Is molecular testing in patients with low risk papillary thyroid carcinoma justified? A Markovian model

Abstract

BackgroundCurrent guidelines consider all cases of papillary thyroid carcinoma (PTC) smaller than 4 cm and without extrathyroidal extension (ETE) and/or lymph node metastases as belonging to the same prognostic group, and therefore the recommendation is for uniform treatment. Xing draws our attention to a small subgroup with Duet Mutations (BRAF E600 and TERT 3636 genes) that are aggressive biologically and should be treated differently. Thus the aim of the present study is to test the validity of this recommendation. MethodsA Markovian Model is used to evaluate the above hypothesis. ResultsA Monte Carlo sensitivity test shows a 5.6 year survival advantage for patients with low-grade PTC, who have the Duet Mutations, and were treated by total thyroidectomy rather than hemithyroidectomy. ConclusionsWe conclude that there is a place for routine molecular tests in low-risk patients with PTC.