The Application Of Ultrasound Risk Assessments Combined With Molecular Markers Galectin-3,c-MET,HBME-1,CK19 Expressions In Benign And Malignant Diagnosis Of Thyroid Solid Nodules

Objective: Ultrasound is the best diagnostic option for preliminary evaluation of thyroid nodules.In the process of thyroid malignant nodule growth and progress,compared with the normal physiological process,there will be abnormal biochemical metabolism and genetic material changes.These abnormalities can be marked by molecular markers.In this study,we select four molecular markers,Galectin-3,c-Met,HBME-1 and CK19,which were maturely studied in pathology researchs.The proposal of this study is,by investigating the risk assessments of thyroid nodules in two-dimensional ultrasonography together with those molecular markers expressions,to evaluate whether there is a correlation between benign and malignant thyroid nodules.In addition,this study is also helpful to determine whether the expression of ultrasound risk assessments combined with molecular markers is meaningful in the differential diagnosis of benign and malignant thyroid nodules.Methods:From December,2015 to September,2016,46 patients(11males and 35 females)with an average age of 47.05 ± 13.08 years(21-77years)were screened out.Immunohistochemistry was performed in one to two nodules of each patient,49 cases in total.Before operations,these patients were treated with two-dimensional ultrasound performed by L12-5(frequency5-12MHz)and 14L5(frequency 5-14MHz)with Philips IU22 and SIMENS ACUSON2000 in order to get satisfying two-dimensional ultrasound images and dynamic images.The secondary assessment was performed by two senior physicians who were assessed by taking an ultrasound image that included nodule shape,aspect ratio,boundary,internal echo,blood flow,posterior echo attenuation,calcification and suspicious metastatic lymph nodes.And then according to suspected malignant signs of the nodular,the malignant risks were assessed and divided into low risk,medium risk and high risk.In addition,we considered a high risk of malignancy when ultrasound shows suspicious thyroid cancer lymph node metastasis.Immunohistochemical staining of galectin-3,HBME-1,c-Met and CK19 was performed in all patients after operations.The Maxvision method was used for staining.The slides were evaluated by senior pathologists according to the literature standard to grade the expression of these markers.Results:46 cases of nodular immunohistochemical staining results included in the statistics,the largest diameter of 0.3-5.0cm,of which 8 benign nodules,malignant nodules 38.There is no significant difference between the actual thyroid nodule size(the longest diameter> 2cm or <2cm)of the patients and the analysis of the final result.Chi-square analysis and trend of chi-square statistical comparison ultrasound indicators,pathological benign and malignant and immunohistochemical differences in the results showed statistically significant(P <0.05)between different benign and malignant nodules Galectin-3,c-Met,HBME-1,CK19 expressions.The results of chi-square test showed that ultrasonography presents significant difference for benign and malignant thyroid nodules and metastatic lymph node evaluation(P <0.05).Compared with the results of ultrasound and immunohistochemical results,the expression level of Galectin-3,c-Met and CK19 increased with the increase of malignant risk rating.Chi-square test results show that different ultrasound indicators of the population of HBME-1different P= 0.175,trendy chi-square test results show P = 0.030,that is,with the level of ultrasound risk assessment HBME-1 expression level there is also an increasing trend.C-Met expression and pathological lymph nodes and ultrasound assessment of metastatic lymph nodes were statistically significant.The results of ROC curve showed that Galectin-3 had the highest diagnostic value of benign and malignant nodules compared with ultrasound risk assessments and c-Met.The sensitivity of each group and combined detection group was compared,in which the result,showed that the sensitivity of ultrasound combined with c-Met was the highest.Conclusions:The expressions of Galectin-3 and c-Met,HBME-1,CK19 in benign and malignant thyroid nodules were different,which means expressions were more common in malignant nodules while less common in ones.The expression of c-Met was correlated with lymph node metastasis.Two-dimensional ultrasound for thyroid nodules risk classification and pathological benign and malignant consistency is high.Ultrasound for thyroid nodules malignant risk assessment accuracy is high,and also for the assessment of suspicious lymph node metastases.Galectin-3 and c-Met increased the grade of expression.Correspondingly,two-dimensional ultrasound has also increased the classification of nodular risk assessment.There is a close relationship between the two.Combined with ultrasound risk assessment and molecular marker expression classification can assist in the differential diagnosis of benign and malignant ultrasound nodules.