Value of BRAF V600E in High-Risk Thyroid Nodules with Benign Cytology Results

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Fig 1.
Diagram of the study group. PTMC indicates papillary thyroid microcarcinoma.
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Fig 2.
Right thyroid with a palpable lesion in a 20-year-old man. US scan of the right thyroid reveals a 25-mm hypoechoic nodule (arrow) with an irregular margin and microcalcification (A). The cytologic diagnosis from US-FNA is benign (B, HE stain, magnification 4X10) and positive for the BRAF V600E mutation. The nodule is confirmed as PTC by surgical pathology (C, HE stain, magnification 10X10).
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Fig 3.
An incidentally found nodule in a 69-year-old woman during US screening. US scans reveal a 13-mm hypoechoic nodule (arrrow) with microcalcification in the right thyroid (A). The cytologic diagnosis from US-FNA is benign (B, HE stain, magnification 4X10) and positive for the BRAF V600E mutation using direct DNA sequencing. The nodule is confirmed as a nodular goiter with underlying lymphocytic thyroiditis (C, HE stain, magnification 10X10).

Table 1:

Clinical and US features and characteristics of thyroid nodules with benign cytology

	Positive for BRAF V600E Mutation	Negative for BRAF V600E Mutation	P
No. of nodules	36	256
Diagnosis			<.001
Malignant	31	6
Benign	5	250
Age (mean) (yr)	44.7 ± 11.3	47.3 ± 13.9	.31
Sex			<.001
F	2	229
M	10	27
Mean size of nodules (mm)	9.4 ± 3.7	11.8 ± 4.1	.41
5–10	23	145
>10	13	112
No. of suspicious US features			<.001
1	11	243
2	17	12
3	7	1
4	1	0
Echogenicity			.11
Hyper- or isoechoic	1	15
Hypoechoic	30	229
Marked hypoechoic	5	12
Margin			.18
Circumscribed	15	137
Not circumscribed	21	119
Calcification			<.001
No calcifications	12	161
Microcalcification	21	72
Macrocalcification	3	23
Shape			<.01
Parallel	16	167
Taller-than-wide	20	89
Evidence of extrathyroidal growth	0	0
Pathologic adenopathy	2	0

Table 2:

Demographics of 5 patients whose nodules had benign cytology results and were positive for the BRAF V600E mutation

No.	Age (yr)	Sex	No. of Suspicious US Features	Size of the Nodules (mm)	Pathology Results
1	48	F	1	5.3	Nodule goiter
2	39	F	2	11	Fibrotic nodule with calcification
3	45	M	2	9	Nodule goiter
4	45	M	1	6	Nodule goiter with underlying lymphocytic thyroiditis
5	69	F	3	13	Nodule goiter with underlying lymphocytic thyroiditis