摘要
目的:探讨细胞学检查结合BRAF V600E基因检测在甲状腺影像报告和数据系统(Thyroid Imaging Reporting andDataSystem,TI-RADS)4类甲状腺结节定性诊断中的价值。方法:收集2019年7月—2020年3月行甲状腺结节超声引导下细针抽吸活组织检查(ultrasound-guided fine-needle aspiration biopsy,US-FNAB)及BRAF V600E基因检测的178例TI-RADS 4类甲状腺结节患者的细胞学及分子生物学检查结果,并与术后病理学检查结果进行对比。结果:根据Bethesda分类,将178例结节分为A组(诊断确切)和B组(诊断模糊)。A组US-FNAB灵敏度、特异度及准确度分别为97.3%、88.9%及96.4%,一致性较好(κ=0.822±0.071),US-FNAB联合BRAF V600E基因检测灵敏度、特异度及准确度为99.3%、88.9%及98.2%,一致性极好(κ=0.904±0.055),比较两种方法的诊断准确度,差异有统计学意义(χ2=74.5,P<0.05)。B组结节有58.3%(7/12)检测到BRAF V600E突变且均为甲状腺乳头状癌(papillary thyroid cancer,PTC)。结论:在行US-FNAB时增加BRAF V600E检测,对于细胞学诊断确切的结节,二者联合诊断准确度提高,对于诊断模糊者,可筛查出恶性结节,提高对TI-RADS 4类甲状腺结节定性诊断的效率。
Objective:To evaluate the value of detection of BRAF V600E combined with cytodiagnosis in qualitative diagnosis of thyroid nodules(TNs)classified as Thyroid Imaging Reporting and Data System(TI-RADS)4.Methods:The cytological and molecular biological results of 178 TNs classified as TI-RADS 4 that underwent ultrasound-guided fine-needle aspiration biopsy(US-FNAB)and detection of BRAF V600E during July 2019 and March 2020 were collected,and compared with the postoperative pathological results.Results:According to the Bethesda System for Reporting Thyroid Cytopathology,178 cases were divided into group A(accurate diagnosis)and group B(unclear diagnosis).In group A,the sensitivity,specificity,and accuracy of US-FNAB was 97.3%,88.9%,96.4%,respectively,and good agreement was observed(κ=0.822±0.071).The sensitivity,specificity,and accuracy of US-FNAB combined with BRAF V600E were 99.3%,88.9%,98.2%,and excellent agreement was observed(κ=0.904±0.055).We compared the diagnostic accuracy of US-FNAB and US-FNAB combined with BRAF V600E,and the difference was statistically significant(χ2=74.5,P<0.05).In group B,BRAF V600E mutation occurred in 7 nodules,and all of them were papillary thyroid cancer(PTC).Conclusion:When the detection of BRAF V600E is added to US-FNAB,the accuracy rate would be improved by the combination of the two detection in nodules diagnosed correctly with cytological detection,and malignant nodules would be screened out in nodules diagnosed dimly with cytological detection.The combination of detection of BRAF V600E with US-FNAB comprehensively could improve the efficiency of qualitative diagnosis of TNs classified as TI-RADS 4.
作者
张柳婷
陈松旺
赵燕妹
ZHANG Liuting;CHEN Songwang;ZHAO Yanmei(Department of Ultrasound,Nanjing First Hospital,Nanjing Medical University,Nanjing 210000,Jiangsu Province,China)
出处
《肿瘤影像学》
2021年第2期124-129,共6页
Oncoradiology