The prognostic value of the BRAFV600E mutation, resulting in poor clinical outcomes of papillary thyroid carcinoma, has been generally confirmed. However, the association of BRAFV600E with aggressive clinical behaviors of papillary thyroid microcarcinoma (PTMC) has not been firmly established in individual studies. We performed this meta-analysis to examine the relationship between BRAFV600E mutation and the clinicopathological features of PTMC. We conducted a systematic search in PubMed, EMBASE, and the Cochrane library for relevant studies. We selected all the studies that reported clinicopathological features of PTMC patients with information available on BRAFV600E mutation status. Nineteen studies involving a total of 3437 patients met these selection criteria and were included in the analyses. The average prevalence of the BRAFV600E mutation was 47.48%, with no significant difference with respect to patient sex (male versus female) and age (younger than 45 years versus 45 years or older). Compared with the WT BRAF gene, the BRAFV600E mutation was associated with tumor multifocality (odds ratio (OR) 1.38; 95% CI, 1.04–1.82), extrathyroidal extension (OR 3.09; 95% CI, 2.24–4.26), lymph node metastases (OR 2.43; 95% CI, 1.28–4.60), and advanced stage (OR 2.39; 95% CI, 1.38–4.15) of PTMC. Thus, our findings from this large meta-analysis definitively demonstrate that BRAFV600E-mutation-positive PTMC are more likely to manifest with aggressive clinicopathological characteristics. In appropriate clinical settings, testing for the BRAFV600E mutation is likely to be useful in assisting the risk stratification and management of PTMC.

The aim of this study is to determine the contribution of neck and chest 99mTc-pertechnetate scan to the management of postoperative patients with suspicious metastatic differentiated thyroid cancer (DTC), particularly to the prediction of response to radioiodine (131I) therapy. Just before 131I administration, a total of 184 postoperative DTC patients with stimulated serum thyroglobulin (ssTg) >10 ng/mL were enrolled to undergo neck and chest 99mTc-pertechnetate scan, which were directly compared with post-therapeutic 131I scan to determine the concordance of site and number of metastatic lesions. The percentage changes in ssTg between 99mTc-pertechnetate-avid group and 99mTc-pertechnetate-nonavid group were compared, and the response to 131I in both groups was analyzed according to the nature of 99mTc-pertechnetate avidity as well. The percentages of concordance between 99mTc-pertechnetate and 131I scan in detecting metastases were 65.7% and 26.0% in per-patient and per-site analyses with low unweighted kappa, respectively. 99mTc-pertechnetate scan led to a change in therapeutic decision making in 19/184 (10.3%) patients. In 72 patients with 131I-avid metastases, the ssTg in 99mTc-pertechnetate-avid group (n = 13) decreased significantly compared with that in 99mTc-pertechnetate-nonavid group (n = 59) (median: −81.56% vs −48.14%; Z = −4.276, P = .000). The difference of therapeutic response between 99mTc-pertechnetate-avid group and 99mTc-pertechnetate-nonavid group was statistically significant (χ2 = 8.4; P = .03). Although the consistency between 99mTc-pertechnetate scan before 131I administration and post-therapy 131I scan in detecting metastases is low, identifying metastases in postoperative DTC patients with elevated ssTg via 99mTc-pertechnetate scan prior to 131I therapy provides incremental value for therapeutic decision making. Notably, patients with 99mTc-pertechnetate-avid metastases may be more prone to benefit from 131I therapy than those with 99mTc-pertechnetate-nonavid metastases.

Poorly differentiated thyroid carcinoma (PDTC) is a rare thyroid carcinoma originated from follicular epithelial cells. No explicit consensus can be achieved to date due to sparse clinical data, potentially compromising outcomes of patients. In this comprehensive review from a clinician’s perspective, the epidemiology and prognosis are described, diagnosis based on manifestations, pathology, and medical imaging are discussed, and both traditional and emerging therapeutics are addressed as well. Turin consensus remains the mainstay diagnostic criteria for PDTC, and individualized assessments are decisive for treatment option. The prognosis is optimal if complete resection is performed at early stage, but dismal in nearly half of patients with locally advanced and/or distant metastatic diseases, in which adjuvant therapies such as 131I therapy, external beam radiation therapy, and chemotherapy should be incorporated. Emerging therapeutics including molecular targeted therapy, differentiation therapy, and immunotherapy deserve further investigations to improve the prognosis of PDTC patients with advanced disease.