弹性超声、细针穿刺细胞学检查、BRAF基因检测对甲状腺恶性结节术前诊断价值分析

Preoperative diagnostic value of ultrasonic elastography,fine needle aspiration cytology and BRAF gene for malignant thyroid nodules

目的探讨甲状腺弹性超声、细针穿刺细胞学检查、BRAF基因检测以及联合诊断对甲状腺恶性结节术前诊断价值分析。方法选取2015年1月至2017年12月在南京中医药大学附属中西医结合医院甲状腺外科住院行手术切除的甲状腺结节患者共193例。收集患者一般资料、甲状腺弹性超声(UE)、细针穿刺病理学检查(FNAC)、BRAF基因实变情况以及术后病理等资料。将术后病理诊断结果作为基本依据,对UE,FNAC以及BRAF单一诊断和联合诊断价值进行比较。结果恶性结节共164例,均由术后病理证实,乳头状癌156例,滤泡细胞癌8例。156例乳头状癌中,合并结节性甲状腺肿2例,合并淋巴细胞性甲状腺炎1例,合并亚急性甲状腺炎1例。手术确诊良性结节29例,其中胶质囊肿1例,桥本甲状腺炎1例,结节性甲状腺肿19例,腺瘤8例。UE诊断效能(AUC=0.635)高于FNAC(AUC=0.605)与BRAF(AUC=0.623),差异有统计学意义(P<0.05)。UE+FNAC诊断效能(AUC=0.684)高于FNAC+BRAF(AUC=0.658)与UE+BRAF(AUC=0.636),差异有统计学意义(P<0.05)。联合3种诊断方法诊断灵敏性有所下降(63.4%),但特异性提高到78.6%,AUC为0.710。结论三种方法联合应用后特异性和诊断效能提高,可以避免不必要的手术。

Objective To evaluate the preoperative diagnosis value the ultrasonic elastography(UE),fine needle aspiration cytology(FNAC)and mutated BRAF gene(BRAF)analysis for thyroid malignant nodules.Methods One hundred and ninety-three patients who underwent thyroid surgery in Nanjing Integrated Traditional Chinese and Western Medicine Hospital between January 2015 and December 2017 were enrolled in this retrospective study.The general information and the results of UE,pathology of FNAC and mutated BRAF gene analysis were collected.Compared with the results of postoperative pathological diagnosis,three kind of method were analyzed respectively.Results There were 164 cases of malignant nodules,of which 2 cases complicated with nodular goiter,1 with lymphocytic thyroiditis and 1 with subacute thyroiditis.Twenty-nine cases were diagnosed as benign nodule,among which 1 case of colloid cyst,1 case of Hashimoto thyroiditis,19 cases of nodular goiter and 8 cases of adenoma.The diagnostic method of UE had better efficiency(AUC=0.635)than FNAC(AUC=0.605)and BRAF(AUC=0.623)significantly(P<0.05).The combination of UE and FNAC had better diagnostic efficiency(AUC=0.684)than FNAC+BRAF(AUC=0.658)and UE+BRAF(AUC=0.636)significantly(P<0.05).The sensitivity of the combination of diagnostic methods dropped to 63.4%,with the specificity and AUC being raised to 78.6%and 0.710 respectively.Conclusions The combination of three kind of diagnostic methods can be used to improve the preoperative specific and diagnosis value of malignant thyroid nodules so as to keep patients from unnecessary surgeries.