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BioMed Research International
Volume 2015 (2015), Article ID 486391, 7 pages
http://dx.doi.org/10.1155/2015/486391
Clinical Study

BRAF Testing in Multifocal Papillary Thyroid Carcinoma

1Department of Pathology and Laboratory Medicine, Tulane University, 1430 Tulane Avenue SL-79, New Orleans, LA 70112, USA
2Department of Mathematics, Tulane University, 6823 St. Charles Avenue, New Orleans, LA 70118, USA
3Department of Medicine, Tulane University, 1430 Tulane Avenue SL-12, New Orleans, LA 70112, USA
4Department of Surgery, Tulane University, 1430 Tulane Avenue SL-22, New Orleans, LA 70112, USA

Received 6 January 2015; Revised 3 March 2015; Accepted 8 March 2015

Academic Editor: Aurelio Ariza

Copyright © 2015 Hillary Z. Kimbrell et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. BRAF V600E mutation is associated with poor prognosis in patients with papillary thyroid carcinoma (PTC). PTC is often multifocal, and there are no guidelines on how many tumors to test for BRAF mutation in multifocal PTC. Methods. Fifty-seven separate formalin-fixed and paraffin-embedded PTCs from twenty-seven patients were manually macrodissected and tested for BRAF mutation using a commercial allele-specific real-time polymerase chain reaction-based assay (Entrogen, Woodland Hills, CA). Data related to histologic characteristics, patient demographics, and clinical outcomes were collected. Results. All mutations detected were BRAF V600E. Seventeen patients (63%) had concordant mutation status in the largest and second-largest tumors (i.e., both were positive or both were negative). The remaining ten patients (37%) had discordant mutation status. Six of the patients with discordant tumors (22% overall) had a BRAF-negative largest tumor and a BRAF-positive second-largest tumor. No histologic feature was found to help predict which cases would be discordant. Conclusions. Patients with multifocal PTC whose largest tumor is BRAF-negative can have smaller tumors that are BRAF-positive. Therefore, molecular testing of more than just the dominant tumor should be considered. Future studies are warranted to establish whether finding a BRAF mutation in a smaller tumor has clinical significance.