BRAF V600E detection in cytological thyroid samples: A key component of the decision tree for surgical treatment of papillary thyroid carcinoma

Collet, Jean-François; Lacave, Roger; Hugonin, Sylvain; Tassart, M.; Fajac, Anne

doi:10.1002/hed.24393

Cited by 6 publications

(7 citation statements)

References 21 publications

(42 reference statements)

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“…Therefore, BRAF mutation detection can influence the treatment strategy and surgical plan of the nodule that cannot definitively fit into a BSRTC category. Studies have suggested that patients with preoperative confirmation of BRAF V600E should undergo total thyroidectomy, regardless of whether the FNAC is malignant or suspected of malignancy 34 . Based on the current study, we have not yet reached this conclusion.…”

Section: Discussioncontrasting

confidence: 69%

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Significance of FNAC, BRAF mutation, and intraoperative frozen section in surgical decision‐making of thyroid nodules

Zhu

Chen

et al. 2023

Diagnostic Cytopathology

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Background A preoperative method is desired to discriminate benign from malignant thyroid nodules. This retrospective study evaluated the diagnostic performance of BRAF (B‐Raf proto‐oncogene) mutation (BRAFV600E) positivity and fine‐needle aspiration cytology (FNAC) relative to intraoperative frozen section pathology. Methods Patients underwent preoperative FNAC of thyroid nodules. Cytology specimens were classified according to the Bethesda System for Reporting Thyroid Cytopathology (BSRTC), and analyzed for BRAFV600E using an amplification‐refractory mutation system (ARMS). Thyroid tissue was surgically removed and frozen sections processed for histology. The sensitivities and specificities of each analysis were compared, alone and in combination. Results Among 346 patients, 333/358 FNACs (93%) showed malignant nodules; 322 (93%) patients received a pathological diagnosis of papillary thyroid carcinoma (PTC). The sensitivity and specificity of BSRTC VI for malignancy was the highest among the BSRTC categories. Compared with FNAC, the BRAFV600E analysis had significantly higher sensitivity and specificity. The diagnostic efficacy of frozen section pathology was significantly higher than that of either BSRTC category or BRAFV600E analysis alone. Combining methods variably improved diagnostic performance. BRAFV600E was not associated with capsule infiltration, neurovascular infiltration, mono‐ or multifocal PTC, lymph node metastasis, or clinical stage. Conclusion The diagnostic performance of preoperative BRAFV600E determination was better than that of the BSRTC‐FNAC category; combining both improved sensitivity and specificity. Patients with positive malignancy scores from both should be recommended for surgery; those with negative scores require close monitoring. Surgical treatment should include comprehensive intraoperative frozen section assessment. BRAF mutations cannot indicate aggressive treatment.

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Section: Discussioncontrasting

confidence: 69%

“…Studies have suggested that patients with preoperative confirmation of BRAF V600E should undergo total thyroidectomy, regardless of whether the FNAC is malignant or suspected of malignancy. 34 Based on the current study, we have not yet reached this conclusion.…”

Section: Discussionmentioning

confidence: 59%

Significance of FNAC, BRAF mutation, and intraoperative frozen section in surgical decision‐making of thyroid nodules

Zhu

Chen

et al. 2023

Diagnostic Cytopathology

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“…Currently, fine needle aspiration biopsy (FNAB) is the first choice for the preoperative diagnosis of multifocality with an acceptable accuracy, since it is even effective on the treatment of the tumour foci with a diameter of 5 mm or less [37]. Although whether BRAF V600E analysis could be routinely used in clinical practice is still controversial, it has been proved to be feasible preoperatively [38]. Moreover, a system meta-analysis has proved that preoperative BRAF V600E test can improve the diagnostic accuracy of FNAB [39].…”

Section: Discussionmentioning

confidence: 99%

The synergic effect of BRAF<sup>V600E</sup> mutation and multifocality on central lymph node metastasis in unilateral papillary thyroid carcinoma

