Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2024
Histopathologic and Clinical Features of Bethesda III-VI Nodules Harboring Isolated RAS Mutations.
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Seo Young-Ji, Huston-Paterson Hattie H, Schumm Max A, Longstaff Xochitl R, Hughes Elena G, Tseng Chi-Hong, Cheung Dianne S, Yeh Michael W, Wu James X, Livhits Masha J
Аннотация
OBJECTIVE: Although thyroid tumors possessing isolated RAS mutations are generally considered to be indolent, the oncologic outcomes of tumors evaluated with comprehensive molecular testing have not been well characterized.
METHODS: We performed a retrospective cohort study of 368 consecutive patients with Bethesda III-VI thyroid nodules at a single institution (2016-2021) who underwent molecular testing with ThyroSeq v3. Patients with isolated RAS mutations were identified, and those with isolated BRAF V600E-mutated cancers were used as comparators. Outcomes of interest included rate of malignancy, high-risk histopathologic features, and structural disease recurrence.
RESULTS: A total of 50 patients (14%) had an isolated RAS-mutated nodule, of whom 41 underwent surgery (median age, 43 years; female, 83%). The malignancy rate on final pathology was 46%, whereas 32% of patients had noninvasive follicular thyroid neoplasm with papillary-like nuclear features and 22% had benign histopathology. In comparison, the isolated BRAF-mutated cohort (86 [24%] patients; median age, 45 years; female, 68%) had a 100% rate of malignancy. Only 2 (11%) of the isolated RAS patients with malignant histopathology had lymph node metastasis, compared with 34 (39%) of the BRAF cohort (P = .016). Over a median follow-up of 5 years, no patients with isolated RAS mutations had a structural recurrence compared with 5 patients (6%) in the isolated BRAF cohort.
CONCLUSION: Bethesda III-VI thyroid nodules with isolated RAS mutations have a low rate of aggressive histopathologic features and are unlikely to recur. Thyroid lobectomy may be sufficient treatment for these tumors.
METHODS: We performed a retrospective cohort study of 368 consecutive patients with Bethesda III-VI thyroid nodules at a single institution (2016-2021) who underwent molecular testing with ThyroSeq v3. Patients with isolated RAS mutations were identified, and those with isolated BRAF V600E-mutated cancers were used as comparators. Outcomes of interest included rate of malignancy, high-risk histopathologic features, and structural disease recurrence.
RESULTS: A total of 50 patients (14%) had an isolated RAS-mutated nodule, of whom 41 underwent surgery (median age, 43 years; female, 83%). The malignancy rate on final pathology was 46%, whereas 32% of patients had noninvasive follicular thyroid neoplasm with papillary-like nuclear features and 22% had benign histopathology. In comparison, the isolated BRAF-mutated cohort (86 [24%] patients; median age, 45 years; female, 68%) had a 100% rate of malignancy. Only 2 (11%) of the isolated RAS patients with malignant histopathology had lymph node metastasis, compared with 34 (39%) of the BRAF cohort (P = .016). Over a median follow-up of 5 years, no patients with isolated RAS mutations had a structural recurrence compared with 5 patients (6%) in the isolated BRAF cohort.
CONCLUSION: Bethesda III-VI thyroid nodules with isolated RAS mutations have a low rate of aggressive histopathologic features and are unlikely to recur. Thyroid lobectomy may be sufficient treatment for these tumors.