title: Diagnostic value of B-RAF(V600E) in difficult-to-diagnose thyroid nodules using fine-needle aspiration: systematic review and meta-analysis.
abstract: Fine-needle aspiration (FNA) is routinely used in the preoperative evaluation of thyroid nodules. However, approximately 5-20% of thyroid nodules are considered indeterminate or suspicious cases that do not meet clinical standards. The B-RAF(V600E) mutation has been reported in FNA specimens. We conducted a systematic review to evaluate the diagnostic value of testing for B-RAF(V600E) in thyroid nodules that are difficult to diagnose by FNA. A systematic literature search was performed from January 1, 2002 to June 30, 2012. Articles were obtained by searching two electronic databases (MEDLINE and EMBASE), hand searching selected journals, and contacting authors. Article quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Sensitivity, specificity, and other measures of accuracy were pooled using random effects models. Summary receiver operating characteristic (SROC) curves were used to summarize overall diagnostic accuracy. A total of 16 studies incorporating 1131 patients were included in a meta-analysis on diagnostic accuracy of B-RAF(V600E) tests. Pooled sensitivity was 0.60 (95% confidence interval [CI]: 0.556-0.634), pooled specificity was 0.99 (95% CI 0.976-0.997), and the area under the curve of the SROC curve was 0.8376. Q index value was 0.7696. Our data suggest a potentially useful adjunct to evaluating thyroid nodules that are difficult to diagnose. The B-RAF(V600E) test has a high positive predictive value and could help clinicians formulate a more individualized treatment schedule. When supplemented with other noninvasive test methods, the B-RAF(V600E) test could be a powerful adjunct with extensive clinical applications.
authors.affiliation: Thyroid and Neck Department, Tianjin Medical University Cancer Institute and Hospital, Tiyuanbei, Hexi District, Tianjin, China, 300060.
authors.forename: Yongsheng
authors.initials: Y
authors.lastname: Jia
authors.forename: Yang
authors.initials: Y
authors.lastname: Yu
authors.forename: Xiaolong
authors.initials: X
authors.lastname: Li
authors.forename: Songfeng
authors.initials: S
authors.lastname: Wei
authors.forename: Xiangqian
authors.initials: X
authors.lastname: Zheng
authors.forename: Xiaoyong
authors.initials: X
authors.lastname: Yang
authors.forename: Jing
authors.initials: J
authors.lastname: Zhao
authors.forename: Tingting
authors.initials: T
authors.lastname: Xia
authors.forename: Ming
authors.initials: M
authors.lastname: Gao
mesh_terms: D044963:Biopsy, Fine-Needle; D006801:Humans; D009154:Mutation; D011237:Predictive Value of Tests; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics*; D012680:Sensitivity and Specificity; D016606:Thyroid Nodule / Q000235:genetics* / Q000473:pathology*
chemical_list: C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf
keywords: BRAFV600E; fine-needle aspiration; thyroid nodule