BRAF V600E基因突变与细针穿刺细胞学对甲状腺乳头状癌诊断价值的Meta分析  

The value of BRAF V600E gene mutation and FNAC in the diagnosis of papillary thyroid carcinoma:Meta-analysis

作　　者：王思雷 张艳[2] 徐建 杨汶士[1] Wang Silei;Zhang Yan;Xu Jian;Yang Wenshi(Department of Breast and Thyroid Surgery,the Central People's Hospital of Tengzhou,Tengzhou 277500,China;Department of the second Neonatology,the Central People's Hospital of Tengzhou,Tengzhou 277500,China;Department of EICU,the Central People's Hospital of Tengzhou,Tengzhou 277500,China)

机构地区：[1]滕州市中心人民医院乳腺甲状腺外科,滕州277500 [2]滕州市中心人民医院新生儿二科,滕州277500 [3]滕州市中心人民医院急诊监护室,滕州277500

出　　处：《国际耳鼻咽喉头颈外科杂志》2024年第1期16-21,共6页International Journal of Otolaryngology-Head and Neck Surgery

摘　　要：目的系统评价BRAF V600E基因突变的检测与细针穿刺细胞学(fine needle aspiration cytology,FNAC)对甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的诊断价值。方法计算机检索中国期刊全文数据库(CNKI)、万方数据库(WANFANG)、维普中文科技期刊数据库(VIP)、Pubmed、Embase、Cochrane图书馆,自2019年1月至2022年12月以病理组织诊断为“金标准”,对比分析BRAF V600E基因突变的检测与FNAC诊断PTC的诊断性试验文献,应用Review Manager 5.0、MetaDiSc软件进行Meta分析,并绘制汇总受试者工作特征(SROC)曲线,计算曲线下面积。结果最终纳入32篇文献共计7223枚甲状腺结节,BRAF V600E基因突变检测和FNAC诊断PTC合并敏感性分别为0.79(95%CI:0.78~0.80)和0.78(95%CI:0.77~0.79);特异性分别为0.96(95%CI:0.95~0.97)和0.90(95%CI:0.89~0.91);诊断比数比分别为64.87(95%CI:33.96~123.94)和22.55(95%CI:14.47~35.14);两种诊断方法联合的敏感性、特异性、诊断比数比分别为0.92(95%CI:0.91~0.93)、0.93(95%CI:0.92~0.94)和141.37(95%CI:85.30~234.31)。SROC曲线下面积分别为0.89、0.88和0.97。结论BRAF V600E基因突变的检测对于PTC的诊断具有较高的特异性,可以有效减少细胞学诊断意义不明确甲状腺结节患者的不必要手术比率,但是其较低的敏感性,限制了其在临床诊断中的单独应用。BRAF V600E基因突变检测联合FNAC应用于PTC的诊断,具有较高的敏感性和特异性,对PTC的术前诊断具有重要的临床意义。Objective To systematically evaluate the diagnostic value of BRAF V600E gene mutation detection and fine needle aspiration cytology(FNAC)in papillary thyroid carcinoma(PTC).Methods The data of CNKI,WANFANG,VIP,PUBMED,Embase and Cochrane libraries were searched.From January 2019 to December 2022,pathological tissue diagnosis was taken as the gold standard,and the literature of BRAF V600E gene mutation detection and FNAC diagnostic tests for PTC were compared and analyzed.Review Manager 5.0 and MetaDiSc software were used for Meta analysis.The working characteristic curve(SROC curve)of summarized subjects was drawn and the area under the curve was calculated.Results Totally 7223 thyroid nodules were included in 32 papers.The combined sensitivity of BRAF V600E gene mutation and FNAC for diagnosing PTC was 0.79(95%CI:0.78-0.80)and 0.78(95%CI:0.77-0.79),respectively;The specificity was 0.96(95%CI:0.95-0.97)and 0.90(95%CI:0.89-0.91),respectively;The diagnostic odds ratio was 64.87(95%CI:33.96-123.94)and 22.55(95%CI:14.47-35.14),respectively;The sensitivity,specificity and diagnostic ratio of the combination of the two diagnostic methods were 0.92(95%CI:0.91-0.93),0.93(95%CI:0.92-0.94)and 141.37(95%CI:85.30-234.31),respectively.The area under SROC curve was 0.89,0.88 and 0.97 respectively.Conclusions The detection of BRAF V600E gene mutation has high specificity for the diagnosis of PTC,and can effectively reduce the rate of unnecessary surgery in patients with thyroid nodules whose cytological diagnostic significance is not clear,but its low sensitivity limits its independent application in clinical diagnosis.BRAF V600E gene mutation detection combined with FNAC has high sensitivity and specificity in the diagnosis of PTC,which has important clinical significance for the preoperative diagnosis of PTC.

关 键 词：甲状腺肿瘤 诊断 META分析 甲状腺乳头状癌 细针穿刺细胞学 BR AF V600E 基因突变 

分 类 号：R736.1[医药卫生—肿瘤]