细针穿刺BRAF单基因检测在甲状腺微小乳头状癌中的诊断价值  

Diagnostic Value of Fine Needle Aspiration BRAF Single Gene Detection in Thyroid Micropapillary Carcinoma

作　　者：林恩德[1] 傅锦波[1] 林福生[1] 陈清贵[1] 罗晔哲[1] 洪晓泉[1] 吴国洋[1] LIN En-de;FU Jin-bo;LIN Fu-sheng;CHEN Qing-gui;LUO Ye-zhe;HONG Xiao-quan;WU Guo-yang(General Surgery,Zhongshan Hospital,Xiamen University,Xiamen,Fujian Province,361004 China)

机构地区：[1]厦门大学附属中山医院普通外科

出　　处：《中外医疗》2019年第34期33-35,共3页China & Foreign Medical Treatment

摘　　要：目的探讨术前细针穿刺BRAF基因检测在甲状腺微小乳头状癌中的临床价值。方法回顾性分析厦门大学附属中山医院普通外科2017年4月—2018年12月共328例甲状腺结节手术患者临床资料。其中<1 cm结节153例患者,≥1 cm甲状腺结节175例患者,根据手术后组织病理学结果,观察两组细针穿刺细胞学结果及BARF基因突变表达情况。计算细针穿刺细胞学、BRAF基因突变和两者联合诊断的敏感性、特异性及准确性,组间比较采用McNemar配对资料2检验。结果以结节直径分为两组,<1 cm结节组中,FNAC在判断结节良恶性的灵敏度、特异度、阳性预测值、阴性预测值、准确率分别是88.2%、95.2%、99.2%、54.1%、89.1%;BRAF基因突变检测在判断结节良恶性的灵敏度、特异度、阳性预测值、阴性预测值、准确率分别是91.0%、100.0%、100.0%、61.8%、92.1%;≥1 cm结节组中,FNAC在判断结节良恶性的灵敏度、特异度、阳性预测值、阴性预测值、准确率分别是88.8%、100.0%、100.0%、78.1%、94.3%;BRAF基因突变检测在判断结节良恶性的灵敏度、特异度、阳性预测值、阴性预测值、准确率分别是77.6%、98.0%、99.0%、63.6%、83.4%。结论单基因检测BRAF突变在<1 cm结节中比FNAC有更好的诊断能力,是甲状腺微小乳头状癌一个可靠的诊断指标。Objective To explore the diagnostic value of preoperative fine needle aspiration BRAF gene detection in thyroid micropapillary carcinoma.Methods A retrospective study was conducted on the clinical data of 328 patients with thyroid nodules who underwent surgery in the Zhongshan Hospital Xiamen University from April 2017 to December 2018.153 patients with<1 cm nodules and 175 patients with≥1 cm thyroid nodules were observed.The sensitivity,specificity and accuracy of FNAC,BRAF gene mutation and combined diagnosis were calculated.Results In the<1 cm nodule group,the sensitivity,specificity,PPV,NPV and accuracy of FNAC were 88.2%,95.2%,99.2%,54.1%and 89.1%,respectively,and the sensitivity,specificity,PPV,NPV and accuracy of BRAF gene mutation detection were 91.0%,100.0%,100.0%,61.8%,92.1%,respectively;In the group of≥1 cm nodule group,the sensitivity,specificity,PPV,NPV and accuracy of FNAC were 88.8%,100.0%,100.0%,78.1%and 94.3%,respectively;The sensitivity,specificity,PPV,NPV and accuracy of BRAF gene mutation detection were 77.6%,98.0%,99.0%,63.6%and 83.4%,respectively.Conclusion Single gene detection of BRAF mutation in nodules<1 cm has better diagnostic ability than FNAC.

关 键 词：甲状腺微小乳头状癌 细针穿刺 BRAF基因突变 术前诊断 

分 类 号：R5[医药卫生—内科学]