The Value Of Us-fna Combined With Detection Of BRAF V600E In Diagnosis Of Benign And Malignant Thyroid Nodules

Objective To evaluate the value of ultrasound-guided fine needle aspiration(US-FNA)combined with detection of BRAF V600 E in diagnosis of benign and malignant thyroid nodules.Methods 211 thyroid nodules from 191 patients who underwent US-FNA were selected during 2016.3-2017.1.Apply TI-RADS for the classification of each nodule before surgery.Each of the nodule used both conventional smear and liquid-based preparation,and used the latter to detect the mutation of BRAF V600 E.The results of FNA were evaluated by Bethesda System.To clarify whether each of the patient underwent surgery by follow-up.Analysis and compare the relation of FNA cytological results?histological results?TI-RADS and the mutation of BRAF V600 E.Results(1)A total of 211 nodules were used to detect the mutation of BRAF V600 E.The mutation rate of BRAF V600 E was significantly different between category?and category?(?2=49.55,P=0.000).(2)There were 114 malignant nodules and 9 benign nodules in 123 operative nodules.100% of the nodules detected of BRAF V600 E mutation were malignant,and all of them were PTC.The sensitivity of individual FNA can be increased from 75.44% to 86.84% by combining BRAF V600 E detection,and the difference was statistically significant(?2=64.23,P=0.000).(3)In 31 indeterminate nodules,the sensitivity?specificity?accuracy of BRAF V600 E mutation detection were 52.00% ? 100.00% ? 61.29%.(4)There are 110 papillary thyroid carcinoma confirmed by pathology.On statistical analysis,there were no significantly different on the mutation rate of BRAF V600 E of gender?age?nodules' size?multifocality and lymph node metastasis(P>0.05),but the mutation rate of BRAF V600 was associated with thyroid capsular invasion.(5)Nodules with the mutation of BRAF V600 E and pathologically confirmed invasion of the glandular membrane,respectively accounted for 91.43%,56.00% and 27.27% in invasion group,adjacent group and away from the membrane group evaluated by ultrasound.Conclusion(1)The mutation rate of BRAF V600 E was significantly different between benign and malignant nodules,and no benign nodules had BRAF V600 E mutation.Consequently,the detection of BRAF V600 E supported the diagnosis of malignant nodules,and the false positive rate was 0%.(2)On the basis of classification of TI-RADS,US-FNA combined with the mutation of BRAF V600 E contributes to increase the detection rate of malignant thyroid nodules.Combination of BRAF V600 E was more efficient than individual FNA,and the results are more reliable.(3)US-FNA combined with the mutation of BRAF V600 E can decrease the misdiagnosis in indeterminate nodules.Surgical treatment is suitable for the nodules with BRAF V600 E mutation.Nodules without mutation should be combined with TI-RADS to re-evaluate the risk of malignancy,for those with a high grade of TI-RADS,surgical treatment or repeated FNA may be recommended to prevent missed diagnosis.(4)The mutation rate of BRAF V600 was associated with thyroid capsular invasion,and this gene can be useful for prediction of invasive behavior of thyroid carcinoma.At the same time,it can assist in the formulation of clinical treatment plan.(5)We find that the risk of invasion in pathology of the nodules is higher in those who showed invasion of the membrane by ultralsound and were detected the mutation of BRAF V600 E.But the number of nodules enrolled was insufficient,we need collect more cases.