Clinical significance of preoperative detection of serum p53 antibodies and BRAF(V600E) mutation in patients with papillary thyroid carcinoma.

The goal of the present study was to evaluate the clinical and diagnostic value of both serum p53-antibodies (Abs) and preoperative fine needle aspiration cytology (FNAC) for BRAF mutation in patients with papillary thyroid carcinoma (PTC). A total of 312 patients, including thyroid adenoma (85) and PTC (227) were enrolled in this study. Two types of enzyme-linked immunosorbent assays (ELISA), phage-ELISA and p53-ELISA, were used to measure serum p53-Ab levels. Sanger sequencing was used to determine BRAF gene mutation in FNA samples. Phage-ELISA was more efficient than conventional p53-ELISA in measuring serum p53-Abs in PTC patients. BRAF mutation analysis with FNAC significantly improved PTC diagnostic sensitivity from 80.18% to 93.83% (P=0.001) and accuracy from 82.31% to 92.37% (P=0.005). Bothp53-Abs and BRAF mutation were positively associated with lymphatic metastasis and advanced TNM stages. Particularly, serum p53-Abs positively associated with multifocality (P=0.02), while BRAF mutation associated with extrathyoidal extension (P=0.01). Furthermore, PTC patients with both elevated serum p53-Abs and BRAF mutation had a higher prevalence of extrathyoidal extension (P=0.003), lymphnode metastasis (P=0.00), multifocality (P=0.04), and advanced TNM stages (P=0.004). Our results indicate that serum p53-Abs alone might not be a reliable biomarker for PTC diagnosis, but the combined analysis of serum p53-Abs and BRAF mutation in FNAC may be useful for optimizing surgical treatment and prognostic prediction of unfavorable clinicopathologic outcomes.