Association Between Preoperative US, Elastography Features and Prognostic Factors of Papillary Thyroid Cancer With BRAFV600E Mutation.

Jun-Mei Xu,Yuan-Yuan Dang,Yong-Jun Chen,Man Chen

doi:10.3389/fendo.2019.00902

Abstract

Purpose: To investigate the value of US and elastography for predicting prognostic factors of papillary thyroid cancer (PTC) in the positive BRAFV600E Mutation group.Materials and Methods: A total of 116 BRAFV600E Mutation patients with PTCs were enrolled in this prospective study, who were preoperatively evaluated by US, US elasticity imaging (EI), and Virtual Touch tissue imaging (VTI) and Virtual Touch tissue quantification (VTQ) of acoustic radiation force impulse (ARFI) imaging. Multivariate logistic regression analysis was performed to assess 23 independent variables for predicting prognostic factors. Diagnostic performance was evaluated with receiver operating characteristic (ROC) curve analysis.Results: Forty-two (36.2%) of 116 PTC patients with BRAFV600E Mutation had central lymph node metastasis (LNM). Nine (7.8%) and fifty-six (48.3%) had lateral LNM and extra-thyroidal extension (ETE), respectively. In multivariate logistic regression analyses, rich internal flow [odds ratio [OR]: 6.66] was the best predictor for central LNM, followed by male sex (OR: 4.22), halo sign absence (OR: 2.78) (all P < 0.05). VTQ ratio (OR: 1.57) was the only predictor for lateral LNM (P = 0.02). Rich internal flow (OR: 6.33) was the strongest predictor for ETE, followed by male sex (OR: 3.29), halo sign absence (OR: 2.90), and VTQ ratio (OR: 1.63) (all P < 0.05).Conclusion: VTQ ratio on ARFI imaging, rich internal flow and halo sign absence on US are the predicting prognostic factors in PTC patients with BRAFV600E Mutation. The specificities were significantly increased by combining ARFI imaging and US features, which has a potential to avoid unnecessary therapeutic neck dissection in the high-risk PTC patients.

Highlights

Papillary thyroid cancer (PTC) is a common endocrine malignancy, which accounts for 80–85% of all thyroid cancers, and generally displays an indolent course [1, 2]
BRAFV600E mutation has been shown to be helpful for identifying aggressive clinic pathologic characteristics and poor prognostication of PTC, the sensitivities and specificities were low [4,5,6,7,8]
In the preoperative US, we found that rich internal flow (OR: 6.66, P = 0.002) was the strongest independent factors to predict central lymph node metastasis (LNM) and ETE, the sensitivities (42.5–42.9%) and specificities (74.3–76.7%) were moderate

Summary

Introduction

Papillary thyroid cancer (PTC) is a common endocrine malignancy, which accounts for 80–85% of all thyroid cancers, and generally displays an indolent course [1, 2]. Thyroid Cancer With BRAFV600E Mutation demonstrated an association of BRAFV600E mutation with aggressive clinic pathologic characteristics and poor prognosis of PTC [4,5,6]. Several other studies have reported no or a partial association of the BRAF mutation with highrisk pathological characteristics [7, 8]. A report of 455 patients with PTC showed that BRAFV600E mutation was not associated with more advanced TNM stage upon diagnosis [8]. The association of the BRAFV600E mutation with more aggressive clinic pathological features in patients with PTC remains controversial

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