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Presurgical screening of fine needle aspirates from thyroid nodules for BRAF mutations: A prospective single center experience
Ramamoorthy Hemalatha1, Rekha Pai1, Marie T Manipadam1, Grace Rebekah2, Anish J Cherian3, Deepak T Abraham3, Simon Rajaratnam4, Nihal Thomas4, Pooja Ramakant3, Paul M Jacob3
1 Department of Pathology, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
2 Department of Biostatistics, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
3 Department of Endocrine Surgery, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
4 Department of Endocrinology and Metabolism, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
Correspondence Address:
Paul M Jacob
Department of Endocrine Surgery, Division of Surgery, Christian Medical College, Vellore, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijem.IJEM_126_18
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Objective: Analysis of BRAF V600E mutation in thyroid fine needle aspirates (FNA) is an important adjunct to cytology, particularly among FNA placed in the “indeterminate category.” However, such a prospective evaluation of FNA obtained from patients with thyroid nodules has been lacking from India. Material and Methods: FNA from 277 patients were prospectively evaluated for BRAF mutations by Sanger's sequencing. A subset of 30 samples was also analyzed by pyrosequencing using the PyroMark BRAF mutation kit. Results: Overall, 27.2% of FNA samples were positive for mutations including 19 (35.8%) of the 53 histologically confirmed papillary thyroid carcinoma (PTC), 2 of the 25 follicular variants of PTC, and 1 anaplastic thyroid carcinoma. Only 1 (2.7%) of the 37 samples in the atypia of undetermined significance/follicular lesion of unknown significance category was BRAF positive. The sensitivity of cytology improved marginally from 67.1% to 68.3% when evaluated with BRAF. Further, a comparison of the clinicopathological characteristics of BRAF positive and negative PTCs showed a significant association (P = 0.05) between lymph node metastasis and BRAF positivity. Conclusion: BRAF positivity was lower than that reported from East Asia with the test being useful in confirming malignancies among the suspicious of malignancy and malignant categories.
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