title: BRAF mutation status in papillary thyroid carcinoma: significance for surgical strategy.
abstract: BACKGROUND
  BRAF mutation is probably the only molecular marker acting as a risk factor that is available before surgery: for this reason, soon after it became quite widespread, it seemed an important tool as a guide towards an individualized surgical therapy in papillary thyroid carcinoma.
  
  
  OBJECTIVE
  Capsule invasion, multifocality, and lymph node involvement are the most important parameters influencing the choice of surgical strategy in front of small papillary cancers and, in more detail, of micro papillary carcinomas. The relationship between these parameters and the BRAF mutation are closely examined through the more recent literature. Capsular invasion seems to show the strongest correlation with the mutation and this has important correlations, thus suggesting that a more aggressive local surgery might be advisable, whereas the correlation between the mutation and lymph node involvement would be weaker, at least according to the most recent studies.
  
  
  CONCLUSIONS
  The personalization of surgical therapy, today, seems easier to achieve thanks to molecular testing. In particular, an important result could be in the short term reduction in the number of completion thyroidectomies following simple lobectomies. Also, post operative radioactivated iodine therapies should be more carefully evaluated and tailored according to BRAF status. A possible flow chart for the decision of the therapeutic approach is proposed in accordance to the results of the literature.
authors.affiliation: Department of Surgical Pathology, University of Pisa, Pisa, Italy, paolo.miccoli@dc.unipi.it.
authors.forename: P
authors.initials: P
authors.lastname: Miccoli
authors.forename: F
authors.initials: F
authors.lastname: Basolo
mesh_terms: D002277:Carcinoma / Q000235:genetics* / Q000473:pathology / Q000601:surgery*; D002291:Carcinoma, Papillary; D004252:DNA Mutational Analysis; D005819:Genetic Markers / Q000235:genetics; D006801:Humans; D008207:Lymphatic Metastasis / Q000235:genetics / Q000473:pathology; D009361:Neoplasm Invasiveness / Q000235:genetics / Q000473:pathology; D057285:Precision Medicine; D011379:Prognosis; D048493:Proto-Oncogene Proteins B-raf; D012307:Risk Factors; D013223:Statistics as Topic; D000077273:Thyroid Cancer, Papillary; D013961:Thyroid Gland / Q000473:pathology; D013964:Thyroid Neoplasms / Q000235:genetics* / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods
chemical_list: D005819:Genetic Markers; C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf