Impact of NRAS Mutations on the Diagnosis of Follicular Neoplasm of the Thyroid

Background. Most patients with a preoperative diagnosis of thyroid follicular neoplasm (FN) undergo diagnostic surgery to determine whether the nodule is benign or malignant. Point mutations at NRAS codon 61 are the most common mutations observed in FN. However, the clinical significance of NRAS mut...

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Published in:International Journal of Endocrinology 2014-01, Vol.2014 (2014), p.444-450-046
Main Authors: Jung, Chan Kwon, Lee, Sohee, Kim, Yourha, Jeon, Sora, Choi, Seung Kyu, Bae, Ja-Seong, Lee, Youn Soo
Format: Article
Language:English
Subjects:
Age
Biopsy
Development and progression
Endocrinology
Females
Gender
Gene mutations
Genetic aspects
Health aspects
Mutation
Physiological aspects
Ras genes
Surgery
Thyroid cancer
Tumors
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Summary:Background. Most patients with a preoperative diagnosis of thyroid follicular neoplasm (FN) undergo diagnostic surgery to determine whether the nodule is benign or malignant. Point mutations at NRAS codon 61 are the most common mutations observed in FN. However, the clinical significance of NRAS mutation remains unclear. Methods. From 2012 to 2013, 123 consecutive patients undergoing thyroidectomy for FN were evaluated prospectively. Molecular analyses for NRAS codon 61 were performed with pyrosequencing. Results. The overall malignancy rate in FN was 48.8% (60/123). Of 123 FNs, 33 (26.8%) were positive for the NRAS mutation. The sensitivity, specificity, positive predictive value, and negative predictive value of a NRAS mutation-positive FN specimen to predict malignancy were 37%, 83%, 67%, and 58%, respectively. Patients with a NRAS-positive FN had a higher malignancy rate in additional thyroid nodules beyond the FN than patients with a NRAS-negative FN. The overall malignancy rate of patients with a NRAS-positive FN was significantly higher than that of patients with a NRAS-negative FN (79% versus 52%; P = 0.008). Conclusions. Determining NRAS mutation status in FN helps to improve the accuracy of thyroid cancer diagnosis and to predict cancer risk in accompanying thyroid nodules.
ISSN:1687-8337
1687-8345
DOI:10.1155/2014/289834