Author(s): Xing M, Clark D, Guan H, Ji M, Dackiw A,
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Abstract PURPOSE: This study investigated the utility of BRAF mutation testing of thyroid fine-needle aspiration biopsy (FNAB) specimens for preoperative risk stratification in papillary thyroid cancer (PTC). PATIENTS AND METHODS: We assessed the T1799A BRAF mutation status in thyroid FNAB specimens obtained from 190 patients before thyroidectomy for PTC and its association with clinicopathologic characteristics of the tumor revealed postoperatively. RESULTS: We observed a significant association of BRAF mutation in preoperative FNAB specimens with poorer clinicopathologic outcomes of PTC. In comparison with the wild-type allele, BRAF mutation strongly predicted extrathyroidal extension (23\% v 11\%; P = .039), thyroid capsular invasion (29\% v 16\%; P = .045), and lymph node metastasis (38\% v 18\%; P = .002). During a median follow-up of 3 years (range, 0.6 to 10 years), PTC persistence/recurrence was seen in 36\% of BRAF mutation-positive patients versus 12\% of BRAF mutation-negative patients, with an odds ratio of 4.16 (95\% CI, 1.70 to 10.17; P = .002). The positive and negative predictive values for preoperative FNAB-detected BRAF mutation to predict PTC persistence/recurrence were 36\% and 88\% for overall PTC and 34\% and 92\% for conventional PTC, respectively. CONCLUSION: Preoperative BRAF mutation testing of FNAB specimens provides a novel tool to preoperatively identify PTC patients at higher risk for extensive disease (extrathyroidal extension and lymph node metastases) and those who are more likely to manifest disease persistence/recurrence. BRAF mutation, as a powerful risk prognostic marker, may therefore be useful in appropriately tailoring the initial surgical extent for patients with PTC.
This article was published in J Clin Oncol
and referenced in Journal of Thyroid Disorders & Therapy