TI-RADS、BRAF V600E突变分析与BSRTC在甲状腺结节鉴别诊断中的价值  

Value of TI-RADS,BRAF V600E mutation analysis and BSRTC in differential diagnosis of thyroid nodules

作　　者：姬祥鹏 郭曼 闻宝杰[2] 张捷[2] 金志斌[2] 于鹏丽[2] 吴敏[2] 孔文韬 JI Xiangpeng;GUO Man;WEN Baojie;ZHANG Jie;JIN Zhibin;YU Pengli;WU Min;KONG Wentao(Nanjing Drum Tower Hospital Clinical College of Jiangsu University,Nanjing 210009,Jiangsu Province,China;Department of Ultrasonic Diagnosis,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing 210009,Jiangsu Province,China;Department of Ultrasonic Diagnosis,The Affiliated Brain Hospital of Nanjing Medical University,Nanjing 210009,Jiangsu Province,China)

机构地区：[1]江苏大学鼓楼临床医学院,江苏南京210009 [2]南京大学医学院附属鼓楼医院超声诊断科,江苏南京210009 [3]南京医科大学附属脑科医院超声诊断科,江苏南京210009

出　　处：《肿瘤影像学》2023年第2期156-162,共7页Oncoradiology

基　　金：南京市卫生青年人才培养工程(QRX17011)。

摘　　要：目的:探讨超声甲状腺影像报告和数据系统(Thyroid Imaging Report and Data System,TI-RADS)、甲状腺细胞病理学Bethesda报告系统(The Bethesda System for Reporting Thyroid Cytopathology,BSRTC)与BRAF V600E突变分析在甲状腺良恶性结节鉴别诊断中的价值。方法:回顾并分析行手术切除的1093个甲状腺结节的术前超声检查、超声引导下细针穿刺活检(fine-needle aspiration biopsy,FNAB)与BRAF V600E突变分析结果。依据TI-RADS分类标准对结节进行分类,采用BSRTC对结节进行细胞学诊断。分别计算3种方法的灵敏度、特异度及曲线下面积(area under curve,AUC)。结果:单独应用时,TI-RADS诊断甲状腺良恶性结节的灵敏度、阴性预测值和准确度最高,分别为99.21%、84.00%和95.97%;BSRTC诊断阳性预测值和约登指数最高,分别为99.22%和78.52%;BRAF V600E突变分析的AUC最高,为0.893;BRAF V600E突变分析和BSRTC特异度最高,均为91.03%。联合应用时,BSRTC联合BRAF V600E突变分析的诊断特异度、阳性预测值、约登指数、准确度和AUC最高,分别为84.62%、98.77%、79.60%、98.90%和0.898;三者联合诊断的灵敏度、阴性预测值最高,分别为99.61%、91.11%。对于BSRTCⅠ、Ⅲ、Ⅳ类结节,联合TI-RADS、BRAF V600E突变分析可以减少误诊,提高恶性结节检出率。结论:BSRTC、TI-RADS与BRAF V600E突变分析与在甲状腺结节诊断中均有较高的价值,三者联合有助于进一步提高甲状腺结节诊断的准确度,减少误判。Objective:To explore the value of the Thyroid Imaging Reporting and Data System(TI-RADS),The Bethesda System for Reporting Thyroid Cytopathology(BSRTC)and BRAF V600E mutation analysis in the differential diagnosis of thyroid nodules.Methods:The preoperative ultrasonography,ultrasound-guided fine-needle aspiration biopsy(FNAB),and BRAF V600E mutation analysis results of 1093 thyroid nodules that underwent surgery resection were analyzed.TI-RADS classification criteria was used to classify the nodules,and BSRTC was used to undergo cytological diagnosis of the nodules.The sensitivity,specificity,and area under curve(AUC)of the three methods were calculated and compared.Results:When applied individually,the sensitivity,negative predictive value,and accuracy of TI-RADS were the highest among the three methods,and they were 99.21%,84.00%,and 95.97%,respectively.BSRTC had the highest positive predictive value,Youden index,and the values were 99.22%,and 78.52%,respectively.BRAF V600E mutation analysis had the highest AUC(0.893).Both BRAF V600E mutation analysis and BSRTC had the highest specialty(91.93%).When applied in combination,the combination of BSRTC and BRAF V600E mutation analysis had the highest specialty(84.62%),positive predictive value(98.77%),Youden index(79.60%),accuracy(98.90%)and AUC(0.898).The highest sensitivity(99.61%),and negative predictive value(91.11%)were achieved when all three methods were combined.For theⅠ,Ⅲ,andⅣnodules,BSRTC combined with TI-RADS and/or BRAF V600E mutation analysis reduced misdiagnosis and improved diagnostic accuracy.For theⅠ,Ⅲ,andⅣnodules,BSRTC combined with TI-RADS and BRAF V600E mutation analysis reduced misdiagnosis and improved diagnostic accuracy.Conclusion:BSRTC,TI-RADS,and BRAF V600E mutation analysis all have high value in the diagnosis of thyroid nodules,and the combination of three methods could improve diagnostic efficiency and reduce misdiagnosis.

关 键 词：甲状腺结节 超声 甲状腺影像报告和数据系统 BRAF V600E 细针穿刺活检 

分 类 号：R736.1[医药卫生—肿瘤] R445.1[医药卫生—临床医学]