Application And Correlation Analysis Of Ultrasound,BSRTC And BRAF V600E Gene In Diagnosis Of Benign And Malignant Thyroid Nodules

Objective:To investigate the value of ultrasound,Bethesda thyroid cell pathological reporting system(BSRTC)and BRAF V600 E gene detection in the diagnosis of benign and malignant thyroid nodules,especially for thyroid nodules less than 1 cm in diameter,and to further explore the relationship between BRAF gene and thyroid ultrasound and pathological signs.Methods:1.From October 2017 to December 2018,155 patients underwent thyroid ultrasound examination in the Fourth Hospital of Hebei Medical University,including 116 single lesions and 39 multiple lesions.Each patient selected one of the most suspicious nodules to be operated on for ultrasound-guided fine needle aspiration cytology and BRAF V600 E gene detection.Based on the gold standard of pathological results after operation,the receiver operating curve(ROC)was constructed and the area under the ROC curve(AUC)was compared to evaluate the effectiveness of the three methods in diagnosis alone and in combination,and the sensitivity,specificity and accuracy of the three methods were compared.2.Fifty-eight thyroid nodules with the largest diameter less than 1 cm were selected to evaluate the diagnostic efficacy of the three methods mentioned above,and to compare the sensitivity,specificity and accuracy.The difference was statistically significant with P<0.05.3.To analyze the expression of BRAF V600 E gene and record the ultrasonographic features of thyroid nodules,such as maximum diameter,calcification,aspect ratio,clinical and pathological features,such as lymph node metastasis,whether the nodules are extracapsular infiltration,and whether they are multifocal tumors.Logistic regression analysis was used to compare the correlation between BRAF V600 E gene mutation positive and ultrasonographic and pathological features in thyroid papillary carcinoma.Results:1.Among the 155 patients with thyroid nodules,136 were malignant: 130 cases of papillary thyroid cancer(including 6 cases of follicular papillary thyroid cancer),6 cases of medullary carcinoma and 19 cases of benign nodules.Among 155 nodules,101 were malignant and 54 were benign.The sensitivity,specificity,accuracy and AUC were 72.79%,89.47%,74.84% and 0.830 respectively.The sensitivity,specificity,accuracy and AUC of BSRTC were 60.56%,94.74%,63.87% and 0.771 respectively.BRAF V600 E was used to diagnose 127 malignant and 28 benign nodules,and the diagnostic sensitivity was 60.56%,94.74%,63.87% and 0.771 respectively.Specificity,accuracy and AUC were 92.65%,94.74%,92.90% and 0.930,respectively.The sensitivity,specificity,accuracy and AUC of ultrasound combined with BSRTC were 80.88%,89.47%,81.94% and 0.852,respectively.The sensitivity,specificity,accuracy and AUC of ultrasound combined with BRAF were 93.38%,84.21%,92.26% and 0.881,respectively.The sensitivity,specificity,accuracy and AUC of the three combinations were 99.26%,84.21%,97.42% and 0.917,respectively.Therefore,BRAF has the highest diagnostic value in the single diagnosis and the combination of BRAF and BRAF has the highest diagnostic value in the combined application(P<0.05).2.From 155 patients,58 cases with the largest diameter of thyroid nodules less than 1 cm were selected,7 cases were benign,51 cases were malignant,and the pathological type was papillary thyroid cancer(1 case was follicular papillary thyroid cancer).The sensitivity,specificity,accuracy and AUC of ultrasound combined with BSRTC were 72.55%,71.43%,72.41% and 0.727,respectively;the sensitivity,specificity,accuracy and AUC of ultrasound combined with BSRTC were 72.55%,57.14%,70.69% and 0.656;the sensitivity,specificity,accuracy and AUC of ultrasound combined with BRAF V600 E gene positive diagnosis were 88.24%,71.43%,86.21% and 0.807,respectively.The sensitivity,specificity,accuracy and AUC were 88.24%,57.14%,84.48 and 0.736,respectively.Ultrasound combined with BRAF gene detection has high sensitivity,specificity and accuracy.Although they have similar diagnostic value(Z= 0.317,P>0.05),but the specificity is low,so ultrasound combined with BRAF has the highest diagnostic value.3.The mutations of BRAF V600 E gene in 127 of 155 nodules were analyzed.The average diameter of nodules was(0.98+0.65)cm,39 cases(35.45%)had multiple malignant tumors,64 cases(58.18%)had poor continuity of breaking through the capsule or capsule,and 63 cases(57.27%)had cervical lymph node metastasis.Statistical analysis showed that BRAF V600 E had no significant difference in capsular breakthrough,multifocal,lymph node metastasis and other related indicators(P>0.05),but only had correlation with the maximum diameter of the nodule(P=0.007).Conclusion:1.In the differential diagnosis of benign and malignant thyroid nodules,the diagnostic value of BRAF V600 E is better than that of ultrasound and BSRTC alone.The combination of the three has the best diagnostic value.2.Ultrasound combined with BRAF V600 E gene detection is the best diagnostic method for nodules less than 1 cm in diameter.3.The maximum diameter of thyroid nodule was correlated with BRAF V600 E gene mutation.