Qu¹,

Hu³

et al. 2018

Endocr J

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Abstract. The purpose of this study is to evaluate the potential synergic effect of BRAF V600E mutation and multifocality on central lymph nodes metastasis (CLNM) in the patients with unilateral papillary thyroid carcinoma (PTC). We enrolled 413 patients with unilateral PTCs who accepted prophylactic unilateral or bilateral central lymph node dissection (LND). Univariate and multivariate analyses were made to determine the association between related factors and CLNM. Then, all patients were divided into 4 groups based on their status of BRAF V600E mutation and multifocality. Relative excess risk of interaction (RERI), attributable proportion (AP) of interaction and synergy index (SI) were applied to evaluate the interactive effect of these two factors on CLNM. Results showed that BRAF V600E mutation and multifocality were independent risk factors for CLNM. A further study revealed that unilateral PTCs accompanying multifocality with BRAF V600E mutation had the highest incidence of CLNM compared with other subgroups. Besides, RERI was 4.323 (95% CI = 1.276-7.369), AP was 0.523 (95% CI = 0.364-0.682) and SI was 2.469 (95% CI = 1.607 to 3.794), indicating a significant additive interaction of BRAF V600E mutation and multifocality on CLNM. The present study has confirmed that BRAF V600E mutation and multifocality are risk factors for CLNM in unilateral PTC. Additionally, unilateral PTC patients accompanying multifocality with BRAF V600E mutation may have an increased risk of CLNM in clinically negative CLNM.

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“…[2] It is well-known for its usually mild clinical course among the cancers with a very high 10-year survival rate (>90%). [6][7][8] However, the recurrence rate has been reported to range between 20% and 30% especially in the neck lymph nodes. [9,10] Thus, the early diagnosis of PTC is vital.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] The overall prognosis of PTC is good with a 10-year survival rate of >90%. [6][7][8] However, the recurrence rate has been reported to range from 20% to 30% especially in the neck lymph nodes. [9,10] The early diagnosis and management of PTC continued remaining a priority.…”

Section: Introductionmentioning

confidence: 99%

BRAF V600E mutation and the Bethesda System for Reporting Thyroid Cytopathology of fine-needle aspiration biopsy for distinguishing benign from malignant thyroid nodules

Sheng

et al. 2021

Medicine

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Background: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) predicts the risk of malignancy for the different categories of the ultrasound-guided fine-needle aspiration biopsy (FNAB). The objective of this study is to investigate the efficiencies of the v-raf murine sarcoma viral oncogene homolog B1 ( BRAF ) V600E mutation test and the TBSRTC categories in distinguishing between benign and malignant thyroid nodules. Methods: In this study, 362 ultrasound-guided fine-needle aspiration (FNA) samples from 344 patients aged from 17 to 76 years old were retrospectively reviewed. The patients were classified into six groups (I–VI) according to the TBSRTC system. The amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) was used to evaluate the BRAF V600E mutation level in total 362 samples. Among of the 344 patients, 128 patients (131 thyroid nodules) who underwent surgeries were followed by histopathological examination. The predictive values of the BRAF V600E mutation test and TBSRTC categories were evaluated in these 131 thyroid nodules. Results: The median ages of the patients in the TBSRTC IV–VI group were smaller than those in the TBSRTC I–III groups. The proportion of nodules over 1 cm was larger than it in the TBSRTC IV group compared to the other groups. Significant differences in BRAF V600E mutation were observed ( P < .001) among these six groups. The sensitivity (89.57%) for the detection of malignant thyroid nodules, negative predictive value (NPV; 45.45%) for the detection of benign nodules, and accuracy (86.26%) for distinguishing between benign and malignant thyroid nodules increased by combining the BRAF V600E mutation test and TBSRTC system when compared with the BRAF V600E mutation test and TBSRTC system respectively. The BRAF V600E mutation test alone demonstrated the increased positive predictive value (PPV; 98.91%) and specificity (93.75%) for the detection of malignant thyroid nodules compared to the TBSRTC method (alone or in combination with the BRAF V600E method). Conclusion: In summary, significant differences in age, nodule diameter, and BRAF V600E mutation were noted among the six categories of the TBSRTC system. The combination of the BRAF V600E mutation test and TBSRTC system demonstrated increases in the NPV, sensitivity, and accuracy, while the BRAF V600E method proved superiority to the TBSRTC system with regard to the PPV and specificity.

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BRAF V600E detection in cytological thyroid samples: A key component of the decision tree for surgical treatment of papillary thyroid carcinoma

Abstract: The preoperative knowledge of the V600E mutation status is fundamental to plan total thyroidectomy with certainty and should be part of the decision tree for the management of thyroid nodules. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1017-1021, 2016.

Cited by 6 publications

References 21 publications

Significance of FNAC, BRAF mutation, and intraoperative frozen section in surgical decision‐making of thyroid nodules

Significance of FNAC, BRAF mutation, and intraoperative frozen section in surgical decision‐making of thyroid nodules

The synergic effect of BRAF<sup>V600E</sup> mutation and multifocality on central lymph node metastasis in unilateral papillary thyroid carcinoma

BRAF V600E mutation and the Bethesda System for Reporting Thyroid Cytopathology of fine-needle aspiration biopsy for distinguishing benign from malignant thyroid nodules

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