Application Of Multimodal Ultrasound Combined BRAFV600E Gene To Thyroid Nodules Classified As Bethesd ⅠAnd Ⅲ

Objective:To observe the value of BRAFV600E gene,Shear Wave Elastography(SWE),Contrast-enhanced Ultrasound(CEUS)in the differential diagnosis of Bethesda category 1 and 3 thyroid nodules confirmed by Fine-needle Aspiration Cytology(FNAC).Methods:The routine ultrasound examination of Wuxi People’s Hospital from January 2017 to March 2019 was performed as TI-RADS 4 and 5 thyroid nodules,and then fine needle aspiration biopsy(FNAB)was performed.After being diagnosed as Bethesda Class 1 and Class 3,107 thyroid nodules were subjected to the BRAFV600E gene mutation detection of fine needle aspiration biopsy samples.The study subjects had complete SWE,CEUS examination and surgical pathological data,and each nodule could effectively extract and extract DNA,and the BRAFV600E test was successful.To evaluate the diagnostic efficacy of SWE,CEUS,BRAFV600E gene alone and in combination in Bethesda category 1 and 3 thyroid nodules based on the postoperative pathological results as the gold standard.Results:All 107 Bethesda category 1(53 cases)and 3(54 cases)thyroid nodules included 54 malignant lesions and 53 benign lesions.The sensitivity of BRAFV600E gene mutation analysis,SWE and CEUS for the diagnosis of Bethesda category 1 and 3 thyroid nodules was 85.2%,77.8%and 81.5%,respectively.The specificity was 100%,84.9%and 81.1%,respectively,and the accuracy was 92.5%,81.3%and 81.3%,respectively.The sensitivity of BRAFV600E gene combined with SWE was 90.7%,the specificity was 100%,and the accuracy was 95.3%.The sensitivity of BRAFV600E gene combined with CEUS was 92.6%,the specificity was 100%,and the accuracy was 96.3%.The sensitivity of the three examinations in combination was 98.1%,the specificity was 100%,and the accuracy was 99.1%.The sensitivity and accuracy of CEUS combined with BRAFV600E gene for diagnosing Bethesda category 1 and 3 thyroid nodules were higher than those of BRAFV600E gene alone,and the differences were statistically significant(P<0.05).The sensitivity and accuracy of SWE combined with BRAFV600E gene were higher than those of BRAFV600E gene alone,and the differences were statistically significant(P<0.05).The sensitivity and accuracy of the three examinations in combination were remarkably higher than the BRAFV600E gene alone and combined with other two examinations,and the differences were statistically significant(P<0.05).Conclusions:1.CEUS combined with BRAFV600E gene and SWE combined with BRAFV600E gene could improve the diagnostic accuracy of benign and malignant thyroid nodules classified as Bethesda category 1 and 3.2.The three examinations in combination showed the best diagnostic efficacy in benign and malignant Bethesda category 1 and 3 thyroid nodules,and the diagnostic accuracy was 99.1%.3.CEUS combined with BRAFV600E gene and SWE combined with BRAFV600E gene could make up for the deficiencies of single BRAFV600E gene detection of unmutated nodules and reduced the false negative of BRAFV600E gene detection.The combination of CEUS and BRAFV600E gene has better diagnostic efficiency than the combination of SWE and BRAFV600E gene,but SWE has better price attraction and easier to carry out than CEUS.The combination of these two examinations could improve the diagnosis of benign and malignant Bethesda category 1 and 3 thyroid nodules,reduce certain false negatives rate.