Korean J Endocr Surg.  2016 Jun;16(2):36-41. 10.16956/kaes.2016.16.2.36.

BRAF(V600E) Test for Suspicious Lateral Lymph Nodes in Papillary Thyroid Cancer

• Kim WW
• Choi HH
• Lee J
• Hwang SO
• Park HY
• Park JY
• Jung JH

• KMID: 2308568
• DOI: http://doi.org/10.16956/kaes.2016.16.2.36

Abstract

PURPOSE
This study evaluates the BRAF(V600E) test with fine-needle aspiration cytology (FNAC) for lateral lymph node (LN) metastasis in papillary thyroid carcinoma (PTC).
METHODS
Ninety-one patients, including 95 lateral LNs with possible PTC metastasis, were consecutively entered into the study. We analyzed the accuracy of results for the BRAF(V600E) test and FNAC for lateral LN metastasis in PTC.
RESULTS
Modified radical neck dissection was performed for 34 cases due to lateral LN metastasis. The sensitivity of FNAC was 88.2% , and the LN-BRAF(V600E) test 64.7%. The specificity and positive predictive value (PPV) were 100% for both tests. The negative predictive values (NPV) were FNAC, 93.8%, and LN-BRAF(V600E), 83.6%. For samples positive with either the BRAF(V600E) test or FNAC, the sensitivity was 94.1%, specificity 100%, PPV value 100%, and NPV 96.8%.
CONCLUSION
This study suggests that the complementary LN-BRAF(V600E) test with FNAC is a supportive diagnostic method for PTC patients with indeterminate or non-diagnostic suspicious lateral LNs.

Keyword

BRAF(V600E) mutation; Lymph node; Metastasis; Papillary thyroid cancer

MeSH Terms

Biopsy, Fine-Needle
Humans
Lymph Nodes*
Methods
Neck Dissection
Neoplasm Metastasis
Sensitivity and Specificity
Thyroid Gland*
Thyroid Neoplasms*

Figure

• 

  Fig. 1 The diagram of the patients who received USG-guided FNAC and surgery.

Reference

1. Zuniga S, Sanabria A. Prophylactic central neck dissection in stage N0 papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 2009; 135:1087–1091.

2. Kim KW. Clinical characteristics of papillary thyroid microcarcinoma. J Korean Thyroid Assoc. 2010; 3:111–115.

3. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994; 97:418–428.

4. Schlumberger MJ. Papillary and follicular thyroid carcinoma. N Engl J Med. 1998; 338:297–306.

5. Kim MJ, Kim EK, Kim BM, Kwak JY, Lee EJ, Park CS, et al. Thyroglobulin measurement in fine-needle aspirate washouts: the criteria for neck node dissection for patients with thyroid cancer. Clin Endocrinol (Oxf). 2009; 70:145–151.

6. Salvatore G, Giannini R, Faviana P, Caleo A, Migliaccio I, Fagin JA, et al. Analysis of BRAF point mutation and RET/PTC rearrangement refines the fine-needle aspiration diagnosis of papillary thyroid carcinoma. J Clin Endocrinol Metab. 2004; 89:5175–5180.

7. Chang H, Lee H, Yoon SO, Kim H, Kim A, Kim BH. BRAF(V600E) mutation analysis of liquid-based preparation-processed fine needle aspiration sample improves the diagnostic rate of papillary thyroid carcinoma. Hum Pathol. 2012; 43:89–95.

8. Jara SM, Bhatnagar R, Guan H, Gocke CD, Ali SZ, Tufano RP. Utility of BRAF mutation detection in fine-needle aspiration biopsy samples read as "suspicious for papillary thyroid carcinoma". Head Neck. 2015; 37:1788–1793.

9. Agretti P, Niccolai F, Rago T, De Marco G, Molinaro A, Scutari M, et al. BRAF mutation analysis in thyroid nodules with indeterminate cytology: our experience on surgical management of patients with thyroid nodules from an area of borderline iodine deficiency. J Endocrinol Invest. 2014; 37:1009–1014.

10. Leboulleux S, Girard E, Rose M, Travagli JP, Sabbah N, Caillou B, et al. Ultrasound criteria of malignancy for cervical lymph nodes in patients followed up for differentiated thyroid cancer. J Clin Endocrinol Metab. 2007; 92:3590–3594.

11. Xing M. BRAF mutation in thyroid cancer. Endocr Relat Cancer. 2005; 12:245–262.

12. Hegedüs L. Clinical practice. The thyroid nodule. N Engl J Med. 2004; 351:1764–1771.

13. Moon HJ, Kim EK, Chung WY, Choi JR, Yoon JH, Kwak JY. Diagnostic value of BRAF(V600E) mutation analysis of thyroid nodules according to ultrasonographic features and the time of aspiration. Ann Surg Oncol. 2011; 18:792–799.