The Value Of Testing BRAF Mutation In The Specimen Of US-FNAC To Evaluate The State Of Classic Papillary Thyroid Cancer

Objective To explore the difference in diagnostic rate between ultrasound-guided Fine-needle aspiration cytology and BRAF V600 E mutation in the specimen of ultrasound-guided Fine-needle aspiration cytology in patients.To explore the correlation between BRAF V600 E mutation in the specimen of ultrasound-guided Fine-needle aspiration cytology in patients with papillary thyroid carcinoma and the features of their clinic,ultrasonoscopies and pathology.And to provide a scientific basis for clinical choice of surgical treatment and choice of surgical methods.Methods 100 patients were selected for obtain complete data of the pathologic results about ultrasound-guided Fine-needle aspiration cytology,the BRAF mutaion and the pathologic results after surgery.The postoperative pathological results were compared with the pathologic results about ultrasound-guided Fine-needle aspiration cytology and the results of BRAF V600 E mutation on ultrasound-guided fine-needle aspiration cytology specimens respectively,and then analyzing the sensitivity and specificity of these two methods.93 patients were selected for obtaining complete data of US examination and the pathologic results about ultrasound-guided Fine-needle aspiration cytology and thyroid surgery including total thyroidectomy and cervical lymph node dissection.Using BRAF Mutation Test Kit to test the mutation.Analyzing the correlation between the clinical and pathologic results and BRAF V600 E mutation.Results BRAF V600 E mutation on ultrasound-guided fine-needle aspiration cytology specimens is better than ultrasound-guided fine-needle aspiration cytology(80.95%>71.42%on sensitivitys,and this result was statistically significant(χ2=4.05,P<0.05).And there was also obvious advantage on specificity of these two method(97.30%>81.08%,χ2=4.17,P0.05).Univariate analysis showed that the risk factors of BRAF V600 E mutation in the specimen of ultrasound-guided Fine-needle aspiration cytology were significantly correlated with famales(χ2=12.418,P<0.05),single focus(χ2=6.800,P<0.05),cervical lymph node metastasis(χ2=31.204,P<0.05)and unclear border in ultrasonoscopies(χ2=5.678,P<0.05).Multi-Logistic Regression Analysis showed that famales(OR=0.135,95%CI=0.031~0.597,P=0.008),single focus(OR=0.078,95%CI=0.015~0.401,P=0.002),cervical lymph node metastasis(OR=39.531,95%CI=7.703~202.877,P=0.000)and unclear border in ultrasonoscopies(OR=7.402,95%CI=1.699~32.249,P=0.008)were the risk factors of BRAF V600 E mutation.Univariate analysis showed that the risk factors of cervical lymph node metastasis for papillary thyroid carcinoma were significantly correlated with famales(χ2=10.303,P<0.05),BRAF V600 E mutation(χ2=31.204,P<0.05)and extrathyroidal invasion(χ2=12.848,P<0.05).Multi-Logistic Regression Analysis showed that BRAF V600 E mutation(OR=13.324,95%CI=4.058~43.744,P=0.000)and extrathyroidal invasion(OR=5.738,95%CI=1.766~18.643,P=0.004)were the risk predictors of cervical lymph node metastasis of papillary thyroid carcinoma.Famales(OR=0.385,95%CI=0.112~1.324,P=0.130)was not the risk predictor.Conclusions BRAF V600 E mutation in the specimen of ultrasound-guided Fine-needle aspiration cytology can improve the sensitivity and specificity of preoperative diagnosis.When cytological diagnosis is not clear,this method can be applied to further clarify the diagnosis.BRAF V600 E mutation in the specimen of ultrasound-guided Fine-needle aspiration cytology was significantly correlated with famales,single focus,cervical lymph node metastasisand unclear border in ultrasonoscopies,so surgical treatment should be chosen when the gene was positive through this method.BRAF V600 E mutation in the specimen of ultrasound-guided Fine-needle aspiration cytology and extrathyroidal invasion were the risk factors in predicting cervical lymph node metastasis of papillary thyroid carcinoma.Patients with these two risk factors should be elected undergoing prophylactic cervical lymph node dissection.