BRAF p.V600E in Papillary Thyroid Cancer: Insights for Oncologists

Nicole A. Cipriani, MD, surgical pathologist at the University of Chicago Medicine, offers practical guidance for community oncologists regarding the role of BRAF p.V600E testing in patients with papillary thyroid carcinoma (PTC). Her key message is, while the presence of the BRAF p.V600E mutation confirms a diagnosis of papillary thyroid carcinoma, it should not be interpreted as a marker of worse prognosis on its own.

“If you have a BRAF p. V600E mutation, it is papillary thyroid carcinoma,” Cipriani emphasizes. “There are other BRAF mutations that are non canonical, that are not necessarily as tightly associated, but the V600E, yes.”

This makes the mutation diagnostically valuable, particularly when confirmed by immunohistochemistry or molecular testing. However, she cautioned against using the presence of the mutation to upstage the patient or modify treatment solely based on risk of recurrence.

"The presence of that mutation should not necessarily bump the patient into an increased risk for recurrence, according to our current understanding," she notes.

Although BRAF p.V600E does not appear to be an adverse prognostic factor, it still has clinical utility. Cipriani points out that the mutation may become important in guiding targeted therapy in patients who develop aggressive, treatment-refractory, or radioactive iodine–resistant disease.

She acknowledges that ongoing and future updates to national guidelines, such as those from the American Thyroid Association, may offer more refined recommendations on how BRAF status should be interpreted.

“I look forward to whatever the new American Thyroid Association guidelines are in terms of how they frame BRAF, but it's an exciting, exciting time,” she concludes.

Overall, Cipriani encourages oncologists to recognize BRAF p.V600E as a diagnostic marker rather than a standalone prognostic tool, while remaining open to its evolving role in therapeutic decision-making.

REFERENCE:

Brumfield A, Azar SA, Nordgren R, et al. Prevalence and Clinical Impact of BRAF p.V600E Mutation in Papillary Thyroid Carcinoma. Endocr Pathol. 2025;36(1):13. Published 2025 Apr 16. doi:10.1007/s12022-025-09859-y