Pathologic Features Associated With Molecular Subtypes of Well-Differentiated Thyroid Cancer.

Alice L Tang, Richard T Kloos, Benjamin Aunins, Tammy M Holm, Mara Y Roth, Michael W Yeh, Gregory W Randolph, Meredith E Tabangin, Mekibib Altaye, David L Steward

Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists 2021 Mar

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To determine the association between pathologic features and molecular classes (BRAF-like, RAS-like, and non-BRAF-like non-RAS-like [NBNR]). Retrospective review of a merged database containing 676 patients, 84% (571/676) were assigned to a molecular class from publicly accessible sequenced data of thyroid neoplasms. The merged cohort included 571 neoplasms: 353 (62%) BRAF-like, 172 (30%) RAS-like, and 46 (8.1%) NBNR. Lymph node metastasis (any N1 disease) was present in 166/337 (49%) of BRAF-like, 23/164 (14%) of RAS-like, and 0/46 (0%) of NBNR and are significantly different (P < .001). Gross extra-thyroidal extension was observed in 27 patients, including 24/331 (7%) of BRAF-like, 2/160 (1%) of RAS-like, and 1/46 (2%) of NBNR (P = .01). N1B lymph node metastases or T4 disease was present in 74/333 (22%) of BRAF-like, 10/160 (6%) of RAS-like, and 1/46 (2%) of NBNR (P < .0001). Distant metastasis was present in 4/151 (2.6%) of BRAF-like, 2/50 (4%) of RAS-like and 0/46 for NBNR (P = .627). Angioinvasion was present in 0/81 (0%) of BRAF-like, 3/53 (6%) of RAS-like, and 3/46 (7%) of NBNR (P = .08); and multifocality was present in 27/81 (33%) of BRAF-like, 9/53 (17%) of RAS-like, and 1/46 (2%) for NBNR (P = .0001). Pathological features of metastasis, gross extra-thyroidal extension, and multifocality were more prevalent in BRAF-like samples compared to RAS-like and NBNR. A trend towards increased frequency of angioinvasion in RAS-like and NBNR cancers compared to BRAF-like samples was observed. Further studies are needed to evaluate if preoperative knowledge of molecular mutations in thyroid tumors aids in decision-making regarding extent of surgery. Copyright © 2020 AACE. Published by Elsevier Inc. All rights reserved.

Citation

Alice L Tang, Richard T Kloos, Benjamin Aunins, Tammy M Holm, Mara Y Roth, Michael W Yeh, Gregory W Randolph, Meredith E Tabangin, Mekibib Altaye, David L Steward. Pathologic Features Associated With Molecular Subtypes of Well-Differentiated Thyroid Cancer. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2021 Mar;27(3):206-211