The reported malignancy rate of RAS-mutated nodules was 10–62%.[24,25] Here, 45.8% of the RAS-mutated nodules were malignant, including 9 PTCs (4 follicular-variants, 44.4%), 1 FTC and 1 NIFTP, which is similar to most of the related reports.[26–28] In addition, there were 5 NRAS-mutated nodules in the total 6 developing lymph node metastasis, suggested the relationship between NRAS mutation and lymph node metastasis. This evidence concerns the gene NRAS and metastatic malignant neoplasm in the lymph nodes.