细针穿刺细胞学联合BRAF基因检测对甲状腺结节诊断价值探讨  

Exploration of the diagnostic value of fine needle aspiration cytology combined with BRAF gene detection for thyroid nodules

作　　者：薛江波[1] 杨迪[1] 吕军鹏 赵亚蒙 XUE Jiangbo;YANG Di;LYU Junpeng;ZHAO Yameng(Department of Pathology,Sanmenxia Central Hospital,Sanmenzia 472100,China)

机构地区：[1]三门峡市中心医院病理科,河南三门峡472100

出　　处：《社区医学杂志》2023年第13期665-669,共5页Journal Of Community Medicine

基　　金：河南省医学科技攻关项目(2021001240)。

摘　　要：目的探讨甲状腺细针穿刺细胞学(FNAC)与BRAF基因联合检测在术前诊断甲状腺结节良恶性的临床应用价值。方法回顾性分析2020-01-01-2022-05-01三门峡市中心医院1705例在院手术切除甲状腺并做相应病理检查患者的临床资料。其中术前甲状腺超声怀疑为恶性,且TI-RADS分级在4a及以上者分别接受超声引导下甲状腺结节FNAC检查及BRAF基因检测者共115例,将结果和术后病理诊断进行比较。结果115例甲状腺结节中,术后病理诊断为恶性结节105例(91.3%),均为甲状腺乳头状癌,其中FNAC细胞学阳性91例,阴性14例;术后病理良性结节10例,术前FNAC细胞学检测阳性2例,阴性8例。FNAC联合BRAF基因突变检测诊断甲状腺结节灵敏度为96.2%,高于单独FNAC检测灵敏度86.7%,χ^(2)=6.047,P=0.014;联合检测准确度为94.8%,高于单独FNAC准确度86.1%,χ^(2)=5.004,P=0.025。联合检测灵敏度高于单独BRAF基因突变检测灵敏度88.6%,差异有统计学意义,χ^(2)=4.309,P=0.038;联合检测准确度和单独BRAF基因突变检测准确度比较,差异无统计学意义,χ^(2)=2.160,P=0.142。结论术前FNAC联合BRAF V600E基因检测优于单独的FNAC或BRAF检测,能提高甲状腺良恶性结节的术前诊断效能。Objective To investigate the clinical value of fine needle aspiration cytology(FNAC)combined with BRAF mutation in preoperative diagnosis of benign and malignant thyroid nodules.Methods Retrospective analysis of the clinical data of 1705 patients who underwent thyroid resection and corresponding pathological examinations at Sanmenxia Central Hospital from January 1,2020 to May 1,2022.Among them,115 cases were suspected to be malignant by preoperative thyroid ultrasound,and those with TI-RADS grading of 4a or above underwent ultrasound guided FNAC examination and BRAF gene detection of thyroid nodules,respectively.The results were compared with postoperative pathological diagnosis.Results Among 115 cases of thyroid nodules,105 cases(91.3%)were diagnosed as malignant nodules by postoperative pathology,all of which were papillary thyroid carcinoma.Among them,91 cases were positive for FNAC cytology and 14 cases were negative.There were 10 cases of postoperative pathological benign nodules,2 cases were positive and 8 cases were negative in preoperative FNAC cytology tests.The sensitivity of FNAC combined with BRAF gene mutation detection in diagnosing thyroid nodules was 96.2%,which was higher than the sensitivity of FNAC detection alone by 86.7%,χ^(2)=6.047,P=0.014.The accuracy of joint detection was 94.8%,which was higher than the accuracy of individual FNAC by 86.1%,χ^(2)=5.004,P=0.025.The sensitivity of joint detection was 88.6%,higher than that of single BRAF gene mutation detection,and the difference was statistically significant,χ^(2)=4.309,P=0.038.There was no statistically significant difference between the accuracy of joint detection and the accuracy of individual BRAF gene mutation detection,χ^(2)=2.160,P=0.142.Conclusion The combination of preoperative FNAC and BRAF V600E gene detection is superior to individual FNAC or BRAF detection,and can improve the preoperative diagnostic efficacy of benign and malignant thyroid nodules.

关 键 词：甲状腺结节 细针穿刺细胞学 BRAF V600E突变 诊断学 

分 类 号：R581[医药卫生—内分泌]