超声造影及BRAF基因突变诊断甲状腺乳头状癌被膜外侵犯

Contrast-enhanced ultrasound and BRAF mutation in diagnosis of extracapsular extension of papillary thyroid carcinoma

目的探讨超声造影(CEUS)及BRAF基因突变在术前诊断甲状腺乳头状癌(PTC)被膜外侵犯中的价值。方法入组119例患者共129个PTC病灶,25个存在被膜外侵犯(A组),104个无被膜外侵犯(B组)。记录传统超声(US)及CEUS模式下PTC与被膜接触范围、是否出现被膜中断现象及患者BRAF基因突变检测结果,计算上述特征单独及联合诊断PTC被膜外侵犯的效能。结果A组BRAF基因突变阳性率、US及CEUS被膜接触范围及被膜中断率均高于B组(P均<0.05)。US及CEUS均以接触范围≥25%为界值诊断被膜外侵犯准确率最高。各超声特征单独及联合BRAF基因突变用于诊断时,CEUS准确率均高于US,CEUS联合BRAF准确率88.37%(114/129)。结论PTC被膜外侵犯特征包括BRAF基因突变阳性、US及CEUS显示结节与被膜接触≥25%及被膜中断。CEUS联合BRAF基因突变对于术前诊断PTC被膜外侵犯具有重要价值。

Objective To investigate the value of contrast-enhanced ultrasound(CEUS)and BRAF mutation in pre-operative diagnosis of extracapsular extension in papillary thyroid carcinoma(PTC).Methods A total of 129 PTC in 119 patients were enrolled,including 25 PTC with extracapsular extension(A group)and 104 PTC without extracapsular extension(B group).Both the range of contact between PTC and thyroid capsule and the presence of discontinued capsule in ultrasound(US)and CEUS,as well as BRAF mutation examination result were recorded.The diagnostic performance of the above features in diagnosis of extracapsular extension in PTC,and the overall diagnostic performance of their combination were calculated.Results Significant differences were found in BRAF mutation,range of capsule contact and the presence of discontinued capsule between US and CEUS(all P<0.05).In different ranges of contact,the threshold of≥25%demonstrated the highest diagnostic accuracy in both US and CEUS.CEUS had higher accuracy than US in diagnosis of extracapsular extension in PTC based on single ultrasonic feature as well as the combination of ultrasonic features and BRAF mutation.The accuracy of CEUS combined with BRAF was 88.37%(114/129).Conclusion The characteristics of extracapsular extension in PTC include BRAF mutation,≥25%range of contact between PTC and thyroid capsule and the presence of discontinued capsule in US and CEUS.CEUS has higher accuracy than US.Combination of BRAF mutation and CEUS has important clinical significance in preoperative diagnosis of PTC extracapsular extension.