Predictive analysis of <i>BRAF</i> V600E mutation and central lymph node metastasis in papillary thyroid carcinoma

The incidence of thyroid carcinoma (THCA) has risen, yet most nodules remain indolent. In classical papillary thyroid carcinoma (PTC), central lymph node metastasis (CLNM) strongly impacts recurrence and survival, highlighting the need for accurate preoperative risk assessment. The present study aimed to identify clinical and molecular predictors of CLNM, focusing on the <i>BRAF</i> V600E mutation, and to develop a personalized nomogram. Gene expression profiles and clinical data from TCGA were analyzed to identify <i>BRAF</i> V600E-associated differentially expressed genes (DEGs) and construct a CLNM risk scoring model, which was further validated using retrospective preoperative fine-needle aspiration cytology (FNAC) and postoperative immunohistochemistry specimens. <i>BRAF</i> V600E was highly prevalent, and associated DEGs showed moderate discriminatory power. Multivariate analysis identified age, tumor size, and high-risk <i>BRAF</i> V600E status as independent predictors, integrated into a nomogram with an ROC of 0.710. Retrospective analyses confirmed the mutation's association with elevated CLNM risk. These findings suggest that patients with PTC with TI-RADS ≥4a nodules and no radiologic cervical LNM may benefit from combined preoperative evaluation, including <i>BRAF</i> V600E testing via FNAC, enabling precise CLNM risk stratification and supporting individualized surgical planning.