Clinical impact of BRAF mutation on the diagnosis and prognosis of papillary thyroid carcinoma: a systematic review and meta-analysis

Background The possible role of BRAFV600E mutation in the diagnosis and prognosis of papillary thyroid carcinoma (PTC) remains controversial. A systematic review to investigate the diagnostic and prognostic role of BRAFV600E mutation in patients with PTC is urgently needed. Methods A systematic review of relevant literatures was performed in PubMed, EMBASE and CENTRAL. The incremental accuracy (IA) of fine needle aspiration biopsy plus BRAFV600E mutation analysis over fine needle aspiration biopsy alone, and the statistical data about the association of BRAFV600E mutation and the prognosis of PTC (risk ratios (RR) for dichotomous data, standard mean differences for continuous data and hazard ratios (HRs) for disease-free survival (DFS) were pooled. Subgroup analysis was performed to explain the heterogeneities. Results A total of 67 studies were included. The pooled IA was 2% (95% confidence interval (CI): 0·5–4%). The pooled RR for gender, multifocality, lymph node metastasis, extrathyroidal invasion and pathological stage was 1·11 (95% CI: 0·98–1·25), 1·17 (95% CI: 1·09–1·24), 1·36 (95% CI: 1·20–1·53), 1·60 (95% CI: 1·41–1·82), and 1·49 (95% CI: 1·33–1·68), respectively. The pooled standard mean differences for age and tumour size were 0·14 (95% CI: 0·04–0·23) and 0·21 (95% CI: 0·1–0·32), respectively. The pooled HR for DFS was 1·96 (95% CI: 1·62–2·37). Subgroup analysis showed that these statistical results were affected by the geographical background of patients, study design and detection methods. Conclusions BRAFV600E mutation analysis can not only be used in the diagnosis of PTC, but can also predict its prognosis.