Background. We investigated the diagnostic value of the BRAF V600E mutation of thyroid nodules according to ultrasonography (US) features and the time of BRAFV600E mutation analysis. Methods. A total of 304 nodules in 295 patients (mean age, 49.4 years) were included. Thyroid nodules were classified as suspicious or probably benign on US. Group 1 (n = 168) included nodules with BRAFV600E mutation analysis at the time of the initial US-guided fine needle aspiration biopsy (US-FNAB) and group 2 (n = 136) included nodules with analysis at the time of the repeat USFNAB. The frequency of malignancy and the BRAFV600E mutation were compared between suspicious and probably benign nodules on US and between groups 1 and 2. Results. Of 304 nodules, 113 were malignant and 59 (52.2%) had the BRAF V600E mutation. Also, 58 of 196 nodules suspicious on US (29.6%) had the BRAFV600E mutation, whereas 1 of 108 (0.9%) probably benign nodules had the BRAFV600E mutation (P value<.0001). The BRAF V600E mutation was more frequently found in nodules suspicious on US than those probably benign in both groups 1 and 2 (P value<.0001 and .0058, respectively). Preoperative detection of the BRAFV600E mutation led surgeons to perform surgery in 5.8% of 103 nodules with benign and nondiagnostic results on cytology in group 1 and 1% of 98 nodules in group 2 without treatment delay. Conclusions. The BRAFV600E mutation analysis was a useful adjunctive diagnostic tool, especially in nodules suspicious on US, and was more effective if performed at the time of the initial US-FNAB.
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