Abstract Background The clinical relevance of the BRAF V600E mutation in the surgical management of early-stage differentiated thyroid carcinoma (DTC) remains unclear. Although common in papillary thyroid carcinoma, its role in guiding surgical decisions in low-risk disease is still debated. Methods We conducted a retrospective single-center study of patients with low-risk DTC (T1–2N0M0) treated surgically between 2000 and 2024. Preoperative BRAF V600E status was available in a subset of patients. The primary endpoint was the association between BRAF status and extent of surgery (lobectomy vs. total thyroidectomy). Secondary endpoints included central compartment lymph node metastases, use of postoperative radioiodine therapy, recurrence requiring reoperation, and overall outcomes. Results Of 196 patients, BRAF status was known in 91 (42 positive, 49 negative). Baseline characteristics were similar between groups. Total thyroidectomy was more frequent in BRAF-positive patients (69% vs. 35.7%; OR 4.199, p = 0.011). Central compartment lymph node metastases were also more common in BRAF-positive tumors (45.2% vs. 14.3%; OR 4.957, p = 0.014). However, rates of clinically significant metastases (≥ 5 nodes or > 2 mm) did not differ significantly. Radioiodine therapy was used more often in BRAF-positive patients (64.3% vs. 30.6%; OR 4.08, p = 0.013). No significant differences in overall treatment outcomes were observed at the end of follow-up. Conclusion BRAF V600E mutation was associated with higher rates of lymph node metastases and more aggressive treatment but did not impact long-term outcomes. These findings support current recommendations that BRAF status alone should not determine surgical extent in low-risk DTC.
Králik et al. (Tue,) studied this question.