Immunohistochemical Detection of Mutated BRAF V600E Supports the Clonal Origin of BRAF-Induced Thyroid Cancers Along the Spectrum of Disease Progression

RA Ghossein, N Katabi, JA Fagin - The Journal of Clinical …, 2013 - academic.oup.com
RA Ghossein, N Katabi, JA Fagin
The Journal of Clinical Endocrinology & Metabolism, 2013academic.oup.com
Background: The mutated BRAF V600E protein has been specifically detected in papillary
thyroid carcinomas (PTCs) using immunohistochemical (IHC) analysis. The clonal origin of
PTCs harboring BRAF mutations has recently been called into question. Objectives: The
purpose of this study was 2-fold:(1) to compare BRAF V600E IHC expression in PTCs,
poorly differentiated thyroid carcinomas (PDTCs), and anaplastic thyroid carcinomas (ATCs)
with DNA mutation analysis; and (2) to study the distribution of BRAF V600E IHC staining …
Background
The mutated BRAF V600E protein has been specifically detected in papillary thyroid carcinomas (PTCs) using immunohistochemical (IHC) analysis. The clonal origin of PTCs harboring BRAF mutations has recently been called into question.
Objectives
The purpose of this study was 2-fold: (1) to compare BRAF V600E IHC expression in PTCs, poorly differentiated thyroid carcinomas (PDTCs), and anaplastic thyroid carcinomas (ATCs) with DNA mutation analysis; and (2) to study the distribution of BRAF V600E IHC staining within thyroid cancer tissues.
Methods
Whole sections and tissue microarrays from 31 PTCs, 38 PDTCs, and 22 ATCs were subjected to both mass spectrometry genotyping for the BRAFT1799A mutation as well as IHC staining for BRAF V600E protein.
Results
Of the 31 PTCs, 16 (52%) showed strong (3+) IHC staining and harbored BRAFT1799A, whereas the remaining 15 (48%) showed absent/faint (0/1+) staining, and were wild type for BRAF (BRAF-wt). Only 5 of 38 (13%) PDTCs harbored mutant BRAF, and these were the only ones with moderate (2+) or 3+ IHC staining. All 14 ATCs with a staining intensity of 3+ harbored BRAFT1799A, whereas the 2 ATCs with 0/1+ staining were BRAF-wt. Six ATCs showed staining of 2+, 5 of which had high background staining. Of those 6 cases, BRAFT1799A was present only in the tumor without background. Homogeneous staining was found in 13 of 14 (93%) PTCs, 3 of 3 (100%) PDTCs, and 12 of 14 ATCs (86%).
Conclusions
First, absent/faint staining for BRAF V600E correlates perfectly with the lack of the BRAFT1799A mutation, whereas strong staining is highly specific for the BRAFT1799A mutation in PTCs, PDTCs, and ATCs. Moderate staining intensity cannot be relied on and should lead to genotypic analysis. Second, homogeneous staining occurs in the vast majority of cases, demonstrating that the BRAFT1799A mutation is a clonal event in thyroid cancer.
Oxford University Press