A Piece of the Puzzle: What Does BRAF Status Mean in the Management of Patients with Papillary Thyroid Carcinoma?

摘要

In summary, a number of studies, including the current study by Sancisi et al. (8), suggest that the BRAF mutation may not be the initiating event in BRAF+ tumors and may not, independent of histology, predict the risk of aggressive disease. So, based on our current knowledge, how should clinicians use BRAF status to manage their patients? For pa- tients with typical papillary cancer on cytology, genotyping is not needed for diagnosis. For patients with an indetermi- nate lesion, a positive test for BRAF (obtained as part of a more comprehensive panel because BRAF alone would be insufficiently sensitive) is almost diagnostic of papillary can- cer, and those patients should have a total thyroidectomy. At this time, the evidence is insufficient to warrant routine pre- operative BRAF testing to determine the extent of surgery or testing of the primary tumor to direct subsequent treatment. The determination of BRAF status and the choice of tyrosine kinase inhibitors or other agents for patients with progres- sive, iodine-refractory disease remains investigational. More pieces of the puzzle will be needed before we have a clear picture of the place of BRAF status in the management of patients with thyroid cancer.