| Objective:The aim of the study was to assess the diagnostic value and correlation of conventional ultrasonography,real-time shear wave elastography(SWE),basic fibroblast growth factor(bFGF)and BRAF V600E in invasiveness of papillary thyroid carcinoma(PTC).To calculate the diagnostic thresholds and screening the statistically significant parameters.To evaluate the diagnostic efficacy of relevant factor on the invasiveness of thyroid cancer by establish Logistic regression equation,to provide more information for clinical risk assessment of PTC and the formulation of individualized treatment.Methods:(1)Three hundred and seven thyroid nodules were included and histopathological results were obtained.Conventional ultrasonography and SWE were performed before the operation.After surgery,307 cases were divided into benign group and PTC group according to the surgical pathological findings.Young’s modulus values between two groups were statistically analyzed.The PTC group was divided into two groups according to whether PTC invaded the perithelium and/or surrounding tissues,statistical data of conventional ultrasound characteristics and Young’s modulus values between two groups were analyzed for screening statistically significant indicators.ROC curves were drawed to calculate the optimal diagnostic threshold of Young’s modulus between the groups.(2)181 cases of PTC were divided into two groups according to whether combine with cervical lymph node metastasis or not.102 cases with cervical lymph node metastasis were grouped single-region(n=1)and multi-regions(n≥2)metastasis,the correlation among the ultrasonic characteristics of PTC,Young’s modulus values and PTC cervical lymph node metastasis were analyzed.Logistic regression equation was established based on the statistically significant parameters,ROC curve was applied to assess the diagnostic efficacy.(3)307 thyroid nodules were tested for bFGF expression,181 PTC were tested for BRAF V600E gene mutation after surgery,then the correlation between bFGF expression,BRAF V600E gene mutation and PTC invasiveness were analyzed.The correlation of conventional ultrasound characteristics,Young’s modulus values and bFGF expression were analyzed,the Logistic regression equation was established,and the ROC curve was applied to assess its diagnostic efficacy.Results:1)307 thyroid nodules included 90 nodular goiter,36 focal thyroiditis and 181 PTC.The statistical results revealed that the differences between the invasive and non-invasive PTC groups were statistically significant(P<0.05)which included age,maximum diameter,irregular margin and internal calcification.The differences of Young’s modulus values(Emax,Emean)between the two groups were statistically significant(P<0.05).The area under the ROC curve of Emax was 0.642 with a 95%CI 0.562-0.722,the optimal diagnostic threshold was 65.3KPa.The area under the ROC curve of Emean was 0.648 with a 95%CI 0.569-0.728,based on which the optimal diagnostic threshold was 59.4KPa.The differences of Emax and Emean between nodular goiter and PTC were statistically significant(P<0.05),the area under the ROC curve for Emax was 0.739 with a 95%CI 0.674-0.804,based on which the optimal diagnostic threshold was calculated as 42.2KPa.The area under the ROC curve for Emean was 0.715 with a 95%CI 0.649-0.781,based on which the optimal diagnostic threshold was calculated as 35.2KPa.The statistical results of general features and ultrasonic manifestations between 36 focal thyroiditis and 181 PTC showed that there were statistically significant differences in internal echo,aspect ratio>1,internal micro-calcification and obscure boundary(P<0.05),there was no statistical significance in Young’s modulus between two groups(P>0.05).There was no significant difference in Young’s modulus between two groups of 181 PTC combined with Hashimoto’s thyroiditis or not(P>0.05).2)181 PTC were divided into two groups according to cervical lymph node metastasis.There were statistically differences in age,maximum diameter,internal calcification,capsule invasion,Emax and Emean between two groups(P<0.05).Statistically significant parameters were introduced into the equation to establish a multivariate Logistic regression equation related to PTC cervical lymph node metastasis.The area under the ROC curve was 76.7%,and the test efficiency was moderate.3)307 cases were detected on bFGF expression,the differences were statistically significant(P<0.05)between nodular goiter and PTC groups,the focal thyroiditis and nodular goiter.The difference of bFGF expression was statistically significant(P<0.05)between two groups of 181 PTC combined with capsule invasion or not.There was no statistically significant in bFGF expression between two groups about 181 PTC with or without cervical lymph node metastasis(P>0.05).BRAF V600E gene mutation detection was not statistically different between 181 PTC with or without capsule invasion(P>0.05).The multivariate Logistic regression equation was established,the area under the ROC curve was 0.864,which indicated that the test efficiency was good.Conclusions:1)The probability of local invasiveness in PTC is likely to increase when the patients are over 45 years old,the nodule diameter increases,and the PTC shows irregular margin or internal calcification.2)PTC is more likely to develop cervical lymph node metastasis when it shows bigger diameter,internal calcification or invasion of the adjacent peritoneum.As the diameter of the PTC nodule increases or the ultrasonogram shows non-hypoecho and very low echo,there is a greater likelihood of multi-regional lymph node metastasis.The higher the Young’s modulus value of PTC,the higher the probability of cervical lymph node metastasis is.3)The grades of positive bFGF expression in 307 cases are ranked from the high to low,locally invasive PTC>non-invasive PTC>nodular goiter>focal thyroiditis.In contrast,bFGF expression is not associated with cervical lymph node metastasis in PTC.The positive rate of BRAF V600E mutation in PTC is higher than that reported in the previous literature,and there is no difference between two groups whether PTC are combined with local invasion or not.The multifactor analysis show that age,maximum diameter,irregular margin,internal calcification,Emax and bFGF expression are meaningful in predicting local invasiveness of PTC.Dual-mode ultrasound and bFGF testing can provide valuable information for clinical assessment of PTC and the development of individualized treatment plan. |
