C-TIRADS分类联合BRAF^(V600E)基因检测对不同大小BethesdaⅢ类甲状腺结节的诊断价值  

Diagnostic value of C-TIRADS combined with BRAF^(V600E)gene detection for different sizes of thyroid nodules in BethesdaⅢ

作　　者：吕丹妮 姜纬[1] 蔡亚文 周文文 邓学东[1] 吕京澴[3] LYU Danni;JIANG Wei;CAI Yawen;ZHOU Wenwen;DENG Xuedong;LYU Jinghuan(Department of Center for Medical Ultrasound,The Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Suzhou 215002,China;Department of Ultrasound,The Sixth People's Hospital of Zhangjiagang City,Suzhou 215600,China;Department of Pathology,The Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Suzhou 215002,China)

机构地区：[1]南京医科大学附属苏州医院苏州市立医院超声中心,江苏苏州215002 [2]张家港市第六人民医院超声科,江苏苏州215600 [3]南京医科大学附属苏州医院苏州市立医院病理科,江苏苏州215002

出　　处：《医学影像学杂志》2024年第12期38-42,共5页Journal of Medical Imaging

摘　　要：目的探讨中国超声甲状腺影像报告和数据系统(Chinese-TIRADS,C-TIRADS)、BRAF^(V600E)基因检测以及二者联合诊断不同大小BethesdaⅢ类甲状腺结节的价值。方法选取94例在我院接受超声引导下甲状腺结节细针穿刺抽吸活检且病理诊断为BethesdaⅢ类的患者,共94个甲状腺结节。根据甲状腺结节的最大直径分为≤1.0 cm组(n=64)和>1.0 cm组(n=30)。所有甲状腺结节术前行C-TIRADS分类和BRAF^(V600E)基因检测,以手术病理结果为金标准,探讨C-TIRADS分类、BRAF^(V600E)基因检测以及二者联合对不同大小Bethesda Ⅲ类甲状腺结节的诊断效能。结果两组中,二者联合的诊断效能优于单独应用C-TIRADS分类(P<0.0001,P=0.0001),二者联合诊断的灵敏度(98.36%、100%)、准确率(96.88%、93.33%)均明显提高,差异有统计学意义(P<0.05)。二者联合诊断在两组中的Kappa值分别为0.650、0.762,均高于CTIRADS分类、BRAF^(V600E)基因检测单独诊断,差异有统计学意义(P<0.05)。最大直径>1.0 cm组中,BRAF^(V600E)基因检测的诊断效能优于C-TIRADS分类,差异有统计学意义(P=0.0137)。BRAF^(V600E)基因在结节最大直径≤0.5 cm组、0.5~1.0 cm组、>1.0 cm组恶性结节中的突变率分别为50.00%、83.67%、87.50%。结论C-TIRAD分类与BRAF^(V600E)基因检测联合应用对两组BethesdaⅢ类结节均具有更好的诊断效能,可显著提高诊断的灵敏度和准确率。对于最大直径>1.0 cm的结节,BRAF^(V600E)基因检测的诊断效能优于C-TIRADS分类。此外,BRAF^(V600E)突变率随甲状腺恶性结节最大直径增大而增高。Objective To evaluate the diagnostic value of Chinese-TIRADS(C-TIRADS),BRAF^(V600E) gene detection and their combination in Bethesda Ⅲ thyroid nodules of various sizes.Methods We selected 94 patients with Bethesda Ⅲ thyroid nodules who underwent fine-needle aspiration biopsy at our hospital.The nodules were categorized into two groups based on their largest diameter:≤1.0 cm(n=64)and>1.0 cm(n=30).All thyroid nodules were preoperatively evaluated using C-TIRADS criteria and tested for the presence of the BRAF^(V600E) gene.The surgical pathological diagnosis was served as the reference standard.Then,we explored the diagnostic efficacy of C-TIRADS classification,BRAF^(V600E) gene detection,and their combination for thyroid nodules of different sizes classified as Bethesda Ⅲ.Results For both groups,the combination of C-TIRADS classification with BRAF^(V600E) gene detection outperformed C-TIRADS alone(P<0.0001,P=0.0001).The sensitivity(98.36%,100%)and accuracy(96.88%,93.33%)of the combined diagnosis of the two methods were significantly improved(P<0.05).The Kappa values for the combined diagnosis in both groups were 0.650 and 0.762(P<0.05),respectively,indicating higher agreement than either C-TIRADS or BRAF^(V600E) gene detection alone.In the>1.0 cm group,the diagnostic efficacy of the BRAF^(V600E) gene detection was superior to that of C-TIRADS(P=0.0137).The mutation rates of the BRAF^(V600E) gene in malignant nodules with a maximum diameter≤0.5 cm,0.5~1.0 cm,and>1.0 cm were 50.00%,83.67%,and 87.50%,respectively.Conclusion For both groups,the combination of C-TIRADS with BRAF^(V600E) gene detection provides superior diagnostic efficacy for Bethesda Ⅲ nodules,enhancing sensitivity and precision.In nodules>1.0 cm,the BRAF^(V600E) gene detection outperforms C-TIRADS in terms of diagnostic efficacy,and the BRAF^(V600E) mutation rate increases with the size of malignant thyroid nodules.

关 键 词：中国超声甲状腺影像报告和数据系统 基因突变 甲状腺结节 超声检查 

分 类 号：R581.3[医药卫生—内分泌] R445.1[医药卫生—内科学]