超声造影联合细针穿刺活检及BRAF基因检测对TI-RADS 4类甲状腺结节的诊断价值  

Diagnostic value of contrast-enhanced ultrasound combined with fine-needle aspiration biopsy and BRAF gene detection for TI-RADS category 4 nodules

作　　者：施红卫 王辉阳[1] 邓华东 彭晨冰[2] 蒋天安 Shi Hongwei;Wang Huiyang;Deng Huadong;Peng Chenbing;Jiang Tianan(Department of Ultrasonography,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310000,China;Department of Ultrasound,Lishui People′s Hospital,Lishui 323000,China)

机构地区：[1]浙江大学医学院附属第一医院超声医学科,杭州310000 [2]丽水市人民医院超声科,丽水323000

出　　处：《中华超声影像学杂志》2022年第3期214-219,共6页Chinese Journal of Ultrasonography

基　　金：国家重大科研仪器研制项目(82027803);国家自然科学基金面上项目(81971623);浙江省自然科学基金重点项目(LZ20H180001)。

摘　　要：目的探讨超声造影联合细针穿刺活检及BRAF基因检测在甲状腺影像报告和数据系统(TI-RADS)4类结节中的临床应用价值。方法本研究收集2019年1月至2020年1月80例于浙江大学医学院附属第一医院和丽水市人民医院接受手术后获取病理结果并于术前二维灰阶超声诊断为TI-RADS 4类甲状腺结节患者的临床资料进行回顾性分析。所有患者均接受了超声造影联合细针穿刺活检和BRAF基因检测,应用ROC曲线分析超声造影联合细针穿刺活检及BRAF基因检测对TI-RADS 4类甲状腺结节的诊断效能。结果以术后病理诊断结果为依据,超声造影诊断TI-RADS 4类甲状腺结节的敏感性、特异性和准确性分别为77.61%、70.97%和75.51%;超声引导下细针穿刺活检诊断TI-RADS 4类甲状腺结节的敏感性、特异性和准确性分别为80.60%、74.19%和78.57%;BRAF基因检测诊断TI-RADS 4类甲状腺结节的敏感性、特异性和准确性分别为79.10%、96.77%和84.69%;联合诊断TI-RADS 4类甲状腺结节的敏感性、特异性和准确性分别为98.51%、70.97%和89.80%;超声造影诊断的AUC为0.790,超声引导下细针穿刺活检诊断的AUC为0.774,BRAF基因检测诊断的AUC为0.799,而联合诊断的AUC为0.847,联合应用的诊断价值明显高于单一诊断方式(P<0.05)。结论超声造影联合细针穿刺活检及BRAF基因检测对TI-RADS 4类甲状腺结节有较高的诊断价值,可以提高术前诊断的准确性。Objective To explore the diagnostic value of contrast-enhanced ultrasound combined with fine-needle aspiration biopsy and BRAF gene detection for TI-RADS category 4 nodules.Methods The clinical datas of 80 patients who underwent surgery in the First Affiliated Hospital,Zhejiang University School of Medicine and Lishui People′s Hospital and diagnosed with TI-RADS 4 thyroid nodules from January 2019 to January 2020 were retrospectively analyzed.All patients received contrast-enhanced ultrasound combined fine-needle aspiration biopsy and BRAF gene detection,the ROC curves were plotted,the area under the ROC curve(AUC)and the best diagnostic cut-off values were calculated,and the application value of ultrasound-enhanced contrast,fine-needle aspiration biopsy and BRAF gene detection were compared.Results Based on the results of pathological diagnosis,in diagnosing TI-RADS 4 thyroid nodules,the sensitivity,specificity and accuracy were 77.61%,70.97%and 75.51%for contrast-enhanced ultrasound,respectively;80.60%,74.19%,and 78.57%for ultrasound-guided fine-needle aspiration biopsy,respectively;79.10%,96.77%,and 84.69%for the BRAF gene test,respectively;and 98.51%,70.97%and 89.80%for the combined diagnosis,respectively.The AUC was 0.790 for contrast-enhanced ultrasound,and 0.774 for ultrasound-guided fine-needle aspiration biopsy,0.799 for BRAF genetic testing,and 0.847 for combined testing.The diagnostic value of combined diagnosis was significantly higher than other diagnostic methods(P<0.05).Conclusions Contrast-enhanced ultrasound combined with fine-needle aspiration biopsy and BRAF gene detection is valuable for the diagnosis of TI-RADS 4 class thyroid nodules and improves the preperative diagnosis.

关 键 词：超声造影 细针穿刺活检 BRAF基因 甲状腺结节 

分 类 号：R445.1[医药卫生—影像医学与核医学] R581[医药卫生—诊断学]