The Application Research Of Ultrasound Combined With BRAF V600E In The Diagnosis Of Papillary Thyroid Carcinoma And Its Invasiveness

Chapter 1Association between BRAF V600 E Mutation and Ultrasound Features in Papillary Thyroid Carcinoma Patients with and without Hashimoto’s Thyroiditis Objective To assess the association between BRAF V600 E mutation and ultrasoundfeatures in papillary thyroid carcinoma(PTC)patients with and without Hashimoto’s thyroiditis(HT).Methods We retrospectively reviewed the ultrasound features and status of BRAF V600 E mutation in 438 consecutive patients with surgically confirmed PTCs.The association between BRAF mutation and ultrasound features were analyzed.In addition,we conducted subgroup analyses in terms of coexistent HT.Results The BRAFV600 E mutation was found in 86.5%(379/438)of patients with PTC.In total PTC patients,Patient age(OR:1.028,P=0.010),age≥50y(OR:1.904,P=0.030),and microcalcification(OR: 2.262,P = 0.015)on ultrasound were significantly associated with BRAFV600 E mutation.None of the other factors such as gender,size,location,nodule number,nodule distribution,capsule contact,capsule involvement,echogenicity,internal component,shape,margin,ratio of height and width,vascularity and blood flow distribution were significantly associated with BRAFV600 E mutation in total PTC patients(all P>0.05).In PTC patients with HT,only solid component(OR: 5.739,P = 0.019)on ultrasound was the significant predictor for BRAFV600 E mutation.Patient age,gender and other ultrasound features had no associations with BRAFV600 E mutation status(all P>?0.05).On the other hand,inPTC patients without HT,patient age(OR: 1.036,P = 0.017)and microcalcification(OR: 3.093,P = 0.017)were significantly associated with BRAFV600 E mutation.Gender and other ultrasound features had no associations with BRAFV600 E mutation status(all P>?0.05).Conclusion Older age and microcalcification are risk factors for BRAFV600 E mutation in PTC patients,especially in those without HT.For those with HT,however,PTCs with BRAF mutation tend to be solid on ultrasound.These factors might be considered when making treatment planning or prognosis evaluation.Chapter 2 Preliminary Study of Shear Wave Elastography in Invasiveness of Thyroid Papillary Carcinoma with Different BRAF V600 E StatusObjective To study the value of shear wave elastography(SWE)in the diagnosis of invasiveness of thyroid papillary carcinoma with different BRAF V600 E status.Methods Elasticity index of SWE(E-min,E-mean,E-max and E-SD),status of BRAF V600 E mutation and extrathyroid invasivenesswere retrospectively analyzed in 216 patients with PTC confirmed by surgery.The diagnostic value of SWE in PTC invasiveness was evaluated,and subgroup analysis was carried out according to the status of BRAF V600 E mutation.The receptor operating characteristic(ROC)curves of PTC elasticity index were analyzed,including sensitivity,specificity,accuracy,positive predictive value(PPV)and negative predictive value(NPV).Meanwhile,the area under the ROC curve(AUC)and the optimal cut-off value were obtained.The AUCs of PTC elasticity index with different BRAF V600 E Status were compared with univariate Z score test.Results Extrathyroid invasiveness occurred in86(39.8%)PTC patients.The extrathyroid invasive rate of PTC with BRAF V600 E mutation was 41.9%(78/186)and that of BRAF V600 E wild type was 26.7%(8/30).Regardless of BRAF V600 E status,the E-mean,E-max and E-SD values of PTC in invasive group were higher than those in non-invasive group(P < 0.05).Among total PTCs,the diagnostic ability of specificity was the highest and the accuracy was the lowest.The specificity of E-mean,E-max and E-SD values were 75.4%,88.5%,80%,and the accuracy were 25.4%,25.7%,24.2%respectively.In the BRAF V600 E wild-type PTCs,the diagnostic ability of sensitivity,specificity and NPV were higher.The sensitivity,specificity and NPV of E-meanvalues were 75%,86.4% and 90.5% respectively.The sensitivity,specificity and NPV of E-maxvalues were 87.5%,90.9% and 95.2%respectively.The sensitivity,specificity and NPV of E-SD valueswere 87.5%,86.4% and 95% respectively.In the BRAF V600 E mutant PTCs,the diagnostic ability of sensitivity was the highest and accuracy was the lowest.The sensitivity of E-mean,E-max and E-SD values were 53.9%,87.2%,88.5%,and the accuracy were 23.3%,22.4% and 20.9%respectively.There was no difference in AUCs between the E-mean、E-max and E-SD values in the same BRAF V600 E state.The AUCs of E-max and E-SD values of BRAF V600 E wild-type PTC were significantly higher than those of BRAF V600 E mutant PTC.There were no significant differences in AUCs of E-max and E-SD values between total PTC and BRAF V600 E mutant PTC.There were no significant differences in AUCs of E-mean values during different BRAF V600 E states.Conclusion PTC nodules with extrathyroid invasiveness exhibit higher SWE elasticity index.SWE elastic index is more accurate in the diagnosis of the PTC invasiveness with BRAF V600 E wild-type status.SWE can be used as a supplement for the preoperative assessment of PTC invasiveness by conventional ultrasound.When evaluating the invasiveness of PTC nodules,it is necessary to select appropriate elasticity indexaccording to the need for comprehensive evaluation.