title: Comparison of the diagnostic accuracy of combined elastosonography and BRAF analysis vs cytology and ultrasonography for thyroid nodule suspected of malignancy.
abstract: OBJECTIVE
  Diagnosing thyroid nodules preoperatively using traditional diagnostic tools - ultrasonography (US) and cytology - still carries a considerable degree of uncertainty, and surgery is recommended for a far from negligible number of patients simply for diagnostic purposes. Thyroid elastosonography (USE) and BRAF analysis have recently proved useful in detecting thyroid malignancies. The aim of this study is to establish whether combining USE and BRAF testing ameliorates preoperative diagnosis of thyroid nodule candidates for intervention by conventional approaches, thereby avoiding the need for diagnostic surgical procedures.
  
  
  METHODS
  We retrospectively analysed the files of 155 consecutive patients with 164 nodules, all assessed by ultrasonography, cytology, USE and BRAF testing, who underwent thyroid surgery.
  
  
  RESULTS
  Of the 164 nodules, 74 (45%) were benign and 90 (55%) were malignant at final histology. Combining ultrasonography and cytology identified 21 (13%) as benign, 93 (57%) as malignant or probably malignant and 50 (30%) as 'suspended' (when the combined test was not able to classify the node as benign or malignant) with a 99% sensitivity, 28% specificity, 63% PPV, 95% NPV and 67% accuracy. Combining USE and BRAF testing indicated that 59 (36%) were benign, 74 (45%) were malignant and 31 (19%) were in a 'suspended' category, with a 95% sensitivity, 74% specificity, 82% PPV, 93% NPV and 86% accuracy.
  
  
  CONCLUSIONS
  In assessing thyroid nodules suspected of malignancy, the combined analysis of USE and BRAF is equally sensitive and more specific than conventional procedures, achieving more accurate preoperative diagnoses than US and cytology combined. USE and BRAF analysis for thyroid nodule evaluation might reduce the number of unnecessary surgical procedures.
authors.affiliation: Endocrinology Unit, Department of Medical and Surgical Sciences, University of Padova, Padova, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Nacamulli
authors.forename: Lorena
authors.initials: L
authors.lastname: Nico
authors.forename: Susi
authors.initials: S
authors.lastname: Barollo
authors.forename: Laura
authors.initials: L
authors.lastname: Zambonin
authors.forename: Giammaria
authors.initials: G
authors.lastname: Pennelli
authors.forename: Maria Elisa
authors.initials: ME
authors.lastname: Girelli
authors.forename: Eric
authors.initials: E
authors.lastname: Casal Ide
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Pelizzo
authors.forename: Federica
authors.initials: F
authors.lastname: Vianello
authors.forename: Isabella
authors.initials: I
authors.lastname: Negro
authors.forename: Sara
authors.initials: S
authors.lastname: Watutantrige-Fernando
authors.forename: Franco
authors.initials: F
authors.lastname: Mantero
authors.forename: Massimo
authors.initials: M
authors.lastname: Rugge
authors.forename: Caterina
authors.initials: C
authors.lastname: Mian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D003584:Cytological Techniques / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000175:diagnosis*; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D014463:Ultrasonography; D055815:Young Adult