细针穿刺细胞学联合穿刺液甲状腺球蛋白及BRAFV600E/RET融合基因检测对甲状腺乳头状癌颈侧区淋巴结转移的诊断价值分析  

Analysis of the diagnostic value of fine-needle aspiration cytology combined with fine-needle aspiration thyroid globulin and BRAFV600e/RET fusion gene detection for cervical lateral lymph node metastasis of papillary thyroid carcinoma

作　　者：倪萍[1] 颜子玲 章双艳 马丙娥[1] 顾青青 钱涛 王建华[1] NI Ping;YAN Ziling;ZHANG Shuangyan;MA Binge;GU Qingqing;QIAN Tao;WANG Jianhua(Department of Thyroid and Breast Surgery,Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing210028,China)

机构地区：[1]南京中医药大学附属中西医结合医院甲状腺乳腺外科,江苏南京210028

出　　处：《中国医药导报》2025年第9期97-101,共5页China Medical Herald

摘　　要：目的探讨细针穿刺细胞学(FNAC)联合穿刺液甲状腺球蛋白(FNA-Tg)及BRAFV600E/RET融合基因检测对预测甲状腺乳头状癌(PTC)颈侧区淋巴结转移的诊断价值。方法回顾性分析2020年6月至2023年12月于南京中医药大学附属中西医结合医院行甲状腺癌根治+颈侧区淋巴结清扫术,并经术后病理确诊的PTC患者,共104例。术前所有患者颈侧区可疑淋巴结均在超声引导下行FNAC、FNA-Tg和BRAFV600E/RET融合基因检测。以术后病理结果为“金标准”,比较FNAC、FNA-Tg、BRAFV600E/RET融合基因检测及联合应用对于诊断PTC颈侧区转移性淋巴结的价值。结果104例PTC患者术前共检测106枚淋巴结。术后病理诊断,101枚为PTC转移性淋巴结,5枚为非转移性淋巴结。FNAC准确诊断66枚,漏诊40枚;FNA-Tg准确诊断93枚,漏诊13枚;BRAFV600E/RET融合基因检测准确诊断70枚,漏诊36枚;三者联合诊断准确诊断101枚,漏诊5枚。三者联合诊断的灵敏度为95.05%,准确率为95.30%,阴性预测值为50.00%,高于FNAC单独检测的60.40%、62.26%、11.11%和FNA-Tg单独检测的87.13%、87.74%、27.78%及BRAFV600E/RET融合基因单独检测的64.36%、66.04%、12.20%。结论FNAC、FNA-Tg及BRAFV600E/RET融合基因检测三者联合应用表现出对PTC颈侧区淋巴结转移更优的检测效能。Objective To explore the diagnostic value of fine-needle aspiration cytology(FNAC)combined with fine-needle aspiration thyroid globulin(FNA-Tg)and BRAFV600E/RET fusion gene detection in predicting the lateral cervical lymph node metastasis of papillary thyroid carcinoma(PTC).Methods A retrospective analysis was conducted on 104 PTC patients who underwent radical thyroidectomy and lateral cervical lymph node dissection in the Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine from June 2020 to December 2023 and were confirmed by postoperative pathology.Pre-operative ultrasound-guided FNAC,FNA-Tg,and BRAFV600E/RET fusion gene detection were performed on the suspicious lateral cervical lymph nodes of all patients.The postoperative pathological results was taken as the“gold standard”,the value of FNAC,FNA-Tg,BRAFV600E/RET fusion gene detection alone and in combination for diagnosing the metastatic lateral cervical lymph nodes of PTC was compared.Results A total of 106 lymph nodes were detected pre-operatively in 104 PTC patients.Post-operative pathological diagnosis showed that 101 were PTC metastatic lymph nodes and five were non-metastatic lymph nodes.FNAC accurately diagnosed 66 lymph nodes,with 40 cases of missed diagnosis;FNA-Tg accurately diagnosed 93 lymph nodes,with 13 cases of missed diagnosis;BRAFV600E/RET fusion gene detection accurately diagnosed 70 lymph nodes,with 36 cases of missed diagnosis;the combined detection of the three accurately diagnosed 101 lymph nodes,with five cases of missed diagnosis.The sensitivity of the combined diagnosis of the three was 95.05%,the accuracy was 95.30%,and the negative predictive value was 50.00%,which were higher than those of FNAC alone(60.40%,62.26%,11.11%),FNA-Tg alone(87.13%,87.74%,27.78%),and BRAFV600E/RET fusion gene detection alone(64.36%,66.04%,12.20%).Conclusion The combined application of FNAC,FNA-Tg,and BRAFV600E/RET fusion gene detect has better detection efficiency for lateral lymph node

关 键 词：甲状腺乳头状癌 甲状腺球蛋白 BRAFV600E RET融合 诊断效能 

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]