甲状腺影像报告和数据系统联合BRAF V600E突变检测对甲状腺细针穿刺细胞学不确定结节的诊断价值  

Diagnostic value of thyroid imaging report and data system combined with BRAF V600E mutation detection for thyroid fine needle puncture cytological uncertain nodules

作　　者：郝增方[1] 李丹[1] 李月红[1] 聂赛赛 赵鹏新[2] 王影[2] 刘围娜[1] 吴文新[1] Hao Zengfang;Li Dan;Li Yuehong;Nie Saisai;Zhao Pengxin;Wang Ying;Liu Weina;Wu Wenxin(Department of Pathology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Thyroid and Breast Surgery,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院病理科,石家庄050000 [2]河北医科大学第二医院腺体外科,石家庄050000

出　　处：《肿瘤研究与临床》2023年第1期48-53,共6页Cancer Research and Clinic

基　　金：河北省医学适用技术跟踪项目(G2019049);河北省医学科学研究课题(20190515)。

摘　　要：目的探讨甲状腺影像报告和数据系统(TIRADS)联合BRAF V600E突变检测对甲状腺细针穿刺细胞学(FNAC)不确定结节的诊断价值,并分析TIRADS分类在筛选需行BRAF V600E突变检测结节中的作用。方法回顾性分析河北医科大学第二医院2018年1月至2021年8月经TIRADS分类、FNAC Bethesda分类、BRAF V600E突变检测和术后组织病理学诊断的337例甲状腺结节患者的临床病理资料。分析TIRADS分类、FNAC Bethesda分类及BRAF V600E突变单独及联合检测在鉴别甲状腺结节良恶性中的作用。结果以术后组织病理学检查结果为金标准,TIRADS分类、FNAC Bethesda分类和BRAF V600E突变检测诊断甲状腺癌的灵敏度分别为76.0%、88.1%和80.4%,特异度分别为84.0%、96.0%和100.0%。59例FNAC不确定结节中,37例(62.7%)术后组织学证实为恶性结节。BRAF V600E突变检测对FNAC不确定结节诊断的灵敏度和准确度分别为51.4%和69.5%,而BRAF V600E突变检测联合TIRADS分类的灵敏度和准确度分别为86.5%和84.7%,两者联合检测的灵敏度和准确度均提高(P值分别为0.002、0.049)。随TIRADS分类中危险风险升高,甲状腺结节BRAF V600E突变阳性率呈逐级升高趋势,其中3类病例低于4a类[14.3%(1/7)比68.6%(24/35),P=0.012],4a类以上相邻各组差异均无统计学意义(均P>0.05)。结论TIRADS联合BRAF V600E突变检测可提高FNAC不确定甲状腺结节诊断的灵敏度和准确度。TIRADS 4a类及以上结节BRAF V600E突变率高,建议患者行常规检测。Objective To investigate the diagnostic value of thyroid imaging report and data system(TIRADS)combined with BRAF V600E mutation detection in differentiating uncertain thyroid nodules by using fine needle aspiration cytology(FNAC),and to analyze the role of TIRADS classification in screening the nodules needed to be routinely detected for BRAF V600E mutation.Methods The clinicopathological data of 337 thyroid nodules patients diagnosed with TIRADS classification,FNAC Bethesda classification,BRAF V600E mutation detection and postoperative histopathology from the Second Hospital of Hebei Medical University between January 2018 and August 2021 were retrospectively analyzed.The role of TIRADS classification,FNAC Bethesda classification and BRAF V600E mutation detection alone and the combined detection in the differentiation of benign and malignant thyroid nodules was also analyzed.Results The postoperative histopathological result was regarded as the gold standard.The sensitivity of TIRADS classification,FNAC Bethesda classification and BRAF V600E mutation for thyroid cancer diagnosis was 76.0%,88.1%and 80.4%respectively,and the corresponding specificity was 84.0%,96.0%and 100.0%,respectively.Histologically,37(62.7%)of 59 nodules with FNAC uncertainty were malignant nodules after the surgery.The sensitivity and accuracy of BRAF V600E mutation detection in the diagnosis of FNAC uncertain nodules were 51.4%and 69.5%,respectively,while the sensitivity and accuracy of BRAF V600E mutation detection combined with TIRADS classification were 86.5%and 84.7%,respectively.The sensitivity and accuracy of BRAF V600E mutation detection combined with TIRADS classification were both improved(P values were 0.002 and 0.049,respectively).The positive rate of BRAF V600E mutation in thyroid nodules increased step by step with the rise of risk degree in TIRADS classification,and the type 3 cases were lower than those in type 4a cases[14.3%(1/7)vs.68.6%(24/35),P=0.012],and there were no statistically significant differences among the adjac

关 键 词：甲状腺结节 细针穿刺细胞学 甲状腺影像报告和数据系统 BRAF V600E突变 

分 类 号：R581[医药卫生—内分泌]