良恶性甲状腺结节的CT诊断与BRAF基因相关性研究

Correlation between CT diagnosis and BRAF gene in benign and malignant thyroid nodules

目的探讨良恶性甲状腺结节的CT征象特点以及与BRAF基因表达的相关性。方法收集上海中医药大学附属曙光医院2015年1月~2017年12月经病理确诊并有完整CT检查资料的甲状腺结节病例87例,记录良恶性结节的CT特点并进行单因素分析,同时进行BRAF V600E基因突变检测。结果 87例甲状腺结节患者中,共发现结节103个,其中良性结节62个,恶性结节41个。良性组CT特征为结节形态规则、边缘清晰,部分其内可见囊变,增强扫描后,表现为明显不均强化,与周围组织关系清晰;恶性组CT特征为结节边界模糊,形态不规则,部分内部可有细点状钙化,增强扫描后可见病灶处体积增大,部分可见"瘤周强化残圈"或"半岛样强化",淋巴结肿大。与良性结节比较,恶性结节在病灶的数目、形态、边界、强化表现和肿大淋巴结方面的差异均有统计学意义(P <0.05),恶性结节BRAF基因15号外显子V600E突变型比例明显高于良性结节(P <0.05)。结论甲状腺结节的CT表现具有一定的特征性,结合BRAF V600E基因突变检测,对于减少漏诊和误诊有一定的参考价值。

Objective To explore the correlation between CT diagnostic characteristics and BRAF gene in benign and malignant thyroid nodules. Methods A total of 87 patients with pathologic and CT data were collected from January 2015 to December 2017 in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine. CT features of benign and malignant nodules were recorded and univariate analysis was performed. The mutation of BRAF V600 E gene was detected simultaneously. Results In 87 cases of thyroid nodules, 103 nodules were found, including62 benign nodules and 41 malignant nodules. The CT features of benign group were nodular morphology, clear edges,and cystic degeneration can be seen in thyroid nodules. Benign nodules showed uneven enhancement and clear relationship with surrounding tissues after enhanced scanning. The CT features of malignant group were blurred nodules with irregular shape and granular calcification. Enhanced scan of malignant nodules showed enlargement of the volume of the lesion, some of them showed "peritumoral enhancement residual circle" or "peninsular enhancement", and enlarged lymph nodes. Compared with benign nodules, malignant nodules had significant differences in number, shape,border, enhancement and enlarged lymph nodules(P < 0.05). The mutation rate of exon 15 of BRAF gene V600 E in malignant nodules was significantly higher than that in benign nodules(P < 0.05). Conclusion The CT feature of thyroid nodule has certain characteristics. Combined with the mutation detection of BRAF V600 E gene, CT images have some reference value for reducing missed diagnosis and misdiagnosis.