Surgical results of thyroid nodules according to a management guideline based on the BRAF(V600E) mutation status.
BACKGROUND
In Korea, where PTC comprises about 90-95% of the reported thyroid cancers, the prevalence of BRAF(V600E) mutation in papillary thyroid carcinoma (PTC) is above 80%.


OBJECTIVE
We analyzed the surgical result according to a management guideline based on the BRAF(V600E) mutation status of thyroid nodules.


METHODS
A total of 865 thyroid nodules were prospectively analyzed for their cytology and BRAF(V600E) mutation status by pyrosequencing. For the patients who had a diagnosis of atypical cells of undetermined significance (ACUS), we recommended surgery when there was positivity for BRAF(V600E) mutation or the nodules were clinically suspicious.


RESULTS
Among 865 cases, 504, 141, 54, 140, 10, and 16 were diagnosed as benign, ACUS, suspicious for malignancy, malignant, suspicious for follicular neoplasm, and nondiagnostic, respectively. None of the 504 benign, 45 (31.9%) of the 141 ACUS, 46 (85.2%) of the 54 suspicious for malignancy, 129 (92.1%) of the 140 malignant, and one (10%) of the 10 suspicious for follicular neoplasm cases showed BRAF(V600E) mutation. Surgery was recommended to all 45 patients with BRAF(V600E) mutation-positive ACUS nodules; among them, 30 patients underwent surgery, 29 had PTC, and one had nodular hyperplasia. All the patients diagnosed as suspicious for malignancy or malignant were advised to undergo an operation, and they turned out to have PTCs regardless of their BRAF(V600E) mutation status.


CONCLUSIONS
We found that performing BRAF(V600E) mutation analysis on the fine-needle aspiration biopsy specimens was of great help to make a therapeutic decision for thyroid nodules when the fine-needle aspiration biopsy results were equivocal.
Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea.
Suk Kyeong
SK
Kim
Tae Sook
TS
Hwang
Young Bum
YB
Yoo
Hye Seung
HS
Han
Dong-Lim
DL
Kim
Kee-Ho
KH
Song
So Duk
SD
Lim
Wan Seop
WS
Kim
Nam Sun
NS
Paik
D044963:Biopsy, Fine-Needle; D002291:Carcinoma, Papillary / Q000235:genetics* / Q000601:surgery*; D045744:Cell Line, Tumor; D004252:DNA Mutational Analysis; D017408:Guidelines as Topic; D006801:Humans; D009154:Mutation / Q000235:genetics* / Q000502:physiology*; D018579:Patient Selection; D011237:Predictive Value of Tests; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics*; D056910:Republic of Korea; D020133:Reverse Transcriptase Polymerase Chain Reaction; D016606:Thyroid Nodule / Q000235:genetics* / Q000473:pathology / Q000601:surgery*
C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf