Su Xingyun, Jiang Xiaoxia, Xu Xin, Wang Weibin, Teng Xiaodong, Shao Anwen, Teng Lisong
Department of Surgical Oncology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China.
Department of Pathology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China.
Onco Targets Ther. 2016 Apr 27;9:2495-509. doi: 10.2147/OTT.S101800. eCollection 2016.
Fine-needle aspiration (FNA) is a reliable method for preoperative diagnosis of thyroid nodules; however, about 10%-40% nodules are classified as indeterminate. The BRAF (V600E) mutation is the most promising marker for thyroid FNA. This meta-analysis was conducted to investigate the diagnostic value of BRAF (V600E) 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 BRAF (V600E) 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 BRAF (V600E) 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 BRAF (V600E) 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 BRAF (V600E) testing in SMC and AUS/FLUS rather than FN/SFN cases. Therefore, BRAF (V600E) analysis can improve the diagnostic accuracy of thyroid FNA, especially indeterminate cases classified as SMC, and select malignancy to guide the extent of surgery.
细针穿刺抽吸活检(FNA)是术前诊断甲状腺结节的可靠方法;然而,约10%-40%的结节被归类为不确定结节。BRAF(V600E)突变是甲状腺FNA最有前景的标志物。本荟萃分析旨在研究BRAF(V600E)分析在甲状腺FNA中的诊断价值,尤其是在不确定病例中的价值。于2015年6月之前在PubMed、科学网、Scopus、Ovid、爱思唯尔和考科蓝图书馆数据库中进行了系统检索,最终共有88项研究纳入本荟萃分析。与FNA细胞学检查相比,BRAF(V600E)检测的协同作用使诊断敏感性从81.4%提高到87.4%,假阴性率从8%降至5.2%。在不确定组中,BRAF(V600E)突变率为23%,在不同亚类中有所不同(可疑恶性细胞[SMC]中为43.2%,意义不明确的非典型性/意义不明确的滤泡性病变[AUS/FLUS]中为13.77%,滤泡性肿瘤/可疑滤泡性肿瘤[FN/SFN]中为4.43%)。BRAF(V600E)分析在SMC中的敏感性高于AUS/FLUS和FN/SFN病例(分别为59.4%、40.1%和19.5%),而特异性则相反(分别为86.1%、99.5%和99.7%)。汇总的受试者工作特征曲线下面积也证实了BRAF(V600E)检测在SMC和AUS/FLUS而非FN/SFN病例中的诊断价值。因此,BRAF(V600E)分析可提高甲状腺FNA的诊断准确性,尤其是对于归类为SMC的不确定病例,并筛选出恶性肿瘤以指导手术范围。