The Application Value Of Fine Needle Aspiration,BRAF And Ultrasonography In Clinical Diagnosis Of Thyroid Papillary Carcinoma

Objective: To analyze the application value of fine needle aspiration,BRAF gene detection and ultrasound examination in clinical diagnosis of thyroid cancer through retrospective analysis.Methods: Subjects are from patients with suspected thyroid cancer treated in the Department of General Surgery of zhongshan hospital xiamen university from July2018 to May 2019.209 thyroid nodules from a total of 188 patients(41 males,147 females,with an average age of 43.27 years)were accumulated.Those thyroid nodules were all diagnosed by fine needle aspiration before operation;meanwhile,Bethesda classification,BRAF v600 e gene detection and ultrasonic TI-RADS classification were also performed.The three methods were analyzed based on postoperative pathology taken as the golden standard.Conditional logistic regression was used to screen the differential diagnosis parameters of PTC,and the working characteristic curve of the subjects was drawn to calculate the area under the curve.The diagnostic test was used to evaluate the effectiveness of BRAF v600 e detection results,Bethesda classification and ultrasonic edge features in the differential diagnosis of PTC.To analyze the correlation between BRAF v600 e gene detection,FNA cytological classification,ultrasound nodule findings and different clinicopathological stages of PTC.Results:(1)The cytological classification of 209 thyroid nodules by FNA showed that the proportions of Bethesda classification I to VI were 9.1%、6.7%、2.9%、3.3%、14.4%、63.3% respectively.The proportion of type VI cells in PTC nodules was significantly higher than that in non-PTC nodules(71.8% vs.10.7%,P<0.001).(2)There were 146 positive nodules in BRAF v600 e,69.9% of the positive rate,while the positive rates of PTC and non PTC were 79.6% and 7.1% respectively.The difference was significant statistically(P<0.001).(3)PTC nodules were most common in TI-RADS type 4 nodules(87.3%),which was significantly higher than that in non-PTC group(P<0.001).(4)BRAF v600 e test results,Bethesda classification and ultrasound edge features are independent predictors of PTC.(5)The results of ROC curve analysis showed that Bethesda classification AUC was the highest,followed by BRAF v600e(0.817,0.799),which was significantly higher than that of ultrasound edge feature(0.687)(P < 0.05).In the combined diagnosis of two indexes,BRAF v600 e + Bethesda classification is AUC0.788,with sensitivity of 0.939.The AUC of the other two and three indexes did not significantly exceed the single index of either BRAF v600 e or Bethesda classification.(6)There was no significant difference statistically between PTC clinicopathological stage and BRAF v600 e gene mutation,FNA cytological classification and ultrasonographic nodules(P>0.05).Conclusion:(1)BRAF v600 e gene variation,FNA cytological classification and ultrasound nodular edge features can be used as independent diagnostic parameters of PTC,in which the detection of BRAF v600 e gene variation can achieve high accuracy in the differential diagnosis of PTC and is of high value in the differential diagnosis of PTC.(2)BRAF v600 e gene detection combined with FNAC can effectively improve the sensitivity of PTC differential diagnosis,reducing the missed diagnosis of malignant nodules,and can be used as a combined parameter for clinical PTC differential diagnosis.(3)The correlation between PTC clinicopathological parameters and BRAF v600 e gene variation,FNAC and ultrasonographic features of nodules is not clear,and further research is needed to provide evidence.