Application Of Ultrasound-guided Fine Needle Aspiration Biopsy Combined With VEGF And MBL Expression In The Diagnosis Of Thyroid Nodules

Objectives To investigate the efficacy of three methods of thyroid fine needle aspiration biopsy(FNAB),vascular endothelial growth factor(VEGF)and mannose-binding lectin(MBL)in the differential diagnosis of thyroid nodules.To analyze the value of combined diagnosis in the differential diagnosis of benign and malignant thyroid nodules,in order to provide a reference for clinically preferred differential diagnosis.Methods Selected patients with thyroid nodules who were treated in Tangshan Workers Hospital,Tangshan People's Hospital,and Tangshan Hongci Hospital from November 2017 to July 2018 as the study subjects.48 nodules confirmed to be malignant by surgical histopathology were the case group,and the 32 benign nodules were the control group.All patients met the puncture indication and obtained informed consent,all performed FNAB and thyroid surgery.Two of the smears fixed after puncture were stained with HE,and the cytological diagnosis was performed by an experienced pathologist,the cytological diagnosis method was based on the thyroid cell pathology Bethesda classification standard.Another 2 to 3 smears were used for immunohistochemical staining of VEGF and MBL.The results of immunohistochemistry were determined by semiquantitative integration method.Using SPSS17.0 statistical software,the postoperative histopathological results were used as the gold standard for determining the nature of thyroid nodules,to determine the relationship between FNAB,VEGF,MBL expression detection and benign and malignant nodules.Multi-factor logistic regression analysis was used to screen the diagnosis method.To screen out meaningful diagnostic methods to calculate the value of separate and combined differential diagnosis of sensitivity,specificity,Yoden index,Kappa.Evaluate the diagnostic value of each method for the differentiation of benign and malignant thyroid nodules,p<0.05 was considered statistically significant.Results 1 The basic characteristics of the study subjects: 68 cases(80 nodules)of thyroid nodules treated with outpatient treatment or hospitalized surgical resection were included in the study.There were 17 males and 51 females,aged 19-62(45.53±9.764)year old.Of the 80 thyroid nodules,48 were malignant nodules confirmed by surgical pathology,all of which were papillary thyroid carcinoma and 32 benign nodules.2 The relationship between each test diagnosis method and the nature of the nodule: Bethesda assessed the diagnosis of benign and malignant thyroid nodules(p<0.01).The higher the Bethesda classification,the greater the proportion of malignant nodules;The positive expression rate of VEGF in malignant thyroid nodules was higher than that in benign nodules(p<0.01);The positive expression rate of MBL in malignant thyroid nodules was higher than that in benign nodules(p<0.01);In multivariate analysis,MBL expression was not associated with the diagnosis of benign and malignant nodules(p>0.05),FNAB cytology and VEGF expression were closely associated with benign and malignant nodules(p<0.05).3 FNAB cytological examination and VEGF expression detection diagnostic evaluation: The sensitivity of FNAB cytology for the diagnosis of benign and malignant thyroid nodules was 79.17%,the specificity was 90.63%,the Yoden index was 0.698,and the Kappa value was 0.673;The sensitivity of VEGF for the diagnosis of benign and malignant nodules was89.58%,the specificity was 81.25%,the Yoden index was 0.708,and the Kappa value was0.712.4 The combined diagnosis of FNAB cytology and VEGF expression detection:FNAB cytology and VEGF detection in parallel diagnosis of benign and malignant thyroid nodules with sensitivity of 93.75%,specificity of 75.00%,Yoden index of 0.688,Kappa value of 0.706.5 Bethesda cytological graded diagnosis evaluation: Bethesda cytological diagnosis has high diagnostic ability for grade ?,?,and ? nodules,and low diagnostic ability for grade ? and ? nodules.6 The value of VEGF detection in the diagnosis of uncertain nodules: In the diagnosis of grade ? and ? nodules,the expression rate of VEGF in malignant nodules was higher than that of benign nodules(p<0.05).The cytological diagnosis of grade ? and ? uncertain nodules was diagnosed in parallel with VEGF detection,the sensitivity of identifying benign and malignant thyroid nodules was88.88%,the specificity was 72.73%,the Yoden index was 0.616,the Kappa value was0.604.Conclusions 1 The thyroid nodules fine needle aspiration cytology and VEGF immunohistochemistry with postoperative histopathological results have a high consistency.2 Fine needle aspiration cytology combined with VEGF immunohistochemical detection results improve the diagnostic sensitivity of malignant nodules,and have certain clinical application value in the identification of thyroid nodules.3 Uncertain nodules combined with VEGF immunohistochemical detection significantly improved the sensitivity of diagnosis,and have certain clinical application value for the diagnosis and evaluation of thyroid nodules.Figure2;Table9;Reference 173...