BRAF V600E突变检测在甲状腺乳头状癌中的临床价值

Clinical value of BRAF V600E mutation detection in diagnosing papillary thyroid carcinoma

目的探讨基于细针穿刺(FNA)细胞学检查的BRAF V600E突变检测在甲状腺乳头状癌(PTC)的临床价值。方法选择2015年8月-2016年4月在宁波市第二医院行甲状腺结节FNA细胞学检查的患者126例,其中38例患者接受了手术切除并获得病理结果。所有患者均经多普勒超声检查并记录结节特点,利用FNA细胞学检查的标本进行BRAF V600E基因检测,分析各指标与PTC的关系。结果良性病变和PTC患者的结节形态、边界情况、手感、回声、BRAF V600E突变等的差异均有统计学意义(P均<0.05),其余指标的差异不显著(P均〉0.05)。BRAF V600E突变组和无突变组的中央区颈淋巴结转移、包膜、肿瘤大小、TNM分期、性别和年龄的差异均无统计学意义(P均〉0.05)。多因素Logistic回归分析显示边界、回声和BRAF V600E突变为恶性结节的独立危险因素,联合诊断的ROC曲线下面积(AUC)为0.834(0.764-0.903)。结论BRAF V600E突变检测是比较有效的PTC辅助诊断手段,但可能无法反应肿瘤的侵袭性。

Objective To investigate the clinical value of BRAF V600E mutation detection in diagnosing papillary thyroid carcinoma(PTC)based on fine-needle aspiration(FNA)cytology.Methods 126 patients undergoing thyroid nodule FNA cytology in the Second Hospital of Ningbo from August 2015 to April 2016 were enrolled in this study.38 patients underwent surgical resection and got pathologic results.All the patients were examined by Doppler ultrasonography,and the characteristics of nodules were recorded.BRAF V600E gene was detected using FNA tissue sample,and the relationship between each index and PTC was analyzed.Results There was statistical significance on the differences in nodule shape,border,feel,echo,BRAF V600E mutation between benign and PTC patients(P<0.05),but the difference of other indicators was not statistically significant(P>0.05).There was no statistical significance on the differences in the cervical lymph node metastasis,tumor size,TNM stage,gender and age between the BRAF V600E mutation group and the non-mutation group(P<0.05).Multivariate Logistic regression analysis showed that boundary,echo and BRAF V600E mutation were in dependent risk factors for malignant nodules.The area under ROC curve(AUC)of combined diagnosis was 0.834(0.764-0.903).Conclusion BRAF V600E mutation detection is a more effective diagnostic tool of PTC,but it may not be able to reflect the invasiveness of the tumor.