Although most international guidelines, including those from the American Thyroid Association, recommend active surveillance or conservative management for nodules ≤1 cm, a growing body of evidence suggested (13, 14) that a small but significant proportion of cases harbor aggressive histological features, such as extrathyroidal extension, lymph node metastasis, and BRAF mutations, even at early stage. Here, BRAF is linked to metastatic malignant neoplasm in the lymph nodes.