Surgical Perspective of T1799A BRAF Mutation Diagnostic Value in Papillary Thyroid Carcinoma

Background: Throughout Indonesia, thyroid cancer is one of the ten commonest malignancies, with papillarythyroid carcinoma (PTC) in our hospital accounting for about 60% of all thyroid nodules. Although fine needleaspiration biopsy (FNAB) is the most reliable diagnostic tool, some nodules are diagnosed as indeterminate andsecond surgery is common for PTC. The aim of this study was to establish the diagnostic value and feasibility oftesting the BRAF T1799A mutation on FNA specimens for improving PTC diagnosis. Materials and
Methods: Thisprospective study enrolled 95 patients with thyroid nodules and future surgery planned. Results of mutationalstatus were compared with surgical pathology diagnosis.
Results: Of the 70 cases included in the final analysis,62.8% were PTC and the prevalence of BRAF mutation was 38.6%. The sensitivity, specificity, positive predictivevalue (PPV), and negative predictive value (NPV) for BRAF mutation analysis were 36%, 100%, 100% and48%, respectively. With other data findings, nodules with “onset less than 5 year” and “hard consistency” wereproven as diagnostic determinants for BRAF mutation with a probability of 62.5%. This mutation was alsoa significant risk factor for extra-capsular extension.
Conclusions: Molecular analysis of the BRAF T1799Amutation in FNAB specimens has high specificity and positive predictive value for PTC. It could be used in theselective patients with clinical characteristics to facilitate PTC diagnosis and for guidance regarding extent ofthyroidectomy.