细胞学核评分结合BRAF V600E检测对BethesdaⅢ类甲状腺结节的诊断价值  

The diagnostic value of cytology nuclear scores combined with BRAF V600E in BethesdaⅢthyroid nodules

作　　者：叶见波[1] 王奕海 胡巧[2] 周祥祯[1] 李梦阳[3] 韦强 YE Jianbo;WANG Yihai;HU Qiao;ZHOU Xiangzhen;LI Mengyang;WEI Qiang(Department of Pathology,the People'Hospital of Guangxi Zhuang Autonomous Region,Guangxi Nanning 530021,China;Department of Ultrasonography,the People'Hospital of Guangxi Zhuang Autonomous Region,Guangxi Nanning 530021,China;Department of Breast and Thyroid Surgery,the People'Hospital of Guangxi Zhuang Autonomous Region,Guangxi Nanning 530021,China;Department of Pathology,Guangxi Hospital Division of the First Affiliated Hospital,Sun Yat-sen University,Guangxi Nanning 530022,China)

机构地区：[1]广西壮族自治区人民医院病理科,广西南宁530021 [2]广西壮族自治区人民医院超声科,广西南宁530021 [3]广西壮族自治区人民医院乳腺甲状腺外科,广西南宁530021 [4]中山大学附属第一医院广西医院病理科,广西南宁530022

出　　处：《现代肿瘤医学》2024年第11期2010-2014,共5页Journal of Modern Oncology

基　　金：广西卫生健康委员会计划课题(编号:Z20180734)。

摘　　要：目的:探讨细针穿刺细胞学(fine needle aspiration cytology,FNAC)意义未明确的非典型细胞(BethesdaⅢ)量化诊断标准,评估核评分结合BRAF V600E检测对BethesdaⅢ类甲状腺结节的诊断价值。方法:对124例原细胞学诊断为BethesdaⅢ类样本,重新经7个形态学指标核评分判读,并用免疫组化或荧光聚合酶链反应(polymerase chain reaction,PCR)法检测BRAF V600E突变。以核评分≥5分或BRAF V600E阳性判读为恶性,以组织学诊断或随访结果为诊断金标准。结果:42(42/124)例BethesdaⅢ类核评分≥5分,30(30/99)例BRAF V600E检测阳性,两种检测方法结合对124例甲状腺结节恶性的敏感度、特异度、阳性预测值、阴性预测值、恶性检出率分别为93.2%、95.0%、91.1%、96.2%、33.1%。结论:BethesdaⅢ类甲状腺结节有较高恶性风险率;核评分≥5分可作为区分甲状腺结节良性或乳头状癌的形态学量化域值,量化核评分可以大幅度减少BethesdaⅢ类的报告比率;核评分≥5分结合BRAF V600E检测,对甲状腺结节良恶性诊断有较高敏感度、特异度,并可提高其恶性检出率。Objective:To research the quantitative diagnostic criteria for atypical follicular cells(BethesdaⅢ)of undetermined significance in fine needle aspiration cytology(FNAC),and to evaluate the diagnostic value of nuclear scores combined with BRAF V600E for BethesdaⅢin thyroid nodules.Methods:124 cases of pre-cytological diagnosis BethesdaⅢwere retrospectively reinterpreted by 7 morphologic nuclear score indexes or were detected for BRAF V600E by immunohistochemistry or fluorescence polymerase chain reaction(PCR).The nuclear score≥5 or positive of BRAF V600E were defined as malignant,and histological diagnosis or follow-up results were used as the diagnostic gold standard.Results:42(42/124)cases pre-cytology BethesdaⅢwere rescored≥5 and 30(30/99)cases were positive for BRAF V600E.The sensitivity,specificity,positive predictive value negative predictive value and malignant detection rate of 124 cases of thyroid nodules malignancy were 93.2%,95.0%,91.1%,96.2%,33.1%,respectively.Conclusion:BethesdaⅢhas a higher risk of malignancy for thyroid nodules.Nuclear score≥5 can be used as morphological quantitative threshold for judging benign and papillary thyroid carcinoma,and it can greatly decrease the rate of BethesdaⅢreporting.The combination of nuclear score≥5 or positive of BRAF V600E has a higher sensitivity and specificity for the diagnosis of benign and malignant thyroid nodules,and it can improve the detection rate of malignancy.

关 键 词：甲状腺结节 核评分≥5分 BethesdaⅢ BRAF V600E 

分 类 号：R736.1[医药卫生—肿瘤]