Neck lymph node metastases can increase the morbidity and mortality of papillary thyroid carcinoma (PTC) patients. This study aimed to determine the role of BRAF V600E and TERT mutations in the incidence of neck lymph node (LN) metastasis in PTC patients. This was a cross sectional study, involving PTC patients at Dr. Cipto Mangunkusumo Hospital, Jakarta. Data were obtained retrospectively based on medical records, except for BRAF V600E and TERT promoter mutations. Tumor tissue specimens of patients were transferred to the Integrated Laboratory of FKUI. BRAF gene multiplication was performed with KOD One PCR Master Mix (Toyobo KMM201), while TERT gene multiplication was performed with PCR Master Mix. Data analysis was performed with SPSS version 20. The data were analyzed using univariate and bivariate analysis with the Chi-Square test. 42 PTC patients were included in the study; 19 (45%) had BRAF mutation, 20 (48%) had TERT mutation, and 20 (48%) had LN metastases. BRAF V600E mutation was associated with LN metastasis [p<0.001, OR = 25.33 (95% CI 4.92 – 130.34)], while TERT mutation was not. Patients with BRAF+ and TERT- mutations were 18.00 times (95% CI 2.01 - 161.05) more likely to develop LN metastasis than patients with BRAF-and TERT-. Furthermore, the presence of TERT mutation along with BRAF mutation increased the risk to 60.00 (95% CI 4.72 – 763.04) higher than patients with BRAF- and TERT-. In PTC cases, BRAF V600E mutation causes a shift in the signalling of the MAPK pathway, resulting in an increase in cell growth, proliferation, and transcription processes. 

BRAFV600E and TERT co-mutation is associated with poor prognosis, such as lymph node metastasis, extra-thyroid extension, and advanced stage. BRAF mutation was significantly associated with LN metastasis in PTC patients, but not TERT mutation. The presence of BRAF & TERT comutation increased the risk of LN metastasis. 

Keywords: papillary thyroid cancer, lymph node metastasis, mutations, BRAF, TERT