Background
Approximately 30% of fine needle aspiration biopsies of the thyroid have inconclusive
results. We conducted a prospective trial to determine whether clinical and molecular
markers could be used in combination to improve the accuracy of thyroid fine needle
aspiration biopsy.
Methods
Clinical, tumor genotyping for common somatic mutations (BRAF V600E, NRAS, KRAS, RET/PTC1,
RET/PTC3, and NTRK1), and the gene expression levels of 6 candidate diagnostic markers
were analyzed by univariate and multivariate methods in 341 patients to determine
whether they could distinguish reliably benign from malignant thyroid neoplasms, and
a scoring model was derived.
Results
By a multivariate analysis, fine needle aspiration biopsy cytology classification,
the presence of a NRAS mutation, and the tissue inhibitor of metalloproteinase 1 expression
level were associated jointly with malignancy. The overall accuracy of the scoring
model, including these 3 variables, to distinguish benign from malignant thyroid tumors
was 91%, including 67% for the indeterminate and 77% for the suspicious FNA subgroups.
Conclusion
Fine needle aspiration biopsy cytology classification, the presence of NRAS mutation,
and tissue inhibitor of metalloproteinase 1 messenger RNA expression levels in combination
provide a greater diagnostic accuracy than fine needle aspiration biopsy cytology
alone to allow selection of more definitive initial operative treatment. The sensitivity
of the scoring model, however, was too low to avoid the need for diagnostic thyroidectomies
for indeterminate fine needle aspiration biopsy findings.
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Article info
Publication history
Accepted:
September 16,
2010
Identification
Copyright
Published by Elsevier Inc.
ScienceDirect
Access this article on ScienceDirectLinked Article
- ErratumSurgeryVol. 151Issue 2
- Preview“A prospective study evaluating the accuracy of using combined clinical factors and candidate diagnostic markers to refine the accuracy of thyroid fine needle aspiration biopsy” by Aarti Mathur, Julie Weng, Willieford Moses, Seth M. Steinberg, Reza Rahabari, Mio Kitano, Elham Khanafshar, Britt-Marie Ljung, Quan-Yang Duh, Orlo H. Clark, and Electron Kebebew, which appeared in Surgery, Vol. 148, No. 6:1170-7, 2010 was published with an incorrect spelling of an author name. The correct spelling for Reza Rahabari should be Reza Rahbari.
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