BRAFV600E mutation as a predictor of thyroid malignancy in indeterminate nodules: a systematic review and meta-analysis

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dc.contributor.authorJinih, Marcel
dc.contributor.authorFoley, Niamh M.
dc.contributor.authorOsho, Olakunle
dc.contributor.authorHoulihan, Lena
dc.contributor.authorToor, Asad Ali
dc.contributor.authorKhan, Jehan Z.
dc.contributor.authorAchackzai, Akbar A.
dc.contributor.authorRedmond, H. Paul
dc.date.accessioned2017-02-06T12:10:46Z
dc.date.available2017-02-06T12:10:46Z
dc.date.issued2016-11-22
dc.date.updated2017-02-06T11:44:22Z
dc.description.abstractBackground: Thyroid nodules are usually diagnosed using fine-needle aspiration (FNA). The sensitivity limitations of FNA result in 10–30% of nodules being classified as “indeterminate”. The BRAFV600E mutation is associated with papillary thyroid carcinoma (PTC). We conducted a systemic review and meta-analysis to evaluate the diagnostic utility of the BRAFV600E mutation in indeterminate nodules. Method: PUBMED and EMBASE were searched for studies testing for the BRAFV600E involving indeterminate nodules (Thy3a, Thy3f, Thy4) and containing information on final surgical histopathology. Thirty two studies involving 3150 indeterminate nodules were included in the analysis. Results: The overall sensitivity and specificity for BRAFV600E for the diagnosis of thyroid malignancy was 0.40 (95% CI: 0.32–0.48) and 1.00 (95% CI: 0.98–1.00) respectively. The diagnostic odds ratio (DOR) was 205.4 (95% CI: 40.1–1052). With a Fagan plot, the post-test probability of thyroid cancer, given a negative mutation was 6%, but this rose to 92% with a positive result. On subgroup analysis, for Thy3a nodules, the pooled sensitivity and specificity for thyroid malignancy was 0.21 (95% CI: 0.13–0.34) and 1.00 (95% CI: 0.98–1.00). For Thy3f nodules, the pooled sensitivity and specificity was 0.09 (95% CI: 0.03–0.20) and 1.00 (95% CI: 0.05–1.00) respectively. For Thy4 nodules, the corresponding sensitivity and specificity was 0.58 (95% CI: 0.5–0.64) and 0.99 (95% CI: 0.95–1.00) respectively. Conclusions: Despite a high specificity for thyroid cancer, BRAFV600E mutation has a low overall sensitivity and therefore has a limited diagnostic value as a single screening test.en
dc.description.statusPeer revieweden
dc.description.versionAccepted Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationJinih, M., Foley, N., Osho, O., Houlihan, L., Toor, A. A., Khan, J. Z., Achakzai, A. A. and Redmond, H. P. (2016) ‘BRAFV600E mutation as a predictor of thyroid malignancy in indeterminate nodules: a systematic review and meta-analysis’, European Journal of Surgical Oncology, 43(7), pp. 1219-1227. doi: 10.1016/j.ejso.2016.11.003en
dc.identifier.doi10.1016/j.ejso.2016.11.003
dc.identifier.endpage1227
dc.identifier.issn0748-7983
dc.identifier.issued7
dc.identifier.journaltitleEuropean Journal of Surgical Oncologyen
dc.identifier.startpage1219
dc.identifier.urihttps://hdl.handle.net/10468/3562
dc.identifier.volume43
dc.language.isoenen
dc.publisherElsevier Ltden
dc.rights© 2016 Elsevier Ltd, BASO - The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved. This manuscript version is made available under the CC-BY-NC-ND 4.0 licenseen
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/en
dc.subjectIndeterminate thyroid noduleen
dc.subjectBRAF V600E mutationen
dc.subjectThy3aen
dc.subjectThy3fen
dc.subjectThy4en
dc.titleBRAFV600E mutation as a predictor of thyroid malignancy in indeterminate nodules: a systematic review and meta-analysisen
dc.typeReviewen
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