Correlation Between Sonographic Characteristics Of Papillary Thyroid Carcinoma With Cervical Lymph Node Metastases And BRAFV600E Mutation

Part 1 The predictive value of sonographic characteristics for cervical lymph node metastases in thyroid papillary carcinomaObjective:To explore the correlation between sonographic characteristics of papillary thyroid carcinoma (PTC) and cervical lymph node metastases;to evaluate the predictive value of ultrasound for cervical lymph node metastases in PTC.Methods?A total of 554 patients with PTC who underwent thyroidectomy and lymph node dissection in our hospital from April 2014 to April 2015were enrolled in the study. And all patients have preoperative ultrasound examination of thyroid and cervical lymph node in our department According to the results of pathology they were divided into PTC with cervical lymph node metastases and PTC without lymph node metastases. gender, age and sonographic features(including number of lesions, maximum diameter, aspect ratio, edge, the contact area between the border and the thyroid capsule, borders, halo, echo, calcification, blood type, with or without Hashimoto's thyroiditis) were compared between the two groups. The correlation between sonographic characteristics of PTC and cervical lymph node metastases was analyzed and a Logisitic regression model was established in order to predict cervical lymphatic metastasis by sonographic characteristics of PTC diagnosed by pathology as dependent. And the predictive value of ultrasound for cervical lymph node metastases in PTC was evaluated.Results:Univariate analysis showed:gender, age and sonographic features of PTC(including the number of lesions, maximum diameter, edge, the contact area between the border and the thyroid capsule, calcification, blood type) were related with cervical lymph node metastases, the difference was statistically significant (P <0.05). Logisitic regression analysis showed:the number of lesions, maximum diameter, edge, the contact area between the border and the thyroid capsule, blood type as well as gender were related with cervical lymph node metastases, the difference was statistically significant (P<0.05); and calcification was not related with cervical lymph node metastases(P>0.05). Male, multiple lesions, the maximum diameter> 10.0mm, irregular edges, in contact with the thyroid capsule, rich blood are risk factors for cervical lymph nodemetastases in PTC. When malignant sonographic features?3, sensitivity, specificity, positive predictive value, negative predictive value, accuracy, Youden index of predict cervical lymph node metastases in PTC were 83.3%,84.8%, 72.5%,91.4%,84.3%,68.1. Compared to conventional ultrasound examination of the cervical lymph nodes, the diagnostic value of ultrasound was improved.Conclusion: The ultrasound examination for primary tumor of PTC has important predictive value for cervical lymph node metastases. When malignant sonographic features (multiple lesions, the maximum diameter of> 10.0mm, irregular edges, in contact with the thyroid capsule, rich blood)?3, it should also be considered to cervical lymph node dissection during surgery, even if abnormal lymph nodes were not found by ultrasound examination of cervical lymph nodes.PTC routine ultrasound for cervical lymph node metastasis has important predictive value. When ultrasound examination for signs of malignant (multiple lesions, the maximum diameter of> 10.0mm, irregular edges, in contact with the thyroid capsule, rich blood)?3 those items, even routine ultrasound cervical lymph nodes found no abnormal lymph nodes during surgery It should also be considered cervical lymph node dissection.Part 2 Correlation between sonographic characteristics of papillary thyroid carcinoma with cervical lymph node metastases and BRAFV600E mutationObjective:To explore the correlation between sonographic characteristics of papillary thyroid carcinoma with cervical lymph node metastases and BRAFV600E mutation;to explore the correlation between predictive result of cervical lymph node metastases in PTC by ultrasound examination and BRAFV600E mutation.Methods:A total of 100 patients with PTC who underwent thyroidectomy and lymph node dissection in our hospital from August 2014 to Octobor 2015 were enrolled in the study. And all patients have preoperative ultrasound examination of thyroid and cervical lymph node in our department According to the results of BRAFV600E mutation test they were divided into mutation group and wild-type group. gender, age and sonographic features(including number of lesions, maximum diameter, aspect ratio, edge, the contact area between the border and the thyroid capsule, borders, halo, echo, calcification, blood type, with or without Hashimoto's thyroiditis) were compared between the two groups. the correlation between sonographic characteristics of papillary thyroid carcinoma with cervical lymph node metastases and BRAFV600E mutation was analyzed and the correlation between predictive result of carcinoma cervical lymph node metastases in PTC by ultrasound examination and BRAFV600E mutation was also analyzed.Results:Univariate analysis showed:sonographic features of PTC(including the number of lesions, edge, the contact area between the border and the thyroid capsule, calcification, blood type) were related with BRAFV600E mutation, the difference was statistically significant (P<0.05). Logisitic regression analysis showed:only the number of lesions was related with cervical lymph node metastases, the difference was statistically significant (P<0.05) and it is also a risk factor for BRAFV600E mutation in PTC. BRAFV600E mutation was related with lymph node metastases in PTC (P <0.05). The rate of BRAFV600E mutation in patients with cervical lymph node metastases was higher than the rate in patients without lymph node metastases. The predictive result of cervical lymph node metastases in PTC by ultrasound examination and BRAFV600E mutation (P<0.05).Conclusion:BRAFV600E mutation was related with lymph node metastases in PTC. And sonographic features of PTC(including the number of lesions, edge, the contact area between the border and the thyroid capsule, calcification, blood type) were related with BRAFV600E mutation. From the perspective of the ultrasound confirms that a significant role of BRAF V600E mutations in the aggressiveness of PTC, but the predictive value of ultrasound for BRAFV600E mutation still needs further study.