The utility of the Bethesda category and its association with BRAF mutation in the prediction of papillary thyroid cancer stage.
OBJECTIVE
This study aims to determine the utility of the Bethesda category and its association with BRAF mutation in prediction of the papillary thyroid cancer (PTC) stage.


METHODS
A prospective study analyzed patients who had ultrasound-suspicious thyroid nodules, underwent FNA and cytological examination, and were classified according to the Bethesda system. Patients from Undetermined Significance Or Follicular Lesion Of Undetermined Significance (AUS/FLUS), Follicular Neoplasm or Suspicious for a Follicular Neoplasm (FN/SFN), Suspicious for Malignant Cells (SMC), and Positive for Malignant Cells (PMC) groups were examined for the BRAF mutation and had a thyroid surgery. Demographical and histological features and stage of the disease were evaluated for PTC patients in accordance with the Bethesda category and its association with BRAF mutation.


RESULTS
Three hundred eight of all patients underwent operation. One hundred forty-three (46.4%) of them were diagnosed with PTC. In 14 (9.8%) PTC cases, FNA biopsies were classified as AUS/FLUS, 23 (16.1%) as FN/SFN, 41 (28.7%) as SMC, and 65 (45.5%) as PMC. I-II stages of PTC were diagnosed for 88 (61.5%) patients and III-IVA for 55 (38.5%). Patients from the SMC and PMC groups had larger tumors, higher incidence of lymph node metastases, classical PTC type, B-type Raf (BRAF) positive, and III-IVA stage cancer, than patients from the AUS/FLUS and FN/SFN groups. When comparing 27 (18.9%) BRAF-negative patients from the AUS/FLUS and FN/SFN groups with 116 (81.1%) BRAF-negative patients from the SMC and PMC groups and all BRAF-positive patients, the prediction of more aggressive histological features and stage was slightly improved.


CONCLUSIONS
Higher Bethesda categories are associated with higher stages of PTC. Association of the Bethesda category with BRAF mutation can slightly improve the value of stage prediction.
Centre of Abdominal Surgery, Vilnius University, Santariškių 2, 08406, Vilnius, Lithuania. augustas.beisa@santa.lt.
Augustas
A
Beiša
Centre of Abdominal Surgery, Vilnius University, Santariškių 2, 08406, Vilnius, Lithuania.
Mindaugas
M
Kvietkauskas
Centre of Abdominal Surgery, Vilnius University, Santariškių 2, 08406, Vilnius, Lithuania.
Virgilijus
V
Beiša
Centre of Haematology, Oncology and Transfusion Medicine, Vilnius University, Vilnius, Lithuania.
Mindaugas
M
Stoškus
Centre of Laboratory Medicine, Vilnius University, Vilnius, Lithuania.
Elvyra
E
Ostanevičiūtė
Mykolas Romeris University, Vilnius, Lithuania.
Eugenijus
E
Jasiūnas
Centre of Haematology, Oncology and Transfusion Medicine, Vilnius University, Vilnius, Lithuania.|Centre of Internal, Family Medicine and Oncology, Vilnius University, Vilnius, Lithuania.
Laimonas
L
Griškevičius
Centre of Abdominal Surgery, Vilnius University, Santariškių 2, 08406, Vilnius, Lithuania.
Kęstutis
K
Strupas
D000328:Adult; D000368:Aged; D002291:Carcinoma, Papillary / Q000145:classification / Q000235:genetics* / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation / Q000235:genetics*; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics*; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000145:classification / Q000235:genetics* / Q000473:pathology*; D013965:Thyroidectomy
C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf
BRAF mutation; Bethesda system; Fine-needle aspiration; Papillary thyroid cancer; Thyroid