Surgical tactics optimization for treatment of BRAF positive papillary thyroid cancer

Backgraund. Papillary thyroid cancer (PTC) has a favorable course and low mortality rates. However, the incidence of morbidity and mortality continues to increase, especially in the high-risk group. BRAF mutation is a marker of the PTC aggressive course.

Aims. Тo study the relationship between surgical treatment tactics and the BRAF positive PTC prognosis.

Materials and methods. Our prospective study included 80 patients with BRAF positive PTC, operated from 2009 to 2016 y. Surgical tactics were determined by existing clinical guidelines. To the patients with BRAF positive thyroid cancer it is proposed to perform thyroidectomy with central compartment lymph node dissection. BRAF status was determined by the PCR method in fine needle aspiration biopsy material (FNAB).

Results. Recurrence was detected in 7 of the 18 patients of the hemi/thyroidectomy group. Among 62 patients from the group of thyroidectomy with central compartment lymph node dissection recurrence was detected only in 3 cases. The mean recurrence time also differed significantly, and in the group of patients with (hemi)thyroidectomy without central compartment lymph node dissection is detected earlier (53 months and 59.61 months). Also, organ-preserving operations without central compartment lymph node dissection in BRAF positive tumor has worse result, regardless of T stage.

Conclusions. In the presence of BRAF-positive PTC thyroidectomy with central compartment lymph node dissection is indicated.

papillary thyroid cancer, BRAF mutation, thyroidectomy, central compartment lymph node dissection

1. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1-133. doi: 10.1089/thy.2015.0020.

2. Бельцевич Д.Г., Ванушко В.Э., Мельниченко Г.А., и др. Российские клинические рекомендации по диагностике и лечению дифференцированного рака щитовидной железы у взрослых. Проект. Редакция 2016 г. // Эндокринная хирургия. – 2015. – Т. 9. – №3. – C. 7–14. [Bel’tsevich DG, Vanushko VE, Mel’nichenko GA, et al. Russian clinical practice guidelines for diagnosis and treatment of differentiated thyroid cancer. Endocrine Surgery. 2015;9(3):7-14. (In Russ.)] doi: 10.14341/serg201537-14.

3. Tuttle RM, Haugen B, Perrier ND. Updated American Joint Committee on Cancer/Tumor-Node-Metastasis Staging System for Differentiated and Anaplastic Thyroid Cancer (Eighth Edition): What changed and why? Thyroid. 2017;27(6):751-756. doi: 10.1089/thy.2017.0102.

4. Haugen BR, Sawka AM, Alexander EK, et al. American Thyroid Association Guidelines on the Management of Thyroid Nodules and Differentiated Thyroid Cancer Task Force Review and Recommendation on the Proposed Renaming of Encapsulated Follicular Variant Papillary Thyroid Carcinoma Without Invasion to Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features. Thyroid. 2017;27(4):481-483. doi: 10.1089/thy.2016.0628.

5. Force USPST, Bibbins-Domingo K, Grossman DC, et al. Screening for Thyroid Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2017;317(18):1882-1887. doi: 10.1001/jama.2017.4011.

6. Lim H, Devesa SS, Sosa JA, et al. Trends in thyroid cancer incidence and mortality in the United States, 1974-2013. JAMA. 2017;317(13):1338-1348. doi: 10.1001/jama.2017.2719.

7. Choi YM, Kim WG, Kwon H, et al. Changes in standardized mortality rates from thyroid cancer in Korea between 1985 and 2015: Analysis of Korean national data. Cancer. 2017;123(24):4808-4814. doi: 10.1002/cncr.30943.

8. Paschke R, Cantara S, Crescenzi A, et al. European Thyroid Association Guidelines regarding thyroid nodule molecular fine-needle aspiration cytology diagnostics. Eur Thyroid J. 2017;6(3): 115-129. doi: 10.1159/000468519.

9. Cooper DS, Doherty GM, Haugen BR, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2006;16(2):109-142. doi: 10.1089/thy.2006.16.109.

10. Диагностика и лечение дифференцированного рака щитовидной железы. Национальные клинические рекомендации, принятые на XI Российском онкологическом конгрессе и IV Всероссийском тиреоидологическом конгрессе. // Эндокринная хирургия. – 2008. – Т. 2. – №1. – С. 3–5. [Diagnostika i lechenie differentsirovannogo raka shchitovidnoy zhelezy. Natsional’nye klinicheskie rekomendatsii, prinyatye na XI Rossiyskom onkologicheskom kongresse i IV Vserossiyskom tireoidologicheskom kongresse. Endocrine Surgery. 2008;2(1):3-5. (In Russ.)] doi: 10.14341/2306-3513-2008-1-3-5.

11. Al Afif A, Williams BA, Rigby MH, et al. Multifocal papillary thyroid cancer increases the risk of central lymph node metastasis. Thyroid. 2015;25(9):1008-1012. doi: 10.1089/thy.2015.0130.

12. Kimbrell HZ, Sholl AB, Ratnayaka S, et al. BRAF testing in multifocal papillary thyroid carcinoma. Biomed Res Int. 2015; 2015:486391. doi: 10.1155/2015/486391.

13. Miccoli P, Basolo F. BRAF mutation status in papillary thyroid carcinoma: significance for surgical strategy. Langenbecks Arch Surg. 2014;399(2):225-228. doi: 10.1007/s00423-013-1153-7.

14. Liu LS, Liang J, Li JH, et al. The incidence and risk factors for central lymph node metastasis in cN0 papillary thyroid microcarcinoma: a meta-analysis. Eur Arch Otorhinolaryngol. 2017;274(3):1327-1338. doi: 10.1007/s00405-016-4302-0.

15. Qu H, Sun GR, Liu Y, He QS. Clinical risk factors for central lymph node metastasis in papillary thyroid carcinoma: a systematic review and meta-analysis. Clin Endocrinol (Oxf). 2015;83(1): 124-132. doi: 10.1111/cen.12583.