Abstract
Papillary thyroid carcinoma (PTC) is the most prevalent thyroid neoplasm, classified into BRAF-like and RAS-like subtypes. Nuclear alterations serve as a diagnostic criterion of PTC and are fully manifested in BRAF-like. This single-center retrospective study aimed to assess the different presentation of nuclear features in 40 samples of BRAFV600E- and 40 samples of RAS-mutated PTCs using both bivariate and multivariate analytic approaches. Nuclear features are evaluated histologically using the 3-point and 8-point scoring systems established by the World Health Organization and the Asian Thyroid Working Group, respectively. We found the presence of membrane irregularities, nuclear elongation, nuclear groove, sickle-shaped nuclei, nuclear pseudoinclusion, and higher nuclear scores are significantly associated with BRAFV600E. Multivariate analysis showed that nuclear pseudoinclusion is predictive for the presence of BRAFV600E mutation (OR=10.97, 95%CI=2.81-42.96, p=0.001) and has sensitivity of 55%, specificity of 92.5%, positive predictive value of 88%, negative predictive value of 67.3%, and accuracy of 73.8%. There are various pathways and protooncogenes associated with the development of thyroid neoplasm. This study found significant differences in nuclear features between BRAFV600E and RAS-mutated PTC. BRAFV600E tend to display florid nuclear features, whereas the RAS- mutation is associated with subtle nuclear features. These findings emphasize the distinct cytological profiles of BL and RL PTC, reinforcing the need for precise subtyping to guide tailored management.
Published Version
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