ABSTRACT
Objective:To investigate the diagnostic value of thyroid imaging report and data system (TIRADS) combined with BRAF V600E mutation detection in differentiating uncertain thyroid nodules by using fine needle aspiration cytology (FNAC), and to analyze the role of TIRADS classification in screening the nodules needed to be routinely detected for BRAF V600E mutation.Methods:The clinicopathological data of 337 thyroid nodules patients diagnosed with TIRADS classification, FNAC Bethesda classification, BRAF V600E mutation detection and postoperative histopathology from the Second Hospital of Hebei Medical University between January 2018 and August 2021 were retrospectively analyzed. The role of TIRADS classification, FNAC Bethesda classification and BRAF V600E mutation detection alone and the combined detection in the differentiation of benign and malignant thyroid nodules was also analyzed.Results:The postoperative histopathological result was regarded as the gold standard. The sensitivity of TIRADS classification, FNAC Bethesda classification and BRAF V600E mutation for thyroid cancer diagnosis was 76.0%, 88.1% and 80.4% respectively, and the corresponding specificity was 84.0%, 96.0% and 100.0%, respectively. Histologically, 37 (62.7%) of 59 nodules with FNAC uncertainty were malignant nodules after the surgery. The sensitivity and accuracy of BRAF V600E mutation detection in the diagnosis of FNAC uncertain nodules were 51.4% and 69.5%, respectively, while the sensitivity and accuracy of BRAF V600E mutation detection combined with TIRADS classification were 86.5% and 84.7%, respectively. The sensitivity and accuracy of BRAF V600E mutation detection combined with TIRADS classification were both improved ( P values were 0.002 and 0.049, respectively). The positive rate of BRAF V600E mutation in thyroid nodules increased step by step with the rise of risk degree in TIRADS classification, and the type 3 cases were lower than those in type 4a cases [14.3% (1/7) vs. 68.6% (24/35), P = 0.012], and there were no statistically significant differences among the adjacent groups above 4a (all P > 0.05). Conclusions:TIRADS combined with BRAF V600E mutation detection can improve the sensitivity and accuracy in the diagnosis of FNAC uncertain thyroid nodules. The BRAF V600E mutation rate of TIRADS 4a and above nodules is high, so routine detection is recommended.
ABSTRACT
Objective:To investigate the clinicopathological features and pathological diagnosis methods of calcifying fibrous tumor (CFT) of the stomach.Methods:The clinicopathological data of 9 patients with gastric CFT in the Second Hospital of Hebei Medical University from August 2015 to May 2020 were retrospectively analyzed, immunohistochemistry was used to detect the immunophenotypic characteristics of gastric CFT, and the relevant literature was reviewed.Results:Among 9 patients with gastric CFT, 1 case was male and 8 cases were female, with a median age of 53 years old (18-63 years old). There were 7 cases occurred in the body of the stomach, while 2 cases in the fundus. All cases were single solid nodule with the cut surface gray-white or gray-red in colour and hard and tough in texture. Maximum diameter of tumor ranged from 0.6 cm to 1.5 cm. Observation under the microscope showed the spindle-shaped tumor cells were sparsely distributed in a large amount of collagenized stroma with scattered lymphocytes and plasma cells infiltration. Calcification or gravel formation was detected in all cases. The tumor cells in 9 cases expressed Vimentin, 3 cases expressed CD34, none of them expressed PDGFRA, SMA, SMMS-1, Desmin, ALK, DOG-1, CD117, S-100, β-catenin, CKpan and calponin; Ki-67 positive index was 1%-3%.Conclusions:Gastric CFT is more common in middle-aged and elderly people, which is characterized by gastric body with smaller volume. The diagnosis of gastric CFT mainly depends on pathological morphology and immunohistochemical examination. It needs to be differentiated from a variety of spindle cell tumors more commonly found in the stomach.