弹性超声联合BRAF v600e基因检测对甲状腺恶性肿瘤术前诊断价值分析

The Value of Combined Ultrasonic Elastography and Mutated BRAF Gene in Preoperative Diagnosis of Thyroid Malignant Carcinoma

为了探讨甲状腺弹性超声联合BRAF v600e基因检测对甲状腺恶性肿瘤术前诊断价值分析,采用回顾性研究,将术后病理诊断结果作为基本依据,用卡方检验比较弹性超声,BRAF v600e基因检测以及联合应用对甲状腺恶性肿瘤术前诊断的敏感性、特异性、阳性预测值、阴性预测值、诊断符合率、漏诊率。共纳入手术确诊病例161例,其中恶性结节共139例,良性结节22例。恶性结节中甲状腺乳头状癌128例,滤泡性癌11例,术前甲状腺细针穿刺细胞病理学检测(Fine needle aspirationcytology,FNAC)准确率为79. 5%。结果显示弹性超声、基因检测、联合应用对甲状腺恶性结节术前诊断的敏感性分别为87. 76%,85. 61%,92. 8%;特异性分别为63. 63%,90. 9%,54. 54%;诊断符合率分别为84. 47%,86. 33%,87. 57%,其中弹性超声的灵敏性(87. 76%)虽高于基因检测的灵敏性(85. 61%),但差异无统计学意义(P>0. 596),而基因检测的特异性(90. 90%)显著高于弹性超声的特异性(63. 63%)(P <0. 05),诊断符合率比较基因检测(86. 33%)高于超声(84. 47%),但无统计学差异(P> 0. 5)。联合诊断的漏诊率(7. 19%)显著低于基因检测(14. 38%)(P <0. 01),联合诊断的误诊率(4. 5%)显著低于弹性超声(36. 37%)(P <0. 01)。BRAF v600e基因检测对甲状腺恶性肿瘤特异性高,联合弹性超声检查,可进一步提高术前检出率,降低漏诊率,为临床提供参考。

To study the value of combined ultrasonic elastography（UE） and mutated BRAF gene in the preoperative diagnosis of thyroid malignant carcinoma,the sensitivity,specificity,positive predictive value,negative predictive value,diagnostic coincidence rate,misdiagnosis rate and omission diagnostic rate were respectively compared among UE group,mutated BRAF gene group and combined application group in this retrospective study. The postoperative pathological diagnosis was used as the golden standard. 161 surgical cases were included with 139 malignant nodules and 22 benign nodules. Among the 139 malignant nodules,128 cases were confirmed as papillary carcinoma and 11 as follicular carcinoma. The sensitivity in UE group,mutated BRAF gene and combined group was 87. 76%,85. 61% and 92. 8% respectively; Specificity was 63. 63%,90. 90%,54. 54%; Diagnosis coincidence rate was84. 47%,86. 33% and 87. 57% respectively. The sensitivity of UE was higher than that of BRAF but with no significant difference（P〉0. 05）. While the specificity of BRAF was higher than that of UE with significant difference（P〈0. 05）. There was no significant diffe-rence between the two groups as regards to diagnostic conincidence（P〉0. 05）. As for the omission diagnostic rate,combined application group was lower than that of BRAF group（P〈0. 01）. Regarding the misdiagnosis rate,combined application group was lower than that of UE group（P〈0. 01）. Mutated BRAF gene had higher specificity. The sensitivity can be enhanced by combining the ultrasonic elastography,which can provide reference for clinical decision.