). The BRAFV600E mutation was present in only 9.1% (1/11) of PTC patients with acromegaly, although 62.5% (10/16) of control patients with PTC had the mutation (p = 0.007). IGF-1Rβ immunostaining showed moderate-to-strong staining in all malignant PTC cells in patients with and without acromegaly. Significantly less staining for IGF-1Rβ was observed in normal adjacent thyroid tissues of PTC patients with acromegaly compared with those without (p = 0.014). CONCLUSION The prevalence of PTC in acromegalic patients was high (25%). An uncontrolled hyperactive GH-IGF-1 axis may play a dominant role in the development of PTC rather than the BRAFV600E mutation in patients with acromegaly.
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Affiliation(s)
- Hee Kyung Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Ji Shin Lee
- Department of Pathology, Chonnam National University Medical School, Gwangju, Korea
| | - Min Ho Park
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Jin Seong Cho
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Jee Hee Yoon
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Soo Jeong Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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Oh SY, Han JY, Lee SR, Lee HT. Improved DNA Extraction Method for Molecular Diagnosis from Smaller numbers of Cells. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2014. [DOI: 10.15324/kjcls.2014.46.3.99] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Seo Young Oh
- Department of Pathology, Konkuk University Medical Center, Seoul 143-729, Korea
- Department of Animal Biotechnology, College of Animal Bioscience & Technology Konkuk University, Seoul 143-701, Korea
| | - Jeong Yeon Han
- Department of Pathology, Seoul National University Hospital, Seoul 110-744, Korea
| | - So Ra Lee
- Department of Pathology, Konkuk University Medical Center, Seoul 143-729, Korea
| | - Hoon Taek Lee
- Department of Animal Biotechnology, College of Animal Bioscience & Technology Konkuk University, Seoul 143-701, Korea
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