免疫标记和BRAF V600E突变联合检测在细胞学诊断不确定甲状腺结节中的应用  

Application of Combined Detection and BRAF V600E Mutation in Cytologicaly Indeterminate Thyroid Nodules

作　　者：王欢[1] 陈昶 姜勇[1] 姜可[2] 李金男[1] 苏学英[1] 雷建勇[2] Wang Huan;Chen Chang;Jiang Yong;Jiang Ke;Li Jinnan;Su Xueying;Lei Jianyong(Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, China;Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu 610041, China)

机构地区：[1]四川大学华西医院病理科,成都610041 [2]四川大学华西医院甲状腺外科,成都610041

出　　处：《成都医学院学报》2022年第1期52-57,共6页Journal of Chengdu Medical College

基　　金：成都市科技项目(No:2019-YF05-00324-SN);四川大学华西医院学科卓越发展1.3.5工程临床研究孵化项目(No:2020HXFH024)。

摘　　要：目的评估免疫标记半乳糖凝集素-3(Gal-3)、细胞角蛋白-19(CK-19)、间皮细胞角蛋白-1(HBME-1)和BRAF V600E突变联合检测对术前甲状腺细胞学诊断不确定结节的良恶甄别作用。方法选取四川大学华西医院2014年12月至2019年3月术前细胞学诊断不确定的甲状腺结节患者992例为研究对象,其中行3项免疫标记和/或BRAF V600E突变辅助检测的314例患者为观察组,未行上述辅助检测的678例为对照组,以术后病理学诊断评估上述检测单独或联合应用辅助技术的诊断价值。结果观察组术后恶性率高于对照组(P<0.001)。观察组中,195例患者行Gal-3、CK-19和HBME-1的免疫标记检测,301例患者行BRAF V600E突变检测,其中仅182例患者行3项免疫标记和BRAF V600E突变联合分析。对于单个检测,BRAF V600E突变和CK-19的特异性和敏感性最高,分别为100.0%和90.6%,当联合使用时诊断效能明显提高。BRAF V600E突变检测、Gal-3和CK-19组合的诊断效果最好,准确率最高达92.9%,该组合术前正确分类了168个恶性结节中的161个(95.8%)和14个良性病变中的8个(57.1%),其中159例甲状腺乳头状癌中有158例被本组合正确分类。结论免疫标记Gal-3、CK-19和BRAF V600E突变检测对细胞学诊断不确定的甲状腺结节有较高的良恶性甄别价值。Objective To evaluate the role of combined detection of galectin-3(Gal-3),cytokeratin-19(CK-19),Hector Battifora mesothelial-1(HBME-1)and BRAF V600E mutation in preoperative diagnosis of benign and malignant thyroid nodules indeterminated by cytology.Methods A total of 992 patients with cytologically indeterminate thyroid nodules in West China Hospital of Sichuan University from December 2014 to March 2019 were included.Among them,314 patients who received auxiliary detection of 3 immunocytochemistry markers and/or BRAF V600E mutation were included in the experimental group,and 678 patients who did not receive such assisted detection were included in the control group.The diagnostic value of the above tests alone or in combination was evaluated by postoperative pathological diagnosis.Results In general,postoperative pathological diagnosis showed higher malignant rate in the experimental group than in the control group(P<0.001).Among the 314 patients in the experimental group,195 patients underwent Gal-3,CK-19 and HBME-1 immunocytochemistry markers detection,301 patients underwent BRAF V600E mutation detection,and only 182 patients underwent combined detection of 3 immunocytochemistry markers and BRAF V600E mutation.For single detection,BRAF V600E mutation had the sensitivity of 100.0%,and CK-19 had the specificity of 90.6%.When used in combination,the diagnostic efficacy was significantly enhanced.The combination of BRAF V600E mutation,CK-19 and Gal-3 showed the best diagnostic performance,with the highest accuracy of 92.9%.This combination correctly classified 161(95.8%)out of 168 malignant nodules and 8(57.1%)out of 14 benign lesions preoperatively.And of 159 papillary thyroid carcinomas(PTC),158 were correctly classified by this combination.Conclusion Combination of immunocytochemistry markers Gal-3,CK-19 and BRAF V600E mutation detection are valuable for preoperative screening of benign and malignant thyroid nodules indeterminated by cytology.

关 键 词：甲状腺结节 细胞学 半乳糖凝集素-3 细胞角蛋白-19 间皮细胞角蛋白-1 BRAF V600E 

分 类 号：R581[医药卫生—内分泌]