J Appl Biomed 22:214-220, 2024 | DOI: 10.32725/jab.2024.025

BRAF V600E positive papillary thyroid carcinoma (TERT and TP53 mutation coexistence excluded): Correlation of clinicopathological features and the extent of surgical treatment and its complications

Jiří Hložek^{1, 2, *}, Jan Rotnágl^{1, 2}, Richard Holý^{1, 2}, Tereza Hložková³, Barbora Peková Bulanová⁴, Vlasta Kuklíková⁴, Běla Bendlová⁴, Jiří Soukup^{5, 6, 7}, Petr Hrabal⁵, Jaromír Astl^{1, 2}

¹ Military University Hospital Prague, Department of Otorhinolaryngology and Maxillofacial Surgery, Prague, Czech Republic

² Charles University, Third Faculty of Medicine, Prague, Czech Republic

³ Masaryk University, St. Anne's University Hospital, Medical Faculty Brno, Department of Otorhinolaryngology and Head and NeckSurgery, Brno, Czech Republic

⁴ Institute of Endocrinology, Department of Molecular Endocrinology, Prague, Czech Republic

⁵ Military University Hospital, Department of Pathology, Prague, Czech Republic

⁶ Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, The Fingerland Department of Pathology, Hradec Králové, Czech Republic.

⁷ Charles University, First Faculty of Medicine and General University Hospital in Prague, Department of Pathology, Prague, Czech Republic

Introduction: Papillary thyroid carcinoma (PTC) frequently harbors the BRAF V600E mutation. Recent research suggests that aggressive behavior in BRAF V600E+ PTC may be due to an undetected mutation in the TERT gene. This study aims to observe the clinicopathological features of BRAF V600+ PTC and correlate them with surgical treatment complications.

Methods: A retrospective analysis was conducted on the BRAF V600E+ PTC cohort from July 2019 to January 2023. The histopathological features and surgical treatment (total thyroidectomy - group A, total thyroidectomy + central block neck dissection - group B) complications were correlated. Patients with TERT and TP53 mutation were excluded. Next-generation sequencing and real-time PCR were used for genetic analysis.

Results: Out of 121 PTCs, 65 cases showed BRAF V600E mutation with the following features: intracapsular spread (13.8%), extracapsular spread (27.7%), extrathyroidal spread (15.4%), multifocality (26.2%), angioinvasion (12.3%), and local metastasis (27.7%). The incidence of surgical complications in group A/B was: reversible recurrent laryngeal nerve (RLN) paresis 3.7/7.1%, RLN paresis permanent 0/2.4%, paresthesia 6.8/23.8%, hypocalcemia 36.4/61.9% on day 1 and 27.3/33.3% on day 3, and bleeding 2.3/9.5%. There was no significant difference in clinicopathological features between the BRAF V600E+ and BRAF V600E- PTC groups. Group B had a significantly higher incidence of hypoacalcaemia on postoperative day 1 (p = 0.047).

Conclusion: The BRAF V600E mutation will certainly remain important in the preoperative diagnosis of PTC. The more radical surgical procedures currently recommended may be abandoned in the future, particularly elective CLND, which has a higher risk of postoperative complications.

Keywords: BRAF V600E; Cancer; Clinicopathologic features; Complications; Mutation; Papillary Thyroid Carcinoma (PTC); Surgery; TERT; Thyroid

Grants and funding:

The study was supported by the Ministry of Defense of the Czech Republic - Project MO 1012 and by the Ministry of Health of the Czech Republic AZV (NU21-01-00448) and MH CZ-DRO (Institute of Endocrinology, 00023761) grants.

Conflicts of interest:

The authors declare no conflicts of interest related to the topic, preparation, or publication of this study. They also state that no pharmaceutical company provided support for the preparation or publication of this work.

Received: September 12, 2024; Revised: November 22, 2024; Accepted: December 5, 2024; Prepublished online: December 9, 2024; Published: December 18, 2024  Show citation