The BRAF V600E mutation in papillary thyroid cancer with positive or suspected pre-surgical cytological finding is not associated with advanced stages or worse prognosis

• Published in: Endocrine 2014-04, Vol.45 (3), p.462-468
• Main Authors: Barbaro, Daniele, Incensati, Roberto Mario, Materazzi, Gabriele, Boni, Giuseppe, Grosso, Mariano, Panicucci, Erica, Lapi, Paola, Pasquini, Cristina, Miccoli, Paolo
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biomarkers, Tumor; Biopsy, Fine-Needle; Carcinoma - genetics; Carcinoma - pathology; Carcinoma - radiotherapy; Carcinoma - surgery; Carcinoma, Papillary; Diabetes; Endocrinology; Female; Follow-Up Studies; Humanities and Social Sciences; Humans; Internal Medicine; Iodine Radioisotopes - administration & dosage; Male; Medicine; Medicine & Public Health; Middle Aged; multidisciplinary; Mutation - genetics; Neoplasm Grading; Neoplasm Staging; Original Article; Prognosis; Proto-Oncogene Proteins B-raf - genetics; Science; Sequence Analysis, DNA - instrumentation; Sequence Analysis, DNA - methods; Thyroid Cancer, Papillary; Thyroid Neoplasms - genetics; Thyroid Neoplasms - pathology; Thyroid Neoplasms - radiotherapy; Thyroid Neoplasms - surgery; Treatment Outcome; Young Adult
• ISSN: 1355-008X; 1559-0100
• DOI: 10.1007/s12020-013-0029-5

The mutation BRAF V600E is thought to be a putative prognostic marker of the aggressiveness of several cancers among which is also papillary thyroid cancer. Our study aimed to evaluate whether this mutation is associated with advanced stages of disease or with a worse prognosis in a series of patients with cytological findings of Thyr 4 and Thyr 5 and who were undergoing total thyroidectomy and routine central compartment lymph-node dissection. 110 patients were consecutively enrolled over an 18-month period from September 2010 to March 2012. All patients had cytological findings that were either indicative of, or positive for papillary thyroid cancer, Thyr 4 or Thyr 5. Detection of BRAF mutation was made on fine-needle aspiration specimen by pyrosequencing after microdissection and DNA extraction of neoplastic cells. After surgical intervention, the patients underwent radioiodine ablation according to our protocol, and follow-up was performed after 8 months. The BRAF V600E mutation was found in 79 % of our cases: 85.7 % of these cases represented the classical variant, 57.8 % the follicular variant, 89.6 % the tall cell variant, and 33.3 % the solid variant. All patients had confirmation of papillary thyroid cancer after histology, with no differences being seen in pTNM presentation between patients with BRAF wild-type and patients with BRAF V600E mutation. Ninety-nine patients underwent radioiodine ablation. Results at follow-up 8 months after radioiodine ablation showed no differences in the rate of ablation between patients harboring BRAF V600E mutation and those having BRAF wild-type. The BRAF V600E mutation doesn’t appear to be a reliable risk factor for the aggressiveness of a tumor. BRAF analysis should neither be the only guide for pre-surgical decisions regarding the extent of surgery nor for post-surgical decisions regarding the aggressiveness of the treatment.