超声引导下细针穿刺和BRAF^(V600E)分子检测在甲状腺癌诊断中的价值

Ultrasound-guided fine needle aspiration biopsy and BRAF^(V600E) molecular detection in the diagnosis of thyroid cancer

目的探讨超声引导下细针穿刺细胞学检查(FNAB)和鼠类肉瘤滤过性毒菌致癌同源体B1(BRAF)^(V600E)(BRAF^(V600E))分子检测在甲状腺癌诊断中的价值。方法回顾性分析2019年1月至2021年12月304例甲状腺结节的患者,并行FNAB细胞病理和BRAF^(V600E)分子检测。以术后病理诊断为金标准,分为FNAB组(n=138)和FNAB联合BRAF^(V600E)组(n=166),采用受试者工作特征曲线(ROC)和曲线下面积(AUC)评估两组的诊断效能,同时分析细胞病理分类BethsedaⅠ、Ⅲ~Ⅴ类结节的超声特点。结果304例患者中诊断为甲状腺癌的患者为278例,其中277例甲状腺乳头状癌,1例甲状腺髓样癌,诊断为良性病变的26例。两组中BethsedaⅠ、Ⅲ~Ⅴ类的结节有53个,超声特点以钙化(28.3%)和结节大小<1 cm(45.3%)为主。依据术后病理结果,FNAB细胞病理诊断组的效能评估:敏感性为93.9%,特异性为57.1%,AUC为0.824。FNAB细胞病理联合BRAF^(V600E)组的效能评估:敏感性为98.0%,特异性为84.2%,AUC为0.911,且AUC联合分析>AUC_(FNAB)。结论FNAB细胞病理联合BRAF^(V600E)基因检测对甲状腺癌的诊断效能优于单独应用FNAB。

Objective To investigate the value of ultrasound-guided fine needle aspiration biopsy(FNAB)and molecular detection of v-raf murine sarcoma viral oncogenic homolog B1(BRAF)^(V600E)(BRAF^(V600E))in the diagnosis of thyroid carcinoma.Methods This study retrospectively analyzed 304 patients with thyroid nodules during Jan.2019 and Dec.2021.FNAB cytopathology and BRAFV600 E molecular testing were performed.With postoperative pathological diagnosis as the gold standard,the patients were divided into FNAB group(n=138)and FNAB combined with BRAF^(V600E)group(n=166).The receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to evaluate the diagnostic efficacy of the two groups.The ultrasound characteristics of BethsedaⅠandⅢ-Ⅴnodules were also analyzed.Results Among the 304 patients,278 were diagnosed with thyroid carcinoma,including 277 papillary thyroid cancer,1 medullary thyroid cancer,and 26 benign lesions.There were 53 nodules with uncertain cell diagnosis,and the characteristics of ultrasonography were calcification(28.3%)and nodular size<1 cm(45.3%)was dominant.According to the postoperative pathological results,efficacy evaluation of FNAB group was as follows:the sensitivity,specificity,and AUC were 93.9%,57.1%and 0.824,respectively.Efficacy evaluation of FNAB combined with BRAF^(V600E)group was as follows:the sensitivity,specificity,and AUC were 98.0%,84.2%and 0.911,respectively.And AUC_(combined analysis)>AUC_(FNAB).Conclusion The diagnostic efficiency of FNAB combined with BRAF^(V600E)is higher than that of FNAB alone.