For instance, detection of BRAFV600E gene variants6, 29 or gene fusions involving ALK,29, 30, 31, 32NTRK33, 34, 35 and BRAF31 upgrades the Bethesda class to a Bethesda VI, as these are likely associated with papillary thyroid cancer (PTC) or may occur in poorly differentiated thyroid cancer (PDTC), anaplastic thyroid cancer (ATC) or, occasionally, medullary thyroid cancer (MTC), and malignancy should be expected in these cases, see Figure 1. This evidence concerns the gene ALK and medullary thyroid gland carcinoma.