{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T13:51:54Z","timestamp":1753883514100,"version":"3.41.2"},"reference-count":29,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Otolaryngology - Head &amp; Neck Surgery"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p> Genomic testing has enhanced pre-surgical decision making for cytologically indeterminate thyroid nodules, but there remains uncertainty regarding RAS mutations. The addition of extra genetic alterations to previous driver mutation panels has been shown to improve predictive value. This study aims to evaluate the relationship between the mutant allele frequency (AF) and likelihood of malignancy in thyroid nodules with RAS mutations. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> A retrospective cohort review was performed evaluating patients with indeterminate cytology (Bethesda categories III, IV and V) and ThyroSeq\u00ae v3 testing demonstrating a RAS mutation, who underwent surgery. Univariate and multivariate regression analyses were used to evaluate relationships between AF, other genetic alterations, and malignancy. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> Thirty-nine patients met criteria, 77% of the thyroid nodules (30\/39) were found to be malignant. None demonstrated aggressive pathology. On univariate regression, there was no relationship between AF and likelihood of malignancy. There was, however, a significant correlation between AF and the rate of an additional genetic alteration. Multivariate analysis found a trend between RAS, a second genetic alteration and malignancy, but it did not reach statistical significance. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p> There was no direct relationship between the level of allelic frequency in thyroid nodules expressing RAS mutations and the likelihood of malignancy. There was a statistically significant relationship between increasing AF and the presence of a second genetic abnormality, suggesting a possible progression from initial driver mutation and then a second genetic alteration prior to malignant transformation. <\/jats:p><\/jats:sec><jats:sec><jats:title>Graphical Abstract<\/jats:title><jats:p> <\/jats:p><\/jats:sec>","DOI":"10.1186\/s40463-022-00611-8","type":"journal-article","created":{"date-parts":[[2023,2,11]],"date-time":"2023-02-11T09:03:36Z","timestamp":1676106216000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Does the likelihood of malignancy in thyroid nodules with RAS mutations increase in direct proportion with the allele frequency percentage?"],"prefix":"10.1177","volume":"52","author":[{"given":"Thomas J.","family":"Hudson","sequence":"first","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, Jewish General Hospital, McGill University, 3755 Ch. de la C\u00f4te-Sainte-Catherine Rd., H3T 1E2, Montreal, QC, Canada"},{"name":"nt of Otolaryngology \u2013 Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc Philippe","family":"Pusztaszeri","sequence":"additional","affiliation":[{"name":"Department of Pathology, Jewish General Hospital, McGill University, Montreal, QC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael P.","family":"Hier","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, Jewish General Hospital, McGill University, 3755 Ch. de la C\u00f4te-Sainte-Catherine Rd., H3T 1E2, Montreal, QC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veronique-Isabelle","family":"Forest","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, Jewish General Hospital, McGill University, 3755 Ch. de la C\u00f4te-Sainte-Catherine Rd., H3T 1E2, Montreal, QC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ji-Wei","family":"Yang","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, McGill University Health Centre, Montreal, QC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3987-8243","authenticated-orcid":false,"given":"Richard J.","family":"Payne","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, Jewish General Hospital, McGill University, 3755 Ch. de la C\u00f4te-Sainte-Catherine Rd., H3T 1E2, Montreal, QC, Canada"},{"name":"nt of Otolaryngology \u2013 Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2023,1,1]]},"reference":[{"key":"bibr1-s40463-022-00611-8","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21492"},{"key":"bibr2-s40463-022-00611-8","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21332"},{"key":"bibr3-s40463-022-00611-8","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2017.0500"},{"key":"bibr4-s40463-022-00611-8","doi-asserted-by":"publisher","DOI":"10.1159\/000339959"},{"key":"bibr5-s40463-022-00611-8","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2018.1153"},{"key":"bibr6-s40463-022-00611-8","doi-asserted-by":"publisher","DOI":"10.1002\/dc.24564"},{"key":"bibr7-s40463-022-00611-8","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.31245"},{"key":"bibr8-s40463-022-00611-8","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2018.4616"},{"key":"bibr9-s40463-022-00611-8","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.2010.167"},{"key":"bibr10-s40463-022-00611-8","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-1469"},{"key":"bibr11-s40463-022-00611-8","doi-asserted-by":"publisher","DOI":"10.1177\/0194599816685697"},{"key":"bibr12-s40463-022-00611-8","doi-asserted-by":"publisher","DOI":"10.3390\/cancers13153785"},{"key":"bibr13-s40463-022-00611-8","doi-asserted-by":"publisher","DOI":"10.1002\/cncy.22112"},{"key":"bibr14-s40463-022-00611-8","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2015.0020"},{"volume-title":"Tumours of the thyroid gland. 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