Study On Characteristics And Ultrasound Multimodal Diagnostic Efficacy Of Metastatic Lymph Nodes With BRAF Gene Mutation In Patients With Papillary Thyroid Carcinoma

Part Ⅰ:Characteristics of metastatic lymph nodes in papillary thyroid carcinoma and the efficacy of ultrasound multimodal diagnosisObjective:Papillary thyroid cancer,characteristics of metastatic lymph nodes with conventional ultrasonic imaging characteristics and the correlation of shear wave ultrasound elasticity imaging parameters,through ultrasonic ultrasonographic characteristics research PTC characteristics of metastatic lymph nodes,analyzed characteristics of thyroid papillary carcinoma metastatic lymph nodes and its correlation with multimodal ultrasonic diagnosis efficiency is discussed.Methods:A total of 86 patients with PTC confirmed by pathology in the Affiliated Hospital of North Sichuan Medical College from June 2019 to December 2020 were collected,and coarse needle puncture specimens were collected.To collect all the research object of basic clinical data,including age,sex,coarse needle biopsy in target lymph nodes(CNB)results,target lymph node gray-scale sonography related parameter values:short length to diameter(L),diameter(S),L/S ratio,real echo(of a CDFI)and color doppler flow imaging,hilus and surrounding changes,and so on and so forth,and modulus of elasticity parameters Emax,Emin,Emean,SD.To analyze the characteristics of metastatic lymph nodes in papillary thyroid carcinoma and to explore its correlation with the diagnostic efficiency of multimodal ultrasound.Results:1.A total of 86 PTC patients were included,among which 60 patients(69.7%)had lymph node metastasis,while 26 patients(30.3%)had no lymph node metastasis.2.single factor analysis results showed that the conventional gray-scale sonography in the transfer and transfer group,short/long diameter,short diameter microcalcification and cystic change,the group of high echo differences statistically significant(P<0.05),the shear wave elastography in the transfer and transfer group Emax,Emean,SD difference had statistical significance(P<0.05),the short diameter,ROC cutoff value of L/S were>0.57 cm,<1.92,the sensitivity of the short diameter,specific degrees,AUC are 77.3%,77.4%and 0.725 respectively;The sensitivity,specificity and AUC of L/S were 62.4%,71.8%and 0.722,respectively.Using Emax>32.9kPa as the cut-off value and AUC of 0.846,the diagnostic sensitivity and specificity were 82.7%and 92.9%,respectively.The sensitivity,specificity and AUC of Emean>21.2kPa were 69.1%,85.7%and 0.785,respectively.The sensitivity,specificity and AUC of SD>6.8 were 68.6%,84.9%and 0.829,respectively.EM AX can obtain higher sensitivity,specificity and AUC,and has higher diagnostic efficacy for lymph node metastasis.3.Analysis results of combined diagnosis:the sensitivity,specificity and AUC of the combined diagnosis were 95.5%,93.1%and 0.991,respectively,which were all higher than the significant univariate indicators of Logistic regression,and the difference of AUC of the combined diagnosis was statistically significant compared with the significant univariate diagnosis of Logistic regression(P<0.05).Conclusion:SWE can be preliminarily used as a promising method to determine benign and malignant lymph nodes.Ultrasound multimodal imaging can significantly improve the accuracy of thyroid cancer metastatic lymph nodes,and ultrasound examination is convenient,fast,non-invasive and repeatable.It can also provide ideas for clinical surgical methods and prognosis evaluation,which is worthy of promotion.Part Ⅱ:Study on the characteristics of metastatic lymph nodes of BRAF gene mutation thyroid cancer and the effectiveness of ultrasound multimodal diagnosisObjective:Explore against murine sarcoma virus oncogenes homologue B1(the Raf murine sarcoma viral oncogene homolog B,mutated BRAF)gene mutation of thyroid papillary carcinoma(papillary thyroid cancer,PTC)lymph node characteristics of metastatic lymph nodes with conventional ultrasonic characteristics and the correlation of shear wave elastography,hope that through ultrasonic ultrasonographic characteristics predict metastatic lymph nodes BRAF gene mutations in patients with PTC,to study the characteristics of metastatic lymph nodes of BRAF gene mutation thyroid carcinoma and the efficacy of multimodal diagnosis.Methods:As above,BRAF gene mutation was detected in the CNB lymph node specimen,and the ultrasonographic characteristics of PTC lymph node metastasis with BRAF gene mutation were analyzed using the mutation results as the standard.Results:1.Among the 60 metastatic lymph nodes,there were 26 lymph nodes in BRAF gene mutation group(43.3%).2.The short diameter,EMAX and SD of BRAF gene mutation group were higher than those of wild group,and the differences werstatistically significant.The ROC cut-off value of short diameter of lymph node was>0.79cm,the sensitivity and specificity were 62.5%,53.3%,and AUC was 0.682.EMAX had a high predictive value for BRAF gene mutation in metastatic lymph nodes(P<0.05).Using EMAX>52.1kPa as the cut-off value,the sensitivity and specificity of the diagnosis were 66.7%and 72.1%,respectively,and the AUC was 0.702.Using SD>8.1 as the cut-off value,the sensitivity and specificity of the diagnosis were 63.9%and 66.9%,respectively,and the AUC was 0.638.In order to further clarify its relevance,the single factor analysis of meaningful ultrasonic indicators as independent variable binary Logistic regression analysis,Logistic regression analysis meaningful index to measure the joint probability,and calculate the joint diagnosis efficiency of Logistic regression,the sensitivity,specificity,AUC is 68.9%,74.6%and 0.797,are higher than the Logistic regression meaningful single factor index,joint diagnosis and AUC compared with single factor diagnosis of the Logistic regression meaningful AUC differences were statistically significant(P<0.05).Conclusion:Multimodal ultrasonography has limited diagnostic significance for BRAF gene mutation PTC lymph node metastasis.