FNA-Tg胶体金免疫层析检测法在甲状腺乳头状癌术中诊断淋巴结转移的应用研究  

Application of FNA-Tg with CGICA test for the intraoperative diagnosis of lymph node metastasis in papillary thyroid carcinoma

作　　者：倪帮高 费媛[1] 吴文爽 魏涛 李志辉[1] 龚日祥[1] 朱精强[1] 苏安平[1] NI Banggao;FEI Yuan;WU Wenshuang;WEI Tao;LI Zhihui;GONG Rixiang;ZHU Jingqiang;SU Anping(Center for Diagnosis and Treatment of Thyroid and Parathyroid Diseases,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Department of Thyroid Surgery,The People’s Hospital of Deyang City,Deyang,Sichuan 618000,P.R.China)

机构地区：[1]四川大学华西医院甲状(旁)腺疾病外科诊疗中心,成都610041 [2]德阳市人民医院甲状腺外科,四川德阳618000

出　　处：《中国普外基础与临床杂志》2022年第5期641-647,共7页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨细针穿刺洗脱液甲状腺球蛋白(fine needle aspiration-thyroglobulin,FNA-Tg)胶体金免疫层析检测法(colloidal gold immunochromatographic assay,CGICA)在术中诊断甲状腺乳头状癌(papillary thyroid carcinoma,PTC)颈部淋巴结转移的临床应用价值。方法选取2019年8–12月期间在四川大学华西医院甲状腺外科行手术治疗的78例PTC患者作为研究对象,对术中清扫的289枚颈部淋巴结标本在离体10 min内行淋巴结细针穿刺抽吸后制备成洗脱液,然后采用CGICA法快速定量检测FNA-Tg水平,洗脱液标记后术后再送检验科行罗氏电化学发光免疫分析法检测FNA-Tg水平。全组淋巴结根据其位置分为中央区组和颈侧区组;根据淋巴结的长径分为<5 mm组、5~10 mm组及>10 mm组。以术后病理报告为金标准,绘制全组数据受试者工作特征(receiver operating characterstic,ROC)曲线,比较曲线下面积(area under curve,AUC),计算FNA-Tg诊断PTC淋巴结转移的最佳截点值。比较CGICA法和罗氏法检测FNA-Tg对全组及不同亚组淋巴结转移诊断的敏感度、特异度、准确率、阳性预测值和阴性预测值。收集术中同时行FNA-Tg CGICA法检测和快速冰冻病理学检查的55枚淋巴结数据,比较CGICA法和快速冰冻病理学检查判断淋巴结转移的诊断效能。结果全组淋巴结FNA-Tg的CGICA法和罗氏法检测的AUC分别是0.850和0.883,差异无统计学意义(Z=1.011,P>0.05),敏感度分别为77.7%和79.6%(χ^(2)=0.05,P>0.05),特异度分别为84.9%和93.5%(χ^(2)=7.50,P<0.05);采用McNemar检验,全组中FNA-Tg的CGICA法和罗氏法两种检测方法诊断结果的差异无统计学意义(P>0.05)。CGICA法检测FNA-Tg的诊断效能在颈侧区组优于中央区组,对淋巴结长径>10 mm组的诊断效能优于淋巴结长径<5 mm组和5~10 mm组。FNA-Tg CGICA法检测和快速冰冻病理学检查诊断结果的差异无统计学意义(P>0.05)。结论CGICA法检测FNA-Tg在诊断PTC颈部淋巴结转移中有�Objective To investigate the efficacy of fine needle aspiration-thyroglobulin(FNA-Tg)with colloidal gold immunochromatographic assay(CGICA)on the assessment of lymph node metastasis during surgery in papillary thyroid carcinoma(PTC)patients.Methods Seventy-eight patients with PTC who underwent surgery in the Department of Thyroid Surgery of West China Hospital of Sichuan University from August to December 2019 were selected as the research objects,289 neck lymph node specimens cleaned during the operation were prepared into eluent after lymph node FNA within 10 minutes in vitro,and then the FNA-Tg level was detected rapidly and quantitatively by CGICA.The specimen of washout fluid was labeled and sent to the laboratory for FNA-Tg detection by Roche electrochemiluminescence immunoassay.The lymph nodes in the whole group were divided into central region group and lateral cervical region group according to their location.According to the long diameter of lymph nodes,they were divided into<5 mm group,5–10 mm group and>10 mm group.With postoperative pathological report as the gold standard,the receiver operating characteristic(ROC)curve of the whole group of data subjects was drawn,and the area under curve(AUC)was compared to calculate the best cut-off value of FNA-Tg in diagnosing PTC lymph node metastasis.The sensitivity,specificity,diagnostic accuracy,positive predictive value and negative predictive value of FNATg CGICA method and Roche method in the whole group and different subgroups were compared.The data of 55 lymph nodes detected by FNA-Tg CGICA method and rapid frozen pathology were collected,and the diagnostic efficacy indexes of CGICA method and rapid frozen pathology in the diagnosis of lymph node metastasis were compared.Results The ROC curves AUC of FNA-Tg detected by CGICA method and Roche method was 0.850 and 0.883,respectively,the difference was not statistically significant(Z=1.011,P>0.05).The sensitivity was 77.7%and 79.6%respectively(χ2=0.05,P>0.05),specificity was 84.9%and 93.5%respectively(χ

关 键 词：甲状腺乳头状癌 颈淋巴结转移 洗脱液 甲状腺球蛋白 胶体金免疫层析检测法 

分 类 号：R736.1[医药卫生—肿瘤]