超声引导下细针穿刺细胞学检查联合BRAFV600E基因检测对甲状腺良恶性结节的诊断价值  

The value of ultrasound-guided fine needle aspiration combined with detection of BRAF V600E in diagnosis ofbenign and malignant thyroid nodules

作　　者：罗志京 薛恩生[1] 俞丽云[1] 何以敉[1] 林文金[1] 钱清富 唐秀斌 Luo Zhijing;Xue Ensheng;Yu Liyun;He Yimi;Lin Wenjin;Qian Qingfu;Tang Xiubin(Department of Ultrasound, Union Hospital of Fujian Medical University, Union Clinical Medical College of Fujian Medical University, Fuzhou 350001, China)

机构地区：[1]福建医科大学协和临床医学院福建医科大学附属协和医院超声科,福州350001

出　　处：《中华超声影像学杂志》2018年第6期500-504,共5页Chinese Journal of Ultrasonography

基　　金：福建省科技计划项目（2014Y0026）

摘　　要：目的探讨超声引导下细针穿刺细胞学检查（US-FNA）结合BRAFV600E检测在诊断甲状腺良恶性结节中的应用价值。方法选择行甲状腺结节US-FNA、BRAFV600E检测及接受手术治疗的患者114例共123个结节，术前依据甲状腺影像报告和数据系统（TIRADS）分类标准进行结节恶性风险分级评估。穿刺所得标本部分用于HE染色，行细胞学诊断，部分用于BRAFV600E检测。结果①123个结节中共71个检测到BRAFV600E突变，其中58个US-FNA诊断为恶性，13个为性质不确定，BRAF突变阳性结节术后病理均为甲状腺乳头状癌。US-FNA联合BRAFV600E检测可提高单独US FNA诊断的敏感性和准确性，差异有统计学意义（均P〈0．001）；②BRAFV600E的突变与侵犯甲状腺被膜相关（χ^2=8．44，P=0．004），联合TI-RADS分类可提示结节侵犯被膜的高风险性；③123个结节中，18个无BRAFV600E突变且US-FNA诊断为性质待定，其中10个结节TI-RADS分类为3b及以上，术后病理6个甲状腺乳头状癌，1个甲状腺滤泡癌，3个甲状腺良性病变。结论US-FNA联合BRAFV600E的检测及TIRADS分类有助于提高甲状腺结节良恶性诊断的准确性，降低USFNA结果的诊断不确定性。Objective To evaluate the value of ultrasound-guided fine needle aspiration（US -FNA） combined with detection of BRAF V600E and thyroid imaging reporting and data system（TI-RADS） in diagnosis of benign and malignant thyroid nodules. Methods In this study, 123 operative thyroid nodules from 114 patients who underwent US-FNA and detection of BRAF V600E were enrolled. TI-RADS was apply for the classification of each nodule before surgery. Specimens from each nodule were subjected for hematoxylin and eosin （HE） staining and cytological diagnosis and detection of BRAF V600E mutation. Results BRAF V600E mutation was found in 71 （71/123） nodules with histologic confirmation of papillary thyroid carcinoma, 58 of which were cytologically diagnosed as carcinoma and 13 were indeterminate. Compared with the postoperative pathological results, US-FNA combined with BRAF V600E could improve the sensitivity and accuracy of diagnosis to thyroid nodules compared with individual US- FNA,and the difference was statistically significant（ P 〈0.001）. ②The mutation rate of BRAF V600E was associated with thyroid capsular invasion（χ^2 = 8.44, P = 0.004）, and combined with TI-RADS could indicate the high-risk of this invasion. ③Among 123 operative nodules, 18 nodules were BRAF V600E negative and cytologically diagnosed as indetermination, 10 of which were TI-RADS 3b or above. After thyroidectomy, 6 nodules were confirmed as papillary-thyroid carcinoma, 1 nodule was thyroid follicularcarcinoma, and 3 nodules were benign ones. Conclusions US-FNA combined with detection of BRAF V600E and TI-RADS can improve the diagnostic accuracy and decrease the misdiagnosis in indeterminate nodules.

关 键 词：超声检查 甲状腺结节 甲状腺影像报告和数据系统 活组织检查 细针 BRAF V600E基因 

分 类 号：R581[医药卫生—内分泌]