超声联合BRAF V600E基因检测模型在主动监测甲状腺微小癌侵袭性中的应用  

Application of ultrasound combined with BRAF V600Egene detection model in proactively detecting theaggressiveness of thyroid microcarcinoma

作　　者：王雨竹 彭梅[1] 姜凡[1] 王圣应 刘建军[2] 陶堃 杨杨[3] 何杰[4] Wang Yuzhu;Peng Mei;Jiang Fan;Wang Shengying;Liu Jianjun;Tao Kun;Yang Yang;He Jie(Dept of Ultrasound,The Second Affiliated Hospital of Anhui Medical University,Hefei 230601;Dept of Head and Neck,The First Affiliated Hospital of USTC West District,Hefei 230001;Dept of Ultrasound,The First Affiliated Hospital of USTC West District,Hefei 230001;Dept of Pathology,The First Affiliated Hospital of USTC West District,Hefei 230001)

机构地区：[1]安徽医科大学第二附属医院超声科,合肥230601 [2]中国科学技术大学附属第一医院西区头颈乳腺外科,合肥230001 [3]中国科学技术大学附属第一医院西区超声科,合肥230001 [4]中国科学技术大学附属第一医院西区病理科,合肥230001

出　　处：《安徽医科大学学报》2022年第4期640-644,共5页Acta Universitatis Medicinalis Anhui

基　　金：安徽省重点研究与开发计划项目(编号:201904a07020068)。

摘　　要：目的建立预测甲状腺微小乳头状癌(PTMC)侵袭性的超声联合基因风险评估模型,为主动监测PTMC侵袭性提供理论依据。方法选取2017年10月-2021年1月264例行手术治疗并经术后病理诊断为PTMC的患者。将2017年10月至2019年4月收集的154例纳入模型组,2019年5月至2021年1月收集的110例纳入验证组。分析模型组154例经术后病理证实为PTMC患者的临床资料、超声特征及BRAF V600E基因结果。采用单因素分析筛选出PTMC侵袭性的危险因素,再将其纳入多因素Logistic回归分析,建立风险预测模型,并将建立的模型代入验证组110例PTMC患者评估其诊断效能。结果多因素分析显示男性、年龄<45岁、微钙化、肿瘤最大径>5 mm、超声疑为腺外侵犯、超声疑为淋巴结转移、BRAF V600E基因突变型为建立模型的危险因素。根据危险因素建立赋分模型,得分越高则风险越高。在110例验证组中评估预测模型预测效能曲线下面积AUC为0.774(95%CI:0.685~0.848),cut-off值为0.4502,灵敏度为83.3%,特异度为62.9%。模型具有较好的诊断效能。结论超声联合BRAF V600E基因检测模型对PTMC侵袭性有一定的预测能力,可为临床治疗方案的选择提供参考。Objective To establish an assessment model for predicting the aggressiveness of papillary thyroid microcarcinoma(PTMC)and to provide a theoretical basis for actively monitoring the same.Methods 264 PTMC patients were included from October 2017 to January 2021.All patients were confirmed by postoperative pathology.154 cases collected from October 2017 to April 2019 were included in the model group while 110 cases collected from May 2019 to January 2021 were included in the validation group.We analyzed the clinical data,ultrasound characteristics,and BRAF V600E gene status of 154 patients in the model group with confirmed PTMC based on pathological examination.Single factor regression was used to screen out risk factors for PTMC invasion,and these factors were then included in a multivariate logistic regression analysis to establish a risk prediction model;the established model was used to evaluate the diagnostic efficacy of 110 PTMC patients in the validation group.Results Multivariate analysis showed that male sex,age<45 years,microcalcification,tumor diameter>5 mm,suspected extraglandular invasion and lymph node metastasis on ultrasound,and BRAF V600E gene mutation were all risk factors for PTMC invasion.A scoring model was established according to risk factors,and the higher the score,the higher the risk.In the 110-case verification group,the area under the predictive performance curve of the evaluation prediction model was 0.774(95%CI:0.685-0.848),the cut-off value was 0.4502,the sensitivity was 83.3%,and the specificity was 62.9%.The model therefore had good diagnostic efficacy.Conclusion Ultrasound combined with BRAF V600E gene detection model can predict the aggressiveness of PTMC to a certain extent,which can provide reference for the selection of clinical treatment options.

关 键 词：侵袭性 BRAF V600E基因 甲状腺微小乳头状癌 

分 类 号：R736.1[医药卫生—肿瘤]