| Objective:There was an analysis on the difference in clinical case characteristics between single-focal papillary thyroid carcinoma(PTC)and multifocal PTC(MPTC),as well as the clinical data,imaging,and laboratory indicators of MPTC patients.Thus,the high-risk factors that affected the multifocality of MPTC was discussed in this study,and the application value of color Doppler ultrasound and BRAF gene V600E in the diagnosis of MPTC was also analyzed,so as to provide reference for the formulation of surgical strategies.Methods:1.There was a retrospective analysis of 819 patients with PTC diagnosed in Huizhou Central People’s Hospital,including 124 cases with multifocal cancer(15.1%)and 695 cases with single-focal cancer(84.9%).Then,the clinical case characteristics of the single-focal group and the multi-focal group were compared,and the clinical case data of patients were statistically analyzed,such as gender,age,tumor diameter,and number of lesions.Univariate analysis was conducted to analyze the differences in these data between patients with single-focal PTC and patients with MPTC,and indicators with statistical differences were included in Logistic multivariate regression analysis to analyze the relationship between these factors and MPTC,thereby exploring whether there were influencing factors.2.The data of color Doppler ultrasound diagnosis and BRAFV600E mutation diagnosis of 124 patients with multifocal cancer were collected,the correlation between color Doppler ultrasound characteristics and BRAF-V600E mutation was explored,and Logistic multivariate regression analysis was performed on the color Doppler ultrasound characteristics related to BRAF-V600E mutation,finally,the diagnostic value of color Doppler ultrasound,BRAF-V600E mutation diagnosis,and the combined diagnosis of the two was studied based on ROC curve.Results:1.There were 103 patients(14.8%)with single focal PTC and 39 patients(31.5%)with multiple focal PTC,and the difference between the two groups was statistically significant(χ~2=23.18,P=0.000).There were 59(8.5%)patients with single focal PTC and 22(17.7%)patients with multiple focal PTC,and the difference between the two groups was statistically significant(χ~2=26.94,P=0.000).There were 256(36.8%)patients with single-focal PTC and 61(49.2%)patients with multi-focal PTC,and the difference between the two groups was statistically significant(χ~2=56.81,P=0.000).There were 551 cases(79.3%)of single-focal PTC patients in stage I,143 cases(20.6%)in stage II,1 cases(0.1%)in stage III,and 0 cases in stage IV(0%),and there were 50 cases(40.3%)of multifocal PTC patients in stage I,72 cases in stage II(58.1%),2 cases in stage III(1.6%),and 0 cases in stage IV(0%).The difference between the two groups was statistically significant(χ~2=45.33,P=0.000).The indicators with statistically significant differences in univariate analysis were incorporated into the binary Logistic regression analysis model,and multivariate analysis showed that capsule invasion(OR=0.636,95%CI 0.423-0.948,P=0.032),extracapsular invasion(OR=0.621,95%CI 0.405-0.967,P=0.017),lymph node metastasis(OR=0.864,95%CI 0.536-1.262,P=0.028),and staging(OR=0.797,95%CI 0.549-1.351,P=0.011)were independent risk factors affecting PTC multifocality.2.75%(93/124)of MPTC nodules had BRAFV600E mutations,while wild-type BRAF alleles accounted for 25%(31/124).Univariate analysis was performed on the conventional and contrast-enhanced ultrasound characteristics of nodules of the BRAFV600E mutant and wild-type groups.Compared with the wild-type BRAF group,the mutant BRAF group showed significant differences in aspect ratio(χ~2=5.216,P=0.022),microcalcification(χ~2=18.565,P=0.001),nodular size after enhancement(χ~2=11.660,P=0.001),enhancement pattern(χ~2=11.614,P=0.001),and enhancement time(χ~2=9.743,P=0.002),and logistic regression was used to analyze the correlation between statistically significant variables and BRAF-V600E mutations in univariate analysis,and Logistic regression analysis was used to analyze the correlation between the statistically significant variables and the BRAF-V600E mutation in the univariate analysis.The results showed that BRAF-V600E mutation was related to microcalcification(OR=2.256;95%CI=1.160-5.500;P=0.020)and enhanced nodule size(OR=2.119;95%CI=1.039-4.321;P=0.039).Conclusion:1.Logistic multivariate regression indicated that capsule invasion,extracapsular invasion,lymph node metastasis,and staging were risk factors that affected the multifocality of PTC.MPTC had a higher risk of envelope invasion and lymph node metastasis than single-focal PTC.2.MPTC had a higher mutation rate of BRAF gene V600E site,and BRAFV600E mutation was related to microcalcification and enhanced nodule size.High-frequency color Doppler ultrasound combined with BRAF gene V600E mutation detection had high clinical application value in the diagnosis of MPTC,among which calcification indicator was the most sensitive. |
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