| Part 1: Study on the influence of nodule size on the detection efficiency of thyroid carcinoma detected by BSRTC in US-FNA samplesObjective:Analysis of the effect of nodule size on Ultrasound guided fine-needle aspiration (US-FNA)cytological detection for thyroid carcinoma(Bethesda Thyroid cytopathology Reporting System(BSRTC).Method:A total of 1250 patients with suspected thyroid cancer were selected from 2018.1 to 2020.8 for the detection of US-FNA sample BSRTC in our department.According to the maximum nodular diameter,the patients were divided into group I(?5mm,263 cases),group II(6-10 mm,731 cases),and group III(> 10 mm,256 cases).The positive rate of BSRTC test(the result indicated thyroid cancer was represented as positive,the positive rate was the detection rate)and the undiagnosed rate were counted and compared among the three groups.A total of 425 patients with thyroid tumor who were operated on in our hospital were selected from the above cases,and then divided into Group I(79 cases),Group II(242 cases),and Group III(104 cases)according to the above criteria.Postoperative pathology was used as the gold standard to calculate and compare the undetectable rate(including false negative and unconfirmed diagnosis)of the three groups.425 patients who had surgery were divided into the checkout group(373 cases)and the not checkout group(52 cases: 12 false negative and 40 cases unconfirmed),compare the statistical difference of the sonographic features between the two groups(location of cancerous nodules,maximum diameter,the uniformity of echo,the boundary,shape,aspect ratio,calcification,flow,rear attenuation),The sonographic features closely related to the detection rate of BSRTC were selected by single factor analysis and multiple factors Logistic regression(i.e.influence factors of US-FNA sampling on BSRTC check out rate).Results:1.The positive rates of BSRTC in all US-FNA samples(1250 cases)were 37.3%,50.6% and 60.5% in the diagnosis of thyroid nodules in the group I,II and III,respectively;the differences between the I and II groups(P=0.022)and the I and III groups(P=0.002)were statistically significant;the differences between the II and III groups were not statistically significant(P=0.136);The undiagnosed rate was 7.6%,5.5% and 2.0% in group I,II and III,respectively.The difference between group I and III(P=0.004)and group II and III(P=0.025)was statistically significant,while the difference between group I and II was not statistically significant(P=0.243).2.Among 425 US-FNA samples undergoing surgery,the un-checkout(I.e.missed diagnosis: false negative + undiagnosed)rate of BSRTC in group I,II and III was 22.8%,11.2% and 6.7%,respectively;the difference between group I and II(P=0.028)and group I and III(P=0.007)was statistically significant;the difference between group III and II was not statistically significant(P=0.247).3.Among the 425 cases of US-FNA samples undergoing surgery,there were statistically significant differences in the nodule location,maximum diameter,echo uniformity and aspect ratio between the checked-out group and the unchecked out group(P < 0.05),which were correlated with the check-out rate of BSRTC.Among them,nodules ?5mm,special location,aspect ratio ?1,and uneven echo are the ultrasonic characteristics that result in low check-out rate of BSRTC(namely,the nodule characteristics that affect US-FNA sampling).Multiple factors Logistic regression analysis showed that nodule location,maximum diameter and echo uniformity were risk factors affecting the check-out rate of BSRTC(P < 0.05).Conclusions:The size of thyroid nodules has an important influence on the check-out rate of thyroid cancer in US-FNA samples BSRTC.The maximum diameter of nodules ?5mm is an important factor that affects the check-out rate of BSRTC in US-FNA samples and leads to the low check-out rate of BSRTC.Innovation points:1.This study analyzes the specific factors affecting the missed diagnosis of BSRTC detection in US-FNA samples.2.In this study,the volume of thyroid carcinoma nodules was taken as the entry point to analyze its influence on BSRTC detection results.3.In this study,thyroid cancer with small volume(maximum diameter ?5mm)was isolated into a separate group.The detection rate of small thyroid carcinoma in US-FNA sample BSRTC was emphatically analyzed.A conclusion was drawn that the detection rate of small thyroid cancer was relatively low than the large volume(maximum diameter > 5mm).Compared with the group bounded by 10 mm in other studies,this study is closer to the present situation that the nodules of suspected thyroid cancer are getting smaller and smaller.Part 2: Value study of US-FNA sample BSRTC combined with BRAFV600 E detection to improve the detection efficiency of thyroid carcinoma ?5mmObjective:The purpose of this study was to investigate the value of ultrasound guided BSRTC combined with BRAFV600 E detection of fine needle specimen in improving the detection rate of thyroid cancer ?5mm.Method:From the above surgical cases,348 patients were further screened for the detection of pre-operative BSRTC and BRAFV600 E in US-FNA samples.According to the maximum diameter of nodules,these patients were divided into 92 cases in group I(?5mm),195 cases in group II(6-10mm),and 61 cases in group III(> 10mm).With postoperative pathology as the standard,the index values of the three groups of cases were separately measured,and the increased rate of thyroid cancer detected by the combined test was compared with that by the BSRTC alone test,and statistical comparison was made.Results:1.The detection results of BSRTC in the US-FNA samples of the three groups showed that the check-out rate of BSRTC in the US-FNA samples increased successively with the increase of thyroid carcinoma nodules(47.8%,74.4%,and 86.9%,respectively,in the I,II,and III groups);The undetected rate(missed diagnosis)decreased successively(52.2%,25.6% and 13.1%,respectively,in group I,II and III).The statistical comparison among the three groups showed that there was a statistically significant difference between group I and II(P=0.038)and group I and III(P=0.022),while there was no statistically significant difference between group III and II(P=0.474).2.The detection results of BRAFV600 E in US-FNA samples from the three groups showed that the BRAFV600 E mutation rates in the I,II and III groups were 97.8%,89.2% and 85.2%,respectively,which decreased successively with nodular enlargement,but the differences were not statistically significant(P=0.612 for the I and II groups,P=0.566 for the I and III groups,and P=0.832 for the II and III groups).3.The combined detection of BSRTC and BRAFV600 E of US-FNA samples from the three groups showed that the check-out rates of Group I,II and III were 100.0%,99.5% and 100.0%,respectively,and the check-out rates of each group were significantly higher than that of BSRTC alone.Statistical comparison among the three groups showed that there was no statistically significant difference(P=0.977 in group I and II,P=1.000 in group I and III,and P=0.980 in group II and III).4.Compared with BSRTC alone,the increased rate of thyroid cancer detected by combined detection of group I,II and III decreased successively with the increase of nodules,which were 52.2%,25.1% and 13.1%,respectively.There were statistically significant differences between groups I and II(P=0.002)and I and III(P=0.000),while there were no statistically significant differences between groups III and II(P=0.087).Conclusions:The preoperative joint detection of BSRTC and BRAFV600 E in US-FNA samples is of great value in improving the check-out rate of thyroid carcinoma nodules ?5mm.The contribution of combined detection of the two methods in improving the detection rate of thyroid cancer mainly lies in improving the detection rate of thyroid cancer in small volume(maximum diameter ?5mm).Therefore,the addition of BRAFV600 E detection in preoperative US-FNA sample BSRTC detection can minimize the missed diagnosis of thyroid cancer with small volume(maximum diameter ?5mm).Innovation points:In this study,the application of BRAFV600 E detection in the diagnosis of thyroid cancer was further refined.Its value in improving the detection rate of thyroid carcinoma nodules in small volume(maximum diameter ?5mm)was emphatically analyzed to make its application in thyroid cancer diagnosis more targeted and accurate. |
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