超声剪切波弹性成像联合BRAF V600E、Galectin-3预测甲状腺结节良恶性的价值  

Shear Wave Elastography Combined with BRAF V600E and Galectin-3 in the Prediction of Benign and Malignant Thyroid Nodules

作　　者：唐丽娜[1] 刘娜香[1] 刘辉[2] 周冬梅[3] 沈友洪[1] 吴周贵[1] 杜忠实[1] TANG Lina;LIU Naxiang;LIU Hui;ZHOU Dongmei;SHEN Youhong;WU Zhougui;DU Zhongshi(Department of Ultrasound,Fujian Cancer Hospital,Cancer Hospital Affiliated to Fujian Medical University,Fuzhou 350014,China;不详)

机构地区：[1]福建省肿瘤医院,福建医科大学附属肿瘤医院超声科,福建福州350014 [2]福建省肿瘤医院,福建医科大学附属肿瘤医院头颈外科,福建福州350014 [3]福建省肿瘤医院,福建医科大学附属肿瘤医院病理科,福建福州350014

出　　处：《中国医学影像学杂志》2021年第1期4-8,共5页Chinese Journal of Medical Imaging

基　　金：福建省科技厅引导性项目(2017Y0021);福建省卫生计生面向农村和城市社区推广适宜技术项目(2017008);国家临床重点专科建设项目资助[No.(2013)544]。

摘　　要：目的探讨剪切波弹性成像(SWE)联合BRAF V600E、Galectin-3预测甲状腺结节良恶性的价值。资料与方法对85例甲状腺结节患者共85枚结节行常规超声、SWE、BRAF V600E及Galectin-3检测。所有患者根据术后或穿刺病理结果分为良性组和恶性组,比较两组SWE参数、BRAF V600E及Galectin-3检测结果的差异;分析SWE及其联合BRAF V600E、Galectin-3对甲状腺结节良恶性的预测效能。结果恶性组弹性最大值(Emax)、弹性平均值(Emean)均高于良性组(P<0.036)。以Emean>20.2 kPa作为阈值,预测恶性结节的特异度(93.3%)高于Galectin-3(+)(73.3%)、SWE+Galectin-3(66.7%)及SWE+BRAF V600E+Galectin-3(66.7%)等;恶性组BRAF V600E基因突变及Galectin-3阳性表达明显高于良性组(P<0.005);SWE联合BRAF V600E预测甲状腺恶性结节的受试者工作特征曲线下面积最大(0.938),差异均有统计学意义(P<0.002),其中特异度、准确度、阳性预测值分别为94.3%、94.1%和98.5%,高于单独使用SWE、Galectin-3(+)和联合应用SWE+Galectin-3;而SWE联合Galectin-3较单独SWE提高了敏感度(88.6%比57.1%)和准确度(84.7%比63.5%),差异均有统计学意义(P<0.05)。结论SWE联合BRAF V600E、Galectin-3检测有助于提高超声对甲状腺结节良恶性的鉴别能力,从而指导临床选择治疗方案。Purpose To explore the value of shear wave elastography(SWE)combined with BRAF V600E and Galectin-3 in the prediction of benign and malignant thyroid nodules.Materials and Methods Eighty-five nodules of 85 patients with thyroid nodules were examined by ultrasonography,SWE,BRAF V600E and Galectin-3,and all patients were divided into benign and malignant groups according to the postoperative and puncture pathological results.The differences of SWE parameters,BRAF V600E and Galectin-3 detection between the two groups were compared.Efficacy of SWE and its combination with BRAF V600E and Galectin-3 in predicting malignant thyroid nodules was analyzed.Results The maximum elasticity(Emax)and mean elasticity(Emean)of the malignant group were higher than those of the benign group(P<0.036).With Emean>20.2 kPa as the cutoff,the specificity of predicting malignant nodules(93.3%)was higher than Galectin-3(+)(73.3%),SWE+Galectin-3(66.7%)and SWE+BRAF V600E+Galectin-3(66.7%)and other parameters.BRAF V600E mutant and Galectin-3 positive expression was statistically significant between benign and malignant groups(P<0.005).SWE combined with BRAF V600E predicted the largest area under the ROC curve of malignant thyroid nodules(P<0.002),its specificity,accuracy and positive predictive value were 94.3%,94.1%and 98.5%,respectively,which was higher than the use of SWE alone,Galectin-3(+)and the combined application of SWE+Galectin-3.The combination of SWE and Galectin-3 improved the sensitivity(88.6%vs.57.1%)and accuracy(84.7%vs.63.5%)compared with the SWE alone.Conclusion SWE combined with BRAF V600E and Galectin-3 improves the differentiation of benign and malignant thyroid nodules,so it can guide the choice of clinical treatment.

关 键 词：甲状腺结节 甲状腺肿瘤 超声检查 弹性成像技术 基因 BRAF V600E基因 GALECTIN-3 病理学 外科 诊断 鉴别 

分 类 号：R445.1[医药卫生—影像医学与核医学] R736.1[医药卫生—诊断学]