title: Clinical management of thyroid nodules with indeterminate cytology: our institutional experience using SIAPEC cytological criteria and V600-BRAF test.
abstract: BACKGROUND
  We evaluated the diagnostic accuracy of thyroid FNAC, integrated with V600E - BRAF mutational study. Herein, we report our experience using the SIAPEC cytological morphological criteria.
  
  
  METHODS
  From September 2009 to December 2010, we performed ultrasound-guided fine needle aspiration cytology (FNAC) on 124 patients with clinical evidence of a thyroid nodule, classifying the results in five cytological categories, according to Italian Society of Pathology and Cytology (SIAPEC) consensus conference morphological criteria. In patients with indeterminate (Tir3), suggestive of malignancy (Tir4) or positive for malignancy specimens (Tir5), we obtained a new biopsy in order to study V600E BRAF status. Patients with a diagnosis of Tir2 were assessed every six months with follow-up in the subsequent years. Patients with cytological diagnosis of Tir3, Tir4 and Tir5 underwent thyroid surgical resection with histological assessment of the lesion. Cyto-histological correlation was evaluated.
  
  
  RESULTS
  We obtained the following results: Tir2 = 103 (83.1%), Tir3 = 14 (11.3%), Tir4 = 2 (1.6%); Tir5 = 5 (4%). B-RAF mutation was found on 1 Tir3, 1 Tir4 and 2 Tir5. Thyroidectomy was performed on 17 patients classified as Tir3, Tir4 and Tir5. The diagnostic specificity of FNB was of 94.5%, a sensitivity of 100%, a predictive value positive for neoplasia of 77.7 % and a predictive value of malignancy of 61.7%.
  
  
  CONCLUSIONS
  Diagnostic accuracy of cytology can be improved through the study of mutational status of BRAF gene. These additional evaluations are well studied, easy to perform and could enter in the current diagnostic procedures to optimize clinical management of thyroid nodular disease.
authors.affiliation: Cytopathology Service, ASL Caserta, Department of Clinical Pathology, University Hospital Marcianise (CE), Italy. diben.g@libero.it
authors.forename: G
authors.initials: G
authors.lastname: Di Benedetto
authors.forename: A
authors.initials: A
authors.lastname: Fabozzi
authors.forename: C
authors.initials: C
authors.lastname: Rinaldi
mesh_terms: D044963:Biopsy, Fine-Needle; D003581:Cytodiagnosis / Q000379:methods*; D004252:DNA Mutational Analysis; D006801:Humans; D017354:Point Mutation; D016133:Polymerase Chain Reaction; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics*; D012680:Sensitivity and Specificity; D016606:Thyroid Nodule / Q000175:diagnosis* / Q000235:genetics*
chemical_list: C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf