甲状腺乳头状癌临床及超声特征与中央区淋巴结转移及BRAF V600E基因突变的相关性研究  

The correlation between clinical and ultrasound features of papillary carcinoma of the thyroid and central lymph node metastasis and BRAF V600E gene mutation

作　　者：伍小芳 张苗苗[1] 赵若兰 王影[1] WU Xiaofang;ZHANG Miaomiao;ZHAO Ruolan;WANG Ying(Department of Gland Surgery,The Second Hospital of Hebei Medical University,Shijiazhuang 050000,Hebei Province,China)

机构地区：[1]河北医科大学第二医院普外五科,河北石家庄050000

出　　处：《肿瘤影像学》2024年第3期256-262,共7页Oncoradiology

基　　金：河北省省级科技计划资助[21377777D]。

摘　　要：目的:探究甲状腺乳头状癌(papillary carcinoma of the thyroid,PTC)患者的临床和超声特征预测中央区淋巴结转移(central lymph node metastasis,CLNM)的价值及其与BRAF V600E基因突变的相关性。方法:选择534例PTC患者进行回顾性研究,根据术前超声诊断可疑PTC病灶大小进行分组。收集患者的临床信息及可疑病灶的超声特征,使用多因素分析及分层分析筛选出与CLNM及BRAF V600E基因突变相关的危险因素。结果:多因素及分层分析表明,病灶与被膜紧贴及BRAF V600E基因突变是PTC病灶>10 mm患者发生CLNM的危险因素;病灶存在微钙化、男性是甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)患者发生CLNM的危险因素(均P<0.05)。BRAF V600E基因突变的发生与桥本甲状腺炎(Hashimoto thyroiditis,HT)的缺失显著相关(P<0.001)。结论:当患者出现可疑的>10 mm PTC病灶且紧贴被膜时,可进行BRAF V600E基因检测预测CLNM的发生。当可疑病灶<10 mm时,男性或病灶存在微钙化的患者更易发生CLNM。病灶较大或无HT共存的PTC患者BRAF V600E基因突变概率更高。PTC的临床和病灶超声特征对CLNM的转移有预测价值,并且与BRAF V600E基因突变相关,有助于临床为患者选择合理的手术方式。Objective:To investigate the clinical and ultrasonic characteristics of papillary carcinoma of the thyroid(PTC)for predicting central lymph node metastasis(CLNM),and the correlation between clinical and ultrasonic characteristics and BRAF V600E mutations.Methods:A retrospective study was conducted in 534 patients with PTC.Groups were grouped according to the size of suspected PTC lesions on preoperative ultrasound.Clinical information and ultrasound characteristics of suspected lesions were collected,and risk factors associated with CLNM and BRAF V600E mutations were screened by multi-factor analysis and stratified analysis.Results:Multi-factor and stratified analysis showed that the close contact between the lesion and the capsule,as well as the BRAF V600E gene mutation,were risk factors for CLNM in patients with PTC>10 mm.The presence of microcalcifications in the lesion or male patients with papillary thyroid microcarcinoma(PTMC)were risk factors for CLNM(P<0.05).The occurrence of BRAF V600E gene mutations is significantly associated with the absence of Hashimoto’s thyroiditis(P<0.001).Conclusion:When the patient has a suspicious>10 mm PTC lesion that is close to the capsule,the BRAF V600E gene test can be performed to predict the occurrence of CLNM.When the suspected lesion is<10 mm,men or patients with microcalcification of the lesion are more likely to develop CLNM.The probability of BRAF V600E gene mutation is higher in PTC patients with larger lesions or without Hashimoto thyroiditis(HT).The clinical and focal ultrasound features of PTC have predictive value for central lymph node metastasis,and are associated with BRAF V600E gene mutation,which is helpful for clinical selection of reasonable surgical methods for patients.

关 键 词：甲状腺乳头状癌 超声 BRAF V600E基因 中央区淋巴结转移 

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