Excessive accumulation of cholesterol in macrophages results in a transformation of the macrophage into foam cells and eventually causes atherosclerosis ( 1, 2 ). The pathogenic process represents a chronic and complicated interaction involving multiple factors. Reverse cholesterol transport (RCT) is a process by which extrahepatic (peripheral) cholesterol is returned to the liver for excretion in the bile and ultimately the feces, thus reducing the risk of atherosclerosis ( 3, 4 ). Although there have been great efforts in discovering drugs against atherosclerosis ( 5 ), the output has been unsatisfactory. Removal of excess cholesterol from macrophage foam cells is considered to be one of the therapeutic strategies ( 6 ). The crucial cellular transporters and receptors that relate to cholesterol effl ux include,
Background: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) predicts the risk of malignancy for the different categories of the ultrasound-guided fine-needle aspiration biopsy (FNAB). The objective of this study is to investigate the efficiencies of the v-raf murine sarcoma viral oncogene homolog B1 ( BRAF ) V600E mutation test and the TBSRTC categories in distinguishing between benign and malignant thyroid nodules. Methods: In this study, 362 ultrasound-guided fine-needle aspiration (FNA) samples from 344 patients aged from 17 to 76 years old were retrospectively reviewed. The patients were classified into six groups (I–VI) according to the TBSRTC system. The amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) was used to evaluate the BRAF V600E mutation level in total 362 samples. Among of the 344 patients, 128 patients (131 thyroid nodules) who underwent surgeries were followed by histopathological examination. The predictive values of the BRAF V600E mutation test and TBSRTC categories were evaluated in these 131 thyroid nodules. Results: The median ages of the patients in the TBSRTC IV–VI group were smaller than those in the TBSRTC I–III groups. The proportion of nodules over 1 cm was larger than it in the TBSRTC IV group compared to the other groups. Significant differences in BRAF V600E mutation were observed ( P < .001) among these six groups. The sensitivity (89.57%) for the detection of malignant thyroid nodules, negative predictive value (NPV; 45.45%) for the detection of benign nodules, and accuracy (86.26%) for distinguishing between benign and malignant thyroid nodules increased by combining the BRAF V600E mutation test and TBSRTC system when compared with the BRAF V600E mutation test and TBSRTC system respectively. The BRAF V600E mutation test alone demonstrated the increased positive predictive value (PPV; 98.91%) and specificity (93.75%) for the detection of malignant thyroid nodules compared to the TBSRTC method (alone or in combination with the BRAF V600E method). Conclusion: In summary, significant differences in age, nodule diameter, and BRAF V600E mutation were noted among the six categories of the TBSRTC system. The combination of the BRAF V600E mutation test and TBSRTC system demonstrated increases in the NPV, sensitivity, and accuracy, while the BRAF V600E method proved superiority to the TBSRTC system with regard to the PPV and specificity.
Purpose To explore the utility of the BRAF V600E mutation in combination with Chinese Thyroid Imaging Reporting and Data System (C-TIRADS) in the management of atypia of undetermined signi cance/follicular lesion of undetermined signi cance (AUS/FLUS) thyroid nodule (TN).Methods 138 AUS/FLUS TNs in 129 patients were included. Each TN underwent preoperative BRAF V600E mutation analysis and was classi ed using the C-TIRADS. Histopathologic diagnosis served as reference standard.Results 46 benign TNs and 92 malignant TNs were identi ed. Malignant TNs were more commonly observed in TNs with a size less than 10mm (P = 0.033). There were signi cant differences in malignancy rate among the different C-TIRADS TNs (P = 0.000), and these TNs with higher C-TIRADS were associated with increased malignancy rate (P for trend = 0.000). The rate of nodule with BRAF V600E mutation increased with the increase of C-TIRADS (P for trend = 0.001). For AUS/FLUS TNs without BRAF V600E mutation, the malignancy rates of the C-TIRADS 3, 4A, 4B, 4C, and 5 were 0%, 21.4%, 20.8%, 70.8%, and 100%, respectively (P = 0.000), and the malignancy rate increased from C-TIRADS 3 to C-TIRADS 5 (P for trend = 0.000). The diagnostic performance of C-TIRADS was similar to the BRAF V600E mutation (P > 0.05), and the sensitivity, negative predictive value, and accuracy of the combination were signi cantly higher than BRAF V600E gene or C-TIRADS alone (P < 0.05).Conclusions C-TIRADS can effectively provide risk strati cation for AUS/FLUS TNs. The combination can be helpful in selecting appropriate management for AUS/FLUS patients.
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