TIRADS联合BRAFV600E基因检测诊断意义不明确的非典型病变或滤泡性病变的临床价值  

Clinical value of TIRADS combined with BRAFV600E gene testing in diagnosing atypical or follicular lesions of undetermined significance

作　　者：李娟 刘潇[2] 叶显俊 LI Juan;LIU Xiao;YE Xianjun(Graduate School of Bengbu Medical University,Bengbu 233000,China;Department of Ultrasound Medicine,the First Affiliated Hospital of University of Science and Technology of China,Anhui Provincial Hospital,Hefei 230001,China)

机构地区：[1]蚌埠医科大学研究生院,安徽蚌埠233000 [2]中国科学技术大学附属第一医院安徽省立医院超声医学科,安徽合肥230001

出　　处：《临床超声医学杂志》2025年第4期327-331,共5页Journal of Clinical Ultrasound in Medicine

摘　　要：目的比较C-TIRADS、ACR-TIRADS分别联合BRAFV600E基因检测在诊断甲状腺意义不明确的非典型病变或滤泡性病变(AUS/FLUS)中的临床价值。方法选取行甲状腺细针穿刺活检病理诊断为AUS/FLUS并经手术病理确诊的甲状腺结节患者221例(共223个结节,其中恶性165个,良性58个),所有结节均行超声检查并进行C-TIRADS、ACR-TIRADS分类,同时行BRAFV600E基因检测。以术后病理结果为金标准,绘制受试者工作特征(ROC)曲线分析各方法单独及联合应用诊断AUS/FLUS良恶性的效能。结果BRAFV600E基因检测结果显示,223个结节中,突变型124个,野生型99个。C-TIRADS 3、4A、4B、4C、5类结节的恶性率分别为12.5%、40.0%、64.6%、98.9%、100%;ACR-TIRADS 2、3、4、5类结节的恶性率分别为0、13.6%、45.7%、92.2%。ROC曲线分析显示,BRAFV600E基因检测诊断AUS/FLUS良恶性的曲线下面积(AUC)、灵敏度、特异度、准确率分别为0.852、73.94%、96.55%、79.82%;C-TIRADS的AUC、灵敏度、特异度、准确率分别为0.880、67.27%、98.28%、75.34%;ACR-TIRADS的AUC、灵敏度、特异度、准确率分别为0.843、85.45%、79.31%、83.86%;C-TIRADS联合BRAFV600E基因检测的AUC、灵敏度、特异度、准确率分别为0.950、90.91%、96.55%、88.34%;ACR-TIRADS联合BRAFV600E基因检测的AUC、灵敏度、特异度、准确率分别为0.937、95.76%、79.31%、82.96%。与ACR-TIRADS联合BRAFV600E基因检测比较,C-TIRADS联合BRAFV600E基因检测的准确率升高,灵敏度降低,差异均有统计学意义(均P<0.05);二者AUC比较差异无统计学意义。结论C-TIRADS、ACR-TIRADS分别联合BRAFV600E基因检测对AUS/FLUS均具有良好的诊断效能,有一定的临床价值。Objective To compare the clinical value of C-TIRADS、ACR-TIRADS combined with BRAFV600E gene testing in diagnosing atypical or follicular lesions of undetermined significance(AUS/FLUS)in thyroid nodules.Methods A total of 221 patients with thyroid nodules diagnosed by fine needle biopsy as AUS/FLUS and confirmed by operation and pathology were selected(223 nodules,of which 165 were malignant and 58 were benign).All nodules underwent ultrasound examination and were classified by C-TIRADS and ACR-TIRADS,with concurrent BRAFV600E gene testing.Taking postoperative pathological results as the gold standard,receiver operating characteristic(ROC)curve was drawn to analyze the efficacy of each method individually and in combination for diagnosing benign and malignant AUS/FLUS lesions.Results BRAFV600E gene testing showed that among 223 nodules,124 were mutant types,99 were wild types.The malignant rates of C-TIRADS 3,4A,4B,4C and 5 category nodules were 12.5%,40.0%,64.6%,98.9%and 100%,respectively.The malignant rates of ACR-TIRADS2,3,4 and 5 category nodules were 0,13.6%,45.7%and 92.2%,respectively.ROC curve analysis showed that the area under curve(AUC),sensitivity,specificity and accuracy of BRAFV600E gene testing in the diagnosis of benign and malignant AUS/FLUS were 0.852,73.94%,96.55%and 79.82%,respectively.The AUC,sensitivity,specificity and accuracy of C-TIRADS were 0.880,67.27%,98.28%and 75.34%,respectively.The AUC,sensitivity,specificity and accuracy of ACR-TIRADS were 0.843,85.45%,79.31%and 83.86%,respectively.The AUC,sensitivity,specificity and accuracy of C-TIRADS combined with BRAFV600E gene testing were 0.950,90.91%,96.55%,and 88.34%,respectively.The AUC,sensitivity,specificity and accuracy of ACR-TIRADS combined with BRAFV600E gene testing were 0.937,95.76%,79.31%and 82.96%,respectively.Compared with ACR-TIRADS combined with BRAFV600E gene testing,the accuracy of C-TIRADS combined with BRAFV600E gene testing was increased,but the sensitivity was decreased,and the differences were statistically significant

关 键 词：超声检查 C-TIRADS ACR-TIRADS 基因突变 意义不明确的非典型病变或滤泡性病变 

分 类 号：R445.1[医药卫生—影像医学与核医学] R736.1[医药卫生—诊断学]