对比细针穿刺细胞学检查、测定穿刺洗脱液甲状腺球蛋白及BRAF基因诊断甲状腺乳头状癌颈部淋巴结转移的效能

Comparison of diagnostic efficacy of fine needle aspirate cytology, fine needle aspirate-thyroglobulin and BRAF gene in cervical metastatic lymph nodes of papillary thyroid carcinoma

目的对比细针穿刺细胞学检查(FNAC)、测定细针穿刺洗脱液甲状腺球蛋白(FNA-Tg)及检测BRAF基因诊断超声疑似甲状腺乳头状癌(PTC)颈部转移淋巴结的效能。方法回顾性分析95例接受甲状腺改良根治术并经病理证实的PTC患者资料,甲状腺改良根治术前或术后超声检查发现疑似颈部转移淋巴结118枚。全部患者均接受细针穿刺活检术,对穿刺标本分别进行FNAC、FNA-Tg及BRAF基因检测。以术后病理作为金标准,计算敏感度、特异度、阳性预测值、阴性预测值、准确率,构建ROC曲线对比分析3种方法诊断转移淋巴结的效能。结果FNAC、FNA-Tg及基因检测诊断PTC颈部淋巴结转移的敏感度、特异度、阳性预测值、阴性预测值及准确率分别为63.95%(55/86)、100%(32/32)、100%(55/55)、50.79%(32/63)及73.73%(87/118),91.86%(79/86)、100%(32/32)、100%(79/79)、82.05%(32/39)及94.07%(111/118)和80.23%(69/86)、100%(32/32)、100%(69/69)、65.31%(32/49)及85.59%(101/118)。FNAC、FNA-Tg、BRAF基因检测的AUC分别为0.820、0.991、0.874,FNAC与FNA-Tg检测、BRAF基因与FNA-Tg检测间AUC差异均有统计学意义(P<0.001),FNAC与BRAF基因检测AUC差异无统计学意义(P=0.099)。结论FNA-Tg检测对超声疑似PTC颈部转移淋巴结的诊断效能高于FNAC和BRAF基因检测。

Objective To compare the diagnostic efficacy of fine needle aspirate cytology(FNAC),fine needle aspirate-thyroglobulin(FNA-Tg)and BRAF genetic testing in diagnosis of suspected cervical metastatic lymph nodes of PTC.Methods A retrospective analysis was performed on 95 patients who received modified radical thyroidectomy and confirmed as PTC by pathology.Totally 118 suspected cervical metastatic lymph nodes found with ultrasound examination before or after modified radical thyroidectomy were all detected with FNAC,FNA-Tg and BRAF genetic testing.Taken postoperative pathology as gold standard,the sensitivity specificity,positive predictive value,negative predictive value and accuracy of three methods were obtained,and ROC curves were constructed to compare the diagnostic efficacy of three methods.Results The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of FNAC was 63.95%(55/86),100%(32/32),100%(55/55),50.79%(32/63)and 73.73%(87/118),respectively,of FNA-Tg was 91.86%(79/86),100%(32/32),100%(79/79),82.05%(32/39)and 94.07%(111/118),respectively,while of BRAF genetic testing was 80.23%(69/86),100%(32/32),100%(69/69),65.31%(32/49),85.59%(101/118),respectively.AUC of FNAC,FNA-Tg and BRAF genetic testing was 0.820,0.991 and 0.874,respectively.The differences of AUC between FNAC and FNA-Tg,BRAF genetic testing and FNA-Tg were statistically significant(P<0.001),whereas between FNAC and BRAF genetic testing was not statistically significant(P=0.099).Conclusion FNA-Tg is more effective than FNAC and BRAF genetic testing in diagnosis of cervical suspected lymph node metastasis of PTC.