The Role Of Preoperative Ultrasonography-Cytopathology-BRAF Gene Detection In Precise Management Of Papillary Thyroid Carcinoma

Objective:To investigate the role of preoperative ultrasound,cytopathology,BRAF^V600Egene detection in the precise management of papillary thyroid carcinoma（PTC）.Methods:1450 patients who underwent FNA and BRAF^V600Egene detection at our thyroid surgery clinic from February 2019 to September 2022 were selected,involving 1718thyroid nodules,of which 550 patients underwent surgery and had complete clinical and pathological data,excluding 1 patient with medullary thyroid carcinoma,for 549patients involving 668 thyroid nodules were enrolled.To calculate the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of ultrasound,FNA,BRAF^V600Egene detection,ultrasound combined with FNA,ultrasound combined with BRAF^V600Egene detection and the combination of all three.The diagnostic efficacy of different diagnostic tools was evaluated by using ROC curve,and the Z test wase used to compare whether there was any difference in AUC among the groups;To investigate the correlation between the clinicopathological profile of patients and the BRAF^V600Emutation;Univariate and multifactorial analysis are used to analye the risk factors of central lymph node metastasis（CLNM）and capsule invasion.Result:549 surgical patients involving 668 nodes were included.547 patients（99.6%）involving 645 thyroid nodules（96.6%）were diagnosed with PTC by surgical pathology;The number of patients with preoperative ultrasound,FNA,and BRAF^V600Egene detection suggestive of thyroid carcinoma were 543,521,and 439,respectively,and the proportion of postoperative pathological PTC was 99.8%（542/543）,100.0%（521/521）,and 100.0%（439/439）;The number of thyroid nodes with preoperative ultrasound,FNA,and BRAF^V600Egene detection suggestive of thyroid carcinoma were 653,584 and 503,respectively,and the proportion of postoperative pathological PTC was 97.2%（635/653）,99.7%（582/584）,99.4%（500/503）.Ultrasound,FNA,and BRAF^V600Egene detection suggested benign but postoperative pathology PTC nodules were 10,63,and 145 respectively.43 of the 63FNA suggested benign PTC nodules were combined with BRAF^V600Emutation.In these 43 nodules,22 nodules were<0.5cm in diameter,19 nodules were≥0.5cm and<1cm in diameter,and 21 nodules were combined with calcification,and 13 cases were combined with Hashimoto’s thyroiditis.Analysis using the ROC curve model revealed that the diagnostic efficacy of FNA is better than that of ultrasound and BRAF^V600Egene detection alone,and the diagnostic efficacy of the combination of the three is better than ultrasound,FNA,BRAF^V600Egene detection,ultrasound combined with FNA and ultrasound combined with BRAF^V600Egene detection.Correlation analysis of BRAF^V600Emutation with suspicious nodules’clinicopathological characteristics revealed that patient age,CLNM,and BSRTC were associated with the occurrence of BRAF^V600Emutation in PTC nodules,and the difference was statistically significant（P<0.05）.Univariate and multifactorial analyses of clinical,ultrasound and pathological characteristics of PTC patients who developed CLNM showed that gender,age,tumor diameter,microcalcifications,capsule invasion,and BRAF^V600Emutation were associated with CLNM in PTC patients,and the difference was statistically significant（P<0.05）.Univariate and multifactorial analyses of clinical,ultrasound and pathological characteristics of PTC nodules who developed capsule invasion showed that tumor diameter were associated with the occurrence of capsule invasion in PTC,and the difference was statistically significant（P<0.05）.Conclusion:1.The diagnostic efficacy of FNA is superior to ultrasound and BRAF^V600Egene detection,and the combination of the three has the highest diagnostic efficacy.Especially for small nodules（<1 cm in diameter）with that significant calcification,Hashimoto’s thyroiditis and poor location that affect and determine the surgical approach,it is recommended that BRAF^V600Egene detection be performed at the same time as FNA diagnosis.2.BRAF^V600Emutation are associated with age,CLNM,and BSRTC in patients with PTC,and BRAF^V600Egene detection contributes to cytologic classification.3.Male,age<55 years,tumor diameter,microcalcifications,capsule invasion,and BRAF^V600Emutation are independent risk factors for the development of CLNM in PTC patients.4.Tumor diameter was an independent risk factor for the development of capsule invasion in PTC.