Study On The Relationship Between BRAF Gene,TSHR And Cervical Lymph Node Metastasis In Papillary Thyroid Microcarcinoma

ObjectiveIn recent years the incidence of Papillary Thyroid Cancer has obvious rise in our country,Especially,the incidence of papillary thyroid microcarcinoma?PTMC?was the most significant.There is also a small papillary carcinoma with invasion of the membrane and/or cervical lymph node metastasis.This study through the detection of BRAF gene mutation and TSHR protein expression in thyroid tissues,combined with comparison of clinical pathology results,find an indicator of potential metastasis and invasive cervical lymph node tissue of PTMC.To assess the condition of preoperative comprehensive science.Comprehensive and scientific evaluation of patients before surgery.In the operation for patients to choose a reasonable and accurate surgical treatment.Provide individualized diagnosis and treatment support for patients after operation.MethodesIn this study,Selection in September 2015-August 2016 in Liaocheng city in shandong province people's hospital of thyroid breast surgery in patients undergoing surgery for 162 cases,Paraffin embedded specimens of primary tumor.Statistical parameters of the corresponding cases.Including gender,age,pathological diagnosis,primary tumor size,primary tumor and neck lymph node surgery,follow-up treatment,tumor diameter?0.5cm as the boundary?,the number of Thyroid Cancer lesions,central and lateral neck lymph nodes metastasis and metastasis rate,primary breakthrough gland capsule the situation.The clinical parameters of all cases were re classified according to the TNM staging system of thyroid cancer in AJCC/UICC2010.Methods 30 cases of benign thyroid lesions and normal paraffin embedded specimens were selected as the control group.1.Fluorescence quantitative PCR technique was used to amplify PTMC primary lesions,benign lesions and adjacent normal tissues.To detect the expression of BRAF gene in primary PTMC,benign tumor and adjacent normal tissues.Immunohistochemical method was used to detect the expression of TSHR and the expression of PTMC in the primary lesions,benign lesions and adjacent normal tissues.2.The expression of BRAF gene and TSHR protein in primary lesions of PTMC,benign lesions and adjacent normal tissues were compared with those of metastatic lymph nodes,and find out the correlation of clinical factors.The experimental data were analyzed by statistical software SPSS 20.0.Count data expressed by the number of cases,the single factor correlation analysis,mutation rate,expression rate compared with Kruskal-Wallis test,and the central BRAF gene and TSHR correlation using chi square test.The difference of P<0.05 was statistically significant.Results1.162 cases of PTMC primary focal BRAF^V600E mutation in 135 cases,the mutation rate is 83.3%.The number of mutations in 30 cases of thyroid benign lesions and adjacent normal tissues was about 0.The 135 cases of BRAF^V600E mutation PTMC,85 cases with lymph node metastasis in central region,the transfer rate was 63%.27 cases of wild type PTMC,9 cases with lymph node metastasis in central region,the transfer rate of 33%.The results showed that the trend?²=5.704,P=0.017,showed that the more the number of central lymph node metastasis,the higher the proportion of mutation,the greater the probability of mutation.Single factor analysis of PTMC group BRAF gene expression results and the clinical parameters,BRAF^V600E mutation and PTMC primary tumor size,capsule invasion,lymph node metastasis,and the patient's age,gender,TNM stage,independent of the number of primary.2.In group PTMC,the expression of TSHR was low in 92 cases,and the expression of was high in all the cases.The expression of TSHR in thyroid benign lesions and adjacent normal tissues was normal.In 92 cases of TSHR lower expression of PTMC,58cases with lymph node metastasis in central region,the transfer rate of 63%.In 70 cases with high expression of PTMC,27 cases with central lymph node metastases,transfer rate was 38.6%.The results showed that the more the number of central lymph node metastasis,the higher the proportion of low expression,the greater the probability of low expression?trend?²=11.036,P=0.001?.Univariate analysis of clinical results and the comprehensive index expression of PTMC group TSHR,BRAF^V600E600E and PTMC mutations in primary tumor size,capsule invasion,lymph node metastasis,and the patient's age,gender,TNM stage,the primary number also has nothing to do.3.The coincidence rate of BRAF gene expression and TSHR expression was 53.1?K=0.06,P=0.256?,which indicated that both of them were no correlation.Conclusion1.BRAF^V600E mutation is one of the markers for differential diagnosis of benign and malignant thyroid tumors.BRAF^V600E mutations and PTMC in primary tumor size,capsule invasion,lymph node metastasis,and age,gender,TNM stage,independent of the number of primary,and central lymph node metastasis number,the greater the probability of mutation.2.The expression of TSHR in PTMC is located in the cell membrane,The expression of TSHR and PTMC in the primary tumor size,capsule invasion,lymph node metastasis,and age,gender,TNM stage,independent of the number of primary,and the number of lymph node metastasis is more,the greater the probability of low differentiation,invasion of the stronger.3.There was no correlation between BRAFV600E mutation and TSHR protein expression.However,the coefficient of agreement indicates that the diagnostic value of PTMC is not similar.The prediction of PTMC invasion and lymph node metastasis of the two can be used jointly.This may be more meaningful for clinical guidance.