The features of contrast enhanced ultrasound and BRAF V600E in papillary thyroid carcinoma

Zi-Mei Lin, Cao-Xin Yan, Yue Song, Yu-Rong Hong, Qing Wen, Yong-Yuan Xu, Min-Qiang Pan, Qin Ye, Pin-Tong Huang


Background: BRAF V600E mutation was proved to be associated with thyroid cancer. Papillary thyroid carcinoma (PTC) with positive BRAF mutation might have a more aggressive behavior. We investigated the correlation of the contrast-enhanced ultrasound (CEUS) features with BRAF 600VE in PTC.
Methods: The medical records of 1,199 patients with 1,315 nodules who underwent CEUS prior to fine needle aspiration (FNA) from January 2016 to March 2018 were retrospectively reviewed. The features of their enhancement were assessed from eight aspects: degree of enhancement, method of enhancement, homogeneity of enhancement, completeness of enhancement, boundary of the enhanced lesions, shape of the enhanced lesions, size of the enhanced lesions, and wash out period of the enhanced lesions. The patients then examined for the BRAF V600E mutation using specimens obtained from FNA.
Results: BRAF mutations were found in 888 of 1,315 nodules. The CEUS features were significantly different between BRAF-positive and BRAF-negative nodules. The BRAF mutation positive nodules were more often with larger size, hypo-enhancement, centripetal enhancement, inhomogeneous enhancement, complete enhancement, blurred boundary, irregular shape, and with wash out period at preoperative CEUS than those without BRAF mutations (P<0.001). However, no significant correlation was showed in Spearman’s rank correlation between the CEUS features and BRAF mutation, except for degree of enhancement, method pattern of enhancement, and completeness of complete enhancement. Multivariate analysis showed that centripetal (OR: 1.465, 95% CI: 1.129–1.903) and no significant enhancement (OR: 0.790, 95% CI: 0.639–0.977) were predictive for the presence of BRAF mutations. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of no significant enhancement and centripetal enhancement of CEUS for predicting BRAF mutation were 68.3%, 40.0%, 91.6%, 11.7%, and 72.4%, 35.1%, 37.8%, 70.0%, respectively.
Conclusions: Our study indicated that preoperative thyroid nodule characteristics on CEUS might serve as a useful tool to BRAF mutation in PTC